Dental Trauma Research Articles

Duloxetine-Induced Sleep Bruxism and Tooth Fracture in Fibromyalgia

Duloxetine is a serotonin-norepinephrine reuptake inhibitor that is approved for the treatment of fibromyalgia. Duloxetine has many side effects such as nausea, somnolence, insomnia, decreased appetite, dry mouth, and constipation. Sleep bruxism is also a very rare side effect of duloxetine. In this case report, a case of a 35-year-old male patient who developed sleep bruxism in the 4th week after duloxetine use, and fracture of the 1st upper molar tooth which had previously undergone root canal treatment after severe bruxism in the 6th week was presented. Duloxetine treatment was stopped and treatment was continued with amitriptyline. The patient had a significant reduction in both bruxism and fibromyalgia symptoms after the amitriptyline treatment. Bruxism symptoms were not observed after one year of follow-up.

Demographic and Clinical Characters of the Patient of Condylar Fracture Treated under the Department of Oral and Maxillofacial Surgery in a Tertiary Level Hospital

Introduction: Mandible is the only mobile bone of the facial skeleton which plays an important role in mastication, speech and deglutition. Being a prominent bone of the facial skeleton, it is one of the most common facial bone to be fractured. Fracture in the mandible causes severe loss of function and disfigurement. Objective: The aim of this paper was to investigate the demographic and clinical characteristics of the patients of condyle fracture treated under the oral and maxillofacial department of a tertiary level hospital of Bangladesh. Methods: This retrospective cross-sectional descriptive type of study was conducted at the Department of Oral and Maxillofacial Surgery in Dhaka Dental College and Hospital, Dhaka, Bangladesh during June, 20 23 to December, 2023. A consecutive sampling technique was used and a series of 120 cases of condyle fracture aged 17-65 years of both sex were retrospectively enrolled in this study. The data were analyzed using Statistical Package for Social Sciences (SPSS), version-23.0. Results: A series of 120 cases of condyle fracture patients were enrolled in this study. Among the patients, the most frequent age group was 30-39 years which includes 62(51.25%) patients. The mean age of the patients was 41.10±10.21 years. A significant gender disparity was observed, with 87(72.5%) of the patients being male. Most of the patients were service holder 63(52.5%). The major cause of injury of the patients was road traffic accident 75(62.5%).Among the study patients, 111(92.5%) had third molar teeth present. Of them, the most frequent 75(67.56%) patients had erupted third molar condition and 36(32.43%) patients had impacted third molar condition. According to distribution of type of impacted teeth, 21(50%) cases, had oriented vertically and followed by mesioangular 11(25%), disto-angular 4(10.7%), and horizontal 6(14.3%). According to distribution of condylar fracture, the most frequent 73 (6.25%) patients had non-displaced injuries. followed by displaced 36(30%) and dislocated 11(8.75%). Conclusion: This study investigated that road accident is the principal factor of condylar fracture and third molar teeth and its position has a significant impact on condylar fracture and at the same time the male are the more prone to condylar fracture than the female in Bangladesh

The technical consultancy office in the evaluation of dental trauma from a road accident

The technical consultancy office in the evaluation of dental trauma from a road accident

Dental trauma related to orotracheal intubation: Prospective study of 43 cases

Dental trauma related to orotracheal intubation: Prospective study of 43 cases

Endodontic Access Cavity Design and Fracture Resistance: A Systematic Review and Meta-Analysis of Conventional vs. Newer Access Cavity.

The era of minimally invasive dentistry has led to the development of new access cavity designs. The impact of various access cavity designs on the fracture resistance of teeth has been extensively studied. The primary aim of this systematic review and meta-analysis is to evaluate and compare the effects of recent modifications in endodontic access cavity design- specifically, conventional, conservative, and truss designs on tooth fracture resistance. Three independent reviewers searched studies across six different databases (PubMed, Scopus, EBSCOhost, BVS, Wiley, and Google Scholar) from January 2000 to July 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were then screened using strict inclusion and exclusion criteria. A quality assessment was performed using a modified version of the quality assessment of in-vitro studies according to the QUIN (Quality Assessment Tool For In Vitro Studies) tool, categorizing the selected articles into low, moderate, and high risk of bias. Quantitative data synthesis was conducted to combine equivalent results using STATA. Forest plots were created with the level of significance set at 0.05 (p = 0.05). Out of 243 articles, 14 met the strict inclusion criteria. Among the selected articles, 11 showed a low risk of bias and three showed a moderate risk. The meta-analysis revealed that fracture resistance of conservative and truss access designs is significantly higher than that of conventional endodontic access, with a standardized mean difference (SMD) of 2.61 (95% 1.47 to 3.74; p-values <0.001) and SMD = -1.26 (95% confidence interval (CI): -1.81 to 0-0.71; p<0.001). The heterogeneity (I²) values for these comparisons were 92% and 65.6%, respectively. The extent of the access cavity has a substantial impact on tooth fracture resistance. Newer conservative and truss endodontic access designs offer better fracture resistance compared to conventional endodontic access.

Clinical application of Er:YAG laser and traditional dental turbine in caries removal in children.

This study compares the clinical efficacy of erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser and traditional dental turbine in caries removal in children. The study cohort comprised 78 children aged 5 to 10 years with caries in two symmetrical maxillary molars. Different carious sides of the same child were randomly divided into control and observed sides. For each child, the caries on the control side were treated with a traditional dental turbine, while the observed side was treated with an Er:YAG laser. The study evaluated the use of anesthetics, pain levels, tooth hypersensitivity and the occurrence and severity of tooth fractures during caries removal with different methods. Additionally, the clinical anxiety and cooperative behavior of the children were observed. The time required for caries removal and cavity preparation by both methods was recorded, and the success rate of treatment was assessed after one year of follow-up. The results indicated a significant reduction in the use of anesthetics, pain and the incidence and severity of tooth hypersensitivity with the use of Er:YAG laser (p < 0.05). No significant difference was found in the occurrence of tooth fractures between the two groups (p > 0.05). The children treated with Er:YAG laser demonstrated better clinical anxiety levels and cooperative behavior. However, the time required for cavity preparation was longer with the use of Er:YAG laser (p < 0.05). After a 12-month follow-up, there was no significant difference in the success rate of treatment between the two groups (p > 0.05). In conclusion, compared to the traditional dental turbine, the use of Er:YAG laser improves treatment comfort and cooperation in children with caries and reduces the need for intraoperative anesthetics.

Management of complicated crown fracture in maxillary incisor using fragment reattachment - 5-year follow-up

Complicated crown-root fractures of maxillary incisors are a relatively common occurrence in cases of trauma to the facial region. Patients with such fractures are in acute pain and usually require emergency care on their first clinical visit. Pain management and restoration of function, esthetics, and phonetics should be the prime objective in handling such patients. The reattachment of fractured tooth fragments is a relatively simple procedure that provides natural esthetics and conservation of tooth structure. This case report describes such a reattachment procedure in a complicated crown-root fracture and its success at 5 years of follow-up.

Prosthetic Maintenance Assessment for Two Implant- Retained Overdentures Reinforced with PEKK Versus Co-Cr Framework: A Randomized Controlled Clinical Trial.

The primary challenge associated with implant overdentures lies in the occurrence of denture fractures around the attachments. Hence, it is recommended to enhance flexural strength through reinforcement frameworks. This study aimed to assess and compare the prosthetic maintenance of mandibular implant overdentures reinforced with Co-Cr and PEKK frameworks. Twenty-four participants with completely edentulous ridges were selected, and two implants were placed at the mandibular canine areas. After osseointegration period, ball attachments were installed. Participants were randomly assigned into two groups: Group I received a mandibular implant overdenture reinforced with a Co-Cr framework, while Group II received a mandibular implant overdenture reinforced with a PEKK framework. Prosthetic maintenance evaluations were conducted in both groups twelve months post-denture insertion. Categorical data were analyzed, and results were presented as frequency and percentage values. Group II exhibited a significantly higher percentage of cases with screw looseness, denture relining, and tooth separation compared to Group I. Although Group II cases showed a non-significant increase in the percentage of insert wear and retention loss. Within the limitations of this study, the findings suggest that Co-Cr, in contrast to PEKK frameworks, offers a more reliable reinforcement of the implant-retained overdentures.

Management of Ellis Class II Fracture in Young Permanent Maxillary Central Incisor

Background: Tooth fracture is a condition of missing or lost fragments of a complete tooth. Tooth fracture usually occurs simultaneously with another oral injury. Objective: This case report discussed the management of Ellis class II fractures on an immature permanent central incisor of a patient who reported to Jenderal Achmad Yani University (Unjani) Dental Hospital. Case: An 11-year-old girl revealed a broken upper left tooth, sensitive to cold drinks that interfered with her appearance one year ago. The patient had a good general condition, no abnormalities during an extraoral examination, and a history of pain on the lower back tooth since a year ago. Case Management: Management of Ellis class II fracture in young permanent central incisor was conducted by using a class IV composite resin restoration. Conclusion: The management of Ellis class II fracture should be conducted holistically and systematically with subjective, intraoral, extraoral, and adjunctive examinations which should be performed correctly and considering the child’s psychology.

Multiple cranial pathologies in spotted hyaenas, Crocuta crocuta

Spotted hyaenas are generally considered to have resilience against injuries and pathogens, and the incidence of pathologies is scarcely reported. However, it is important for ecological studies and conservation efforts to have a clear overview of the physical threats that can occur in the life of a species. The present paper describes and interprets several osteopathologies in the crania of the spotted hyaena, Crocuta crocuta, in the collections of the Royal Museum for Central Africa (RMCA) in Tervuren, Belgium. Of the fifty-two specimens from central Africa examined, twenty-three (i.e., 44 %) of them showed evidence of pathologies, including injuries, congenital pathologies, and disease. Selected specimens were scanned using Computed Tomography and their internal cranial structures were studied. Here we describe and discuss the different types of pathologies evident in the crania of these hyaenas: craniosynostosis, microtia, osteomyelitis and periodontitis, as well as a trauma indicated by cranial fractures, dental fractures, and bite puncture marks. Some pathologies reported herein are novel for hyaenas, and there are some instances of multiple pathologies in the same individual. Implications of these pathologies, including the social interactions of hyenas, conservational threats, as well as biased data sampling, are highlighted. This study improves our knowledge of disease and trauma experienced by hyaenids, and provides a better understanding of their biology, and the potential threats faced by these iconic animals. This case study offers a comparative base for similar studies in other carnivorans, to clarify the pathological background of apex predators.

Orthodontic management of traumatized teeth: a survey among orthodontists

BackgroundInformation on previous traumatic dental injuries is important as they can lead to increased complications during orthodontic treatment and impact the treatment planning and outcomes. The aim of this study was to assess the knowledge of Jordanian orthodontists in orthodontic management of traumatized permanent teeth.MethodsCross-sectional survey among active registered orthodontists using a questionnaire distributed by hand.ResultsThe study included 139 orthodontists. Nearly half of orthodontists treated between one to three patients with a history of traumatic dental injuries in the past 3 months. Only 43.2% of the participant asked routinely about history of trauma. A vast discrepancy in times waited before orthodontic movement and in the orthodontic management approach of traumatized teeth was noted. A statistically significant negative relationship between age and knowledge level was found (p = 0.002). A significantly higher level of knowledge was found among participants who had fellowship or board certification than those having the high diploma degree (P-0.032) and also who had treated patients with history of dental trauma in the last 3 months than those who did not (p = 0.001).ConclusionsThe knowledge of the surveyed orthodontists in both the recommended observation period before orthodontic treatment and management approaches of traumatized teeth during orthodontic treatment was insufficient. Years of clinical experience significantly affected knowledge, with older participants having lower levels of knowledge. Orthodontists who treated patients with history of dental trauma in the last 3 months had significantly higher knowledge in orthodontic management of traumatized teeth. Orthodontists needs to be aware of the proper timing and strategies on orthodontic management of traumatized permanent teeth to improve the long term prognosis and to reduce further complications during orthodontic treatment through proper management.

Pulp Cavity Calcification in SLE Patient Associated with Long-term Use of Glucocorticoids: A Case Study with Endodontic Approaches

Background Calcification in the tooth pulp cavity occurs in response to various factors, including dental trauma and chronic irritation. Systemic lupus erythematosus (SLE) is the most common type of lupus, causing widespread inflammation and tissue damage in the affected organs. The SLE condition is generally managed by long-term use of drugs, including glucocorticoids (GCs). Objective This study aimed to assess the association of pulp cavity calcification in SLE patients with long-term use of GCs and to present endodontic perspectives on the issue. Case Presentation A female SLE patient with a history of long-term use of GCs visited our hospital for an oral surgery examination due to an accident. The crown of tooth 11 was visibly fractured. The tooth was sensitive to cold stimulus, while tooth 21 was mobile. Various examinations (including electric pulp test and panoramic radiography) pointed to the diagnosis of chronic pulpitis in the affected teeth (11 and 21), and cone beam computed tomography (CBCT) revealed that the pulp cavities in all teeth were almost completely calcified. Thus, the root canal treatment (RCT) was attempted and followed by crown restoration for the affected teeth. The involvement of GCs in the pulp cavity calcification was assessed. Conclusion According to this case and a series of related studies, long-term use of glucocorticoids is associated with the incidence of pulp cavity obliteration (PCO). More frequent dental examinations and appropriate adjustments in medication use (dose and duration) should be considered and implemented.

Clinical Evaluation of Metal Dental Prostheses in Captive Wild Felids.

Captive felids are prone to dental fractures, and the recommended treatment involves endodontics (root canal treatment), prosthodontics (coronal restoration), or tooth extraction. A single-unit dental prosthesis can restore the crown of a tooth whose structure has been partially or completely lost. Nine animals out of 35 captive wild felids kept under human care in 7 different Brazilian institutions were selected for the study. The animals selected included the little spotted cat (Leopardus tigrinus), ocelot (L. pardalis), margay cat (L. wiedii), pampas cat (L. colocolo), jaguarundi cat (Puma yagouaroundi), puma (P. concolor), jaguar (Panthera onca), lion (P. leo), and tiger (P. tigris). Nineteen canine prosthodontic crowns (18 full and one 3/4) were cemented using dual-cure resin cement and their feasibility was evaluated for 30 months. Fourteen (73%) remained fixed to the tooth and 5 (27%) were lost after the evaluation period. This study aimed to assess the longevity of prosthodontic crowns in the canine teeth of wild felids. Furthermore, it aimed to determine the functionality and longevity of teeth which had received prosthodontic crowns.

PENATALAKSANAAN TRAUMA GIGI PADA ANAK USIA TUMBUH KEMBANG

Dental trauma is often found in children of growing age due to poor psychomotor coordination, making them prone to falls. This can cause damage to the teeth and their supporting tissues, which can interfere with mastication, speech, aesthetics and the eruption of permanent teeth. The management of dental trauma in children is still poorly understood by parents and teachers, therefore an approach is needed regarding the first treatment of trauma to primary teeth. The choice of Community Service target at Kepodang preschool was due to a request from the school principal as the community leader. Education and training activities were carried out on Monday, March 4th 2024 for a total of 22 teachers and parents. The aim of this activity is to increase knowledge, motivate changes in attitudes and behavior in maintaining oral health, and provide learning about first care for trauma in primary teeth. An initial assessment of knowledge and attitudes regarding first care for trauma in primary teeth was carried out through administering a pre-test with multiple choice questions. The material given includes dental and oral health problems, prevention methods, as well as first treatment for trauma in primary teeth by using the power point text, discussion, and a simulation of how to brush teeth with songs. Evaluation was carried out through a post test with multiple choice questions. Evaluation of the post test results shows that there was an increase in test score. The results of this activity recommend continuing this training activity in kindergartens or other elementary schools, especially for teachers and parents

Oral health status of Dutch Armed Forces recruits in the years 2000, 2010 and 2020, a retrospective repeated cross-sectional study.

Studies on oral health status of adults are sparse and rarely include data on endodontic treatment and trauma. In the military, those data are available because recruits are routinely assessed with a clinical and radiological examination at the start of their career. This study aimed to identify differences in oral health status of Dutch Armed Forces recruits between cohorts, departments, sex, age and rank, with DMF-T, endodontic treatment and dental trauma as outcome measures. Data from Electronic Patient Files from all recruits enlisted in 2000, 2010 and 2020 were used for analysis in a hurdle model resulting in the estimated cohort effect, controlled for the demographic variables. The total number of recruits was 5,764. Due to the retrospective character of the study a proxy was used to compose D-T and dental trauma. The mean DMF-T number in recruits decreases from 5.3 in cohort 2000 to 4.13 in cohort 2010 and 3.41 in cohort 2020. The percentage of endodontically treated teeth increases from 6% in cohort 2000 to respectively 9% in 2010 and 8% in 2020. The percentage of recruits showing signs of dental trauma did not change significantly between cohort 2000 (3.1%) and cohort 2010 and 2020 (both 2.7%). Oral health in Armed Forces recruits is improving over the years, following a similar trend as the general population in the Netherlands. Lower SES represented by enlisted rank showed substantial lower oral health status.

Expedited Treatment of a Fractured Tooth by Rebonding: A Case Report

Fractured maxillary anterior are a common occurrence when a person experiences trauma to the face. A patient sought treatment at a endodontics and prosthodontics practice after experiencing trauma to his maxillary right central incisor that resulted in a complete horizontal fracture. This case report describes a novel way to restore a fractured anterior tooth with a highly esthetic outcome that can be completed relatively easily in the clinic or in an austere environment.

Dentition Anomalies and Cranial Abnormalities in Invasive Beavers (Castor canadensis) in Tierra Del Fuego, Argentina.

The study of dentition anomalies and pathologies in wildlife contributes, together with other indicators, to understanding the relevance of some factors on the health status of populations. This has not been properly evaluated in invasive mammals. To test the feasibility of eradication, the government of Tierra del Fuego performed the eradication of beavers (Castor canadensis) from 2016 to 2018: 1121 animals were removed and 970 examined. These beavers were examined to analyze the incidence of dentition anomalies and other dentition and cranial conditions. The beavers presented two dentition anomalies: hypodontia and hyperdontia (0.41% in both cases), and for the first time, a dentition anomaly in the upper quadrants was reported. Beavers also presented artifactual tooth loss (0.30%) and acquired tooth loss (0.61%) but with low incidence. The presence of fractured teeth (0.41%) and caries (0.31%) occurred in all age classes, also with low incidence. The third molar tooth was the most affected, showing a female bias. The 0.93% of skulls had a cranial abnormality represented as a buccal curvature. Malocclusion cases also were recorded (0.51%). The low prevalence of dentition anomalies, fractured teeth, caries, and cranial abnormalities would not compromise the lifespan of beavers. These results leave a precedent of dentition anomalies and dentition and cranial conditions in an invasive mammal.

Long-term complications and management of dental trauma in the adult patient - Part 2: discoloured, displaced and missing teeth.

The second paper in this two-part review series aims to outline the long-term complications of dental trauma in the adult patient in relation to discoloured, displaced or missing teeth. A brief overview of the cause of discolouration is outlined, followed by assessment and management options. These can include bleaching, veneers, or crown restorations to mask the discolouration. Displacement of teeth from the socket can occur due to luxation injuries. Management can include simple digital manipulation, surgical repositioning, or orthodontic extrusion based on the severity of extrusion and the time from injury. Teeth can be lost early or in the long-term following dental trauma and associated hard and soft tissues deficiencies may also ensue. Replacement options can include a removable partial prosthesis, resin-retained bridge or dental implants. Often, hard and soft tissue augmentation procedures may be required to address any defects and rebuild lost anatomical contours. A thorough assessment followed by the development of a sound management plan which takes patients' general and local factors into account can ensure a predictable and successful treatment outcome. This would end in an aesthetically pleasing and a functionally stable result for the patient.

Mahidol Study 2: Treatment Outcomes and Prognostic Factors of Regenerative Endodontic Procedures in Immature Permanent Teeth

IntroductionStudies on the clinical outcomes and prognostic factors of regenerative endodontic procedures (REPs) in a large population and long-term recall period have been limited. Therefore, the aims of this study were to evaluate treatment outcomes and prognostic factors of REPs. MethodsImmature permanent teeth treated with REPs with a minimum one-year follow-up period were included. Treatment outcomes (functional retention, healed rate, root development, and sensibility test response) and any prognostic factors were analyzed with multivariable Cox regression, linear regression, and modified Poisson regression. ResultsOne-hundred-twenty REPs teeth with a mean 41.7-month recall period were included with a functional retention rate of 97.5%. The healed, healing, and diseased rates of REPs were 80%, 9.2%, and 10.8%, respectively. Significant prognostic factors for healed were age (<12 years old) and root development stage (stages 4 and 5). Changes in the apical diameter, root length, root width, and radiographic root area after REPs were 56.8%, 8.3%, 23.2%, and 21.7%, respectively. Significant prognostic factors for continued root development were age and etiology of pulpal disease (from caries or dental anomalies). The sensibility test response rate was 41.7% with significant positive factors of ethylenediaminetetraacetic acid irrigation and capping material level above the cemento-enamel junction. ConclusionREPs demonstrated high functional retention and healed rates. Patients <12 years old presented a higher healed rate and continued root development (excluding root length). Dental caries or anomalies had higher continued root development compared with dental trauma. The sensibility test response was related to ethylenediaminetetraacetic acid irrigation and level capping material.

Reattachment of Fractured Tooth Segment in Minimally Invasive Way - A Case Report

Dental trauma frequently results in coronal fractures of the front teeth. Root canal therapy followed by reattaching the fractured segment with fiber post reinforcement is a viable alternative in cases of complex fractures where the fractured segment is present and there is close approximation of the segment to the intact tooth. Reattaching a fractured piece is a quicker, less involved process that offers immediate relief, better aesthetics, and function restoration. The present case report is of a 11-year-old boy with an uncomplicated crown fracture of permanent maxillary right central incisor and a palatal uncomplicated crown–root fracture of his permanent maxillary left central incisor . The fractured fragment was reattached using nano-filled dual-cure composite resin and tooth restored with composite resin. The fragment showed opaque discoloration that reduced over time but still persisted after 1 year. During the follow-up period, no unfavorable radiographic changes were seen. The prognosis of the teeth was favorable with good esthetic results. Keywords: Fragment reattachment, Fragment rehydration, Periodontal health, Root fracture, Uncomplicated crown.