Enamel-dentin Fracture Research Articles

Mineral trioxide aggregate pulpotomies: A case series outcomes assessment

The greatest threats to developing teeth are dental caries and traumatic injury. A primary goal of all restorative treatment is to maintain pulp vitality so that normal root development or apexogenesis can occur. If pulpal exposure occurs, then a pulpotomy procedure aims to preserve pulp vitality to allow for normal root development. Historically, calcium hydroxide has been the material of choice for pulpotomy procedures. Recently, an alternative material called mineral trioxide aggregate (MTA) has demonstrated the ability to induce hard-tissue formation in pulpal tissue. The authors describe the clinical and radiographic outcome of a series of cases involving the use of MTA in pulpotomy procedures. Twenty-three cases in 18 patients were treated with MTA pulpotomy procedures in an endodontic private practice. All of the patients had been referred to the practice for diagnosis and treatment of a symptomatic tooth. All of the authors provided treatment. Pulpal exposures were either due to caries or complicated enamel dentin fractures. Nineteen teeth in 14 patients were available for recall. The mean time of recall was 19.7 months. Of the 19 cases, 15 involved healed teeth, and three involved teeth that were healing. One of 19 cases involved a tooth with persistent disease. MTA may be useful as a substitute for calcium hydroxide in pulpotomy procedures. Further research, however, is required to clarify this conclusion. MTA conceivably could replace calcium hydroxide as the material of choice for pulpotomy procedures, if future research continues to show promising results.

Traumatic intrusion of permanent teeth. Part 3. A clinical study of the effect of treatment variables such as treatment delay, method of repositioning, type of splint, length of splinting and antibiotics on 140 teeth

A prospective study of 140 intruded permanent teeth was examined for the following healing complications: pulp necrosis (PN), root resorption (RR; surface, inflammatory and replacement resorption), and defects in marginal periodontal bone healing (MA). The occurrence of these healing complications was related to various treatment factors such as treatment delay, method of repositioning (i.e. expecting re-eruption, orthodontic reposition and surgical reposition), type of splint (rigid, semirigid and flexible), length of splinting (days) and the use of antibiotics. Treatment delay, i.e. before and after 24 h, had no effect upon healing. Active repositioning in individuals with incomplete root formation (surgical or orthodontic) had a negative effect upon the three healing parameters compared with spontaneous eruption. In teeth with complete root formation and an age of 12-17 no repositioning was still the best treatment in regard to MA. In individuals older than 17 years of age, cases were not anticipated to spontaneously erupt and in these cases, the general choice of treatment was either active orthodontic or surgical repositioning. The former procedure appeared in this treatment scenario to slightly reduce the risk of MA complications. However, this treatment procedure was also found to be more time demanding (an average of 22 consultations for orthodontic repositioning compared with 17 consultations for surgical repositioning). If a surgical repositioning was performed, the type of splint (i.e. flexible, semirigid or rigid) appeared to have no significant effect on the type of healing. The same applied to the length of splinting time (shorter or longer than 6 weeks). No effect of dentin covering procedures for associated crown fractures (enamel-dentin fractures) could be demonstrated. Likewise, antibiotics had no apparent effect upon healing. In conclusion, in patients with intruded teeth with incomplete root formation, spontaneous eruption should be expected. In patients with completed root formation and with an age of 12-17 spontaneous eruption can still occur, but must be monitored very carefully. In older patients (i.e. >17 years) with completed root formation, either surgical or orthodontic extrusion should be attempted. The latter procedure appeared to lead to a slight reduction (not significant) in the risk of MA complications. The extent and direction of the intrusion may however favour surgical repositioning.

Therapeutic and economic implications of traumatic dental injuries in Denmark: an estimate based on 7549 patients treated at a major trauma centre.

To analyse the type and extent of injuries presented by patients seeking treatment for traumatic dental injuries at a major trauma centre. Furthermore, to analyse acute and subsequent treatment demands and treatment costs. A therapeutic and economic analysis was performed of 7549 patients treated for traumatic dental injuries in a major trauma centre located at the University Hospital in Copenhagen, Denmark. Cases were divided into uncomplicated (concussion, subluxation, enamel and enamel-dentine fractures) and complicated cases (crown fractures with exposed pulps and crown-root fractures, luxation injuries with displacement of the tooth and bone fractures). Primary tooth injuries were found in 2874 patients, involving 5443 teeth, among which 62.8% had complicated injuries. Permanent tooth injuries were found in 4525 patients, involving 10,673 teeth, among which 40.4% had complicated injuries. The cost of treatment (including acute trauma service, follow-up and subsequent restoration) was estimated to be 0.6-1 mill USD a year for the patients treated in this trauma centre. If this figure is transferred to the estimated trauma population in Denmark, a yearly cost of traumatic dental injuries appears to range from 2 to 5 mill USD per 1 mill inhabitants per year according to the treatment scenario. Thus, treatment of traumatic dental injuries comprises an expensive part of the health services in Denmark.

Childhood obesity: a risk factor for traumatic injuries to anterior teeth.

The relationship between obesity and traumatic dental injuries was evaluated in a study population of 938 6- to 11-year-old schoolchildren from Rome, Italy, and it was suggested by the lifestyle and the physical activity of obese children, which, according to many authors, is different from the lifestyle of other children. The subjects were examined at school: presence and type of dental injury, overjet, incisor protrusion, upper lip incompetence and presence of obesity were recorded. Trauma predisposition was evaluated with a questionnaire investigating the behaviour which may predispose to impacts. Six out of eight questions in this questionnaire concerned the children's lifestyle and the trauma predisposition score was therefore also considered an estimate of lifestyle and physical activity. The dental injury prevalence of the study population was 21.3% and obesity prevalence was 11.4%. Of the obese children 30.8% had dental injuries vs. only 20.0% of non-obese subjects (P = 0.007). Obese children had only enamel and enamel-dentine fractures and the main reported trauma cause was indoor play; conversely, lean children also had other types of injuries and the most frequently reported cause was outdoor play. The main predisposing factors significantly affecting the probability of dental injury, evaluated with multiple logistic regression, were upper lip uncoverage (OR: 1.23; P = 0.02), overjet larger than 3 mm (OR: 1.68; P = 0.001) and obesity (OR: 1.45; P = 0.01). Surprisingly, trauma predisposition was a protective factor (OR: 0.50; P = 0.00001). The results of this study were explained by the significant inverse correlation between obesity and trauma-predisposing behaviour, thus suggesting that subjects frequently playing sports and lively games were not only less obese but also more skillful and, for this reason, less prone to trauma when they fell or sustained impacts.

Resin-bonded cast coverage for fractured posterior teeth

Enamel-dentin fracture without pulpal involvement of intact posterior teeth demands restoration of form and function while preserving as much sound tooth material as possible. A partial-coverage restoration cast in nonprecious metal and air-abraded and bonded to the tooth by an adhesive resin is suggested. The strong bond of the adhesive resin to the enamel and dentin of the tooth and to the airabraded metal allows for simple fabrication of a cast partial coverage that requires only minimal tooth preparation.

Reasons for seeking treatment after traumatic dental injuries

The purpose of this study was to determine the reasons why parents of children seek treatment after traumatic injuries to primary teeth. The sample consisted of 114 5-month to 8-year-old children with 196 injured primary teeth. The reason for parents seeking treatment varied according to the type of injury. Parents of children with enamel fractures and enamel-dentin fractures without pulpal exposure were more concerned about esthetics. Of the patients presenting concussions, parents were more responsive to color change of the tooth and to the tooth response to the trauma, mainly abscess formation. In luxations and lateral displacements, the parents sought dental treatment because of their own reaction to the clinical situation, i.e., blood, crying. Very few were concerned with possible consequences to the primary and/or permanent teeth. In no category of injury were the parents most concerned about the consequences to the primary and/or permanent teeth.

Traumatic dental injuries in nursery schoolchildren from Baghdad, Iraq

The purpose of this study was to determine, by age and sex, 1) the prevalence of traumatic injuries to primary incisors and canines, and 2) their distribution according to type in nursery schoolchildren from the city of Baghdad. The sample consisted of 2389 children aged 1-4 yr enrolled in 39 nursery schools. The prevalence of injuries was 24.4% (24.5% in boys and 24.3% in girls). The largest percentage of injuries was demonstrated by the 4-yr-old children. There were no differences between boys and girls in their susceptibility to traumatic dental injuries. Combining both sexes, the most common type of injury was the enamel fracture (83.8%), followed by concussion (7.4%) and enamel-dentin fracture (6.2%).

Traumatic dental injuries in schoolchildren from Santo Domingo.

The purpose of this retrospective study was to analyze, by age and sex, 1) the prevalence of traumatic injuries to permanent incisors and canines, and 2) their distribution according to type in schoolchildren from the city of Santo Domingo, in the Southern part of the Dominican Republic, which is located in the Caribbean Archipelago. The sample consisted of 1200 children aged 6-17 yr enrolled in eight public and private schools. Garcia-Godoy's classification for traumatic injuries was used. The prevalence of injuries was 12.2% (13.1% in boys and 11.2% in girls). The largest number of injuries was presented by the 14-yr-old children (17.4%) followed by the 13- and 12-yr-olds (15.7% and 11.7%, respectively). More boys injured their teeth than girls (not significantly) with a boy-to-girl ratio of 1.1:1. The most common type of injury in both sexes was enamel-dentin fracture, followed by enamel fracture.

Traumatic dental injuries in preschoolchildren from Santo Domingo.

The purpose of this retrospective study was to analyze, by age and sex, 1) the prevalence of traumatic injuries to primary incisors and canines, and 2) their distribution according to type in preschoolchildren from the city of Santo Domingo, in the Southern part of the Dominican Republic, which is located in the Caribbean Archipelago. The sample consisted of 800 children aged 3-5 years enrolled in 24 public and private preschools. The prevalence of injuries was 35% (32.8 in boys and 37.2 in girls). The largest number of injuries was presented by the 5-year-old children. More girls suffered traumatic injuries than boys (not significantly) with a boy-to-girl ratio of 0.9:1. Combining both sexes, the most common type of injury was the enamel-dentin fracture (32.6%), followed by enamel fracture (31.2%) and concussion (23.5%).

Follow-up study of permanent incisors with enamel-dentin fractures after acute trauma.

The present investigation evaluated the prognosis for vitality after an acute trauma in 3144 permanent incisors with enamel-dentin fracture as the only damage and in 923 incisors with enamel-dentin fracture combined with other symptoms on the damaged tooth. The teeth were examined at regular intervals. The observation time was more than 2 years in the case of 78.9% of the material. Pulpal necrosis developed in 250 teeth (6.1%). Pulp death occurred in 3.2% of teeth with enamel-dentin fracture as the only damage. The combination of enamel-dentin fracture and concussion resulted in pulpal necrosis in 5.8% and cases involving both concussion and mobility showed pulpal necrosis in 30.1% of teeth. A registration of the enamel-dentin fracture based on the extent of dentin exposure was undertaken. The relationship between extent of dentin exposure and pulpal necrosis as well as influence of treatment on pulpal necrosis was clearly illustrated. It is concluded that information on damage to the mineralized tissue without details of damage occurring at the same time to supportive tissue is of doubtful value in assessing the prognosis.