Enamel-dentin Fracture Research Articles

Electrosurgical Adjunct for Soft Tissue Management of the Paediatric Dental Trauma Patient

The interface between dental restorations and the neighbouring soft tissue is of key significance for restorative success and longevity. Trauma-related enamel–dentine fractures are frequently present with the restorative challenge of subgingival margins and little remaining tooth structure. This report looks at two paediatric dental trauma patients with extensive crown fractures resulting in subgingival margins, which posed a poor long-term tooth survival. Electrosurgery was used before definitive composite restorations to allow for supragingival margins and access. Each patient attended the Child Dental Health Department at the University of Manchester Dental Hospital for assessment and treatment provision. CPD/Clinical Relevance: This article identifies electrosurgery as an increasingly useful adjunct to restorative management of traumatized permanent incisor teeth in paediatric patients.

Traumatic Dental Injuries among Adolescents and Young Adults in Iași, Romania: Legal and Medical Perspectives.

This study aims to assess the etiology, frequency, and localization of dental and periodontal trauma in adolescents and young adults, along with these individuals' predisposition based on age, gender, and residence. Materials and Methods This retrospective study included 109 adolescents and young adults from a database of the Emergency and Oral and Maxillofacial Surgery department at "Sf. Spiridon" Hospital, Iasi, Romania. The collected data included demographic details, mechanisms of dental and periodontal trauma, treatment approaches, and clinical outcomes. Statistical analysis was performed using SPSS 26.0, with comparisons based on age, gender, and residence. Enamel fractures (23.9%) and enamel-dentin fractures without pulp exposure (20.2%) were the most frequent dental injuries. Concussion (58.7%), subluxation (21.1%), luxation, avulsion (7.3%), and extrusion (5.5%) were common periodontal injuries. The anterior region of the dental arch accounted for the majority (60.6%) of injuries. Adolescents under 17 years were more prone to enamel-dentin fractures without pulp exposure (23.8%), enamel-dentin fractures with pulp exposure (20.6%), and root fractures (20.6%), while young adults over 18 years had a higher incidence of enamel fractures (32.6%) and crown-root fractures (30.4%). Falls (66.7%) were the predominant cause of trauma for female patients, whereas male patients were more often injured during sports activities (49.3%). The younger age group was 0.29 times more likely to sustain enamel-dentin fractures without pulp exposure (p = 0.049, OR = 0.291) and root fractures (p = 0.047, OR = 0.241). Traumatic dental injuries are more prevalent in young adults compared to adolescents, with falls and sports activities being the most common causes, particularly among males. These findings emphasize the need for targeted preventive programs aimed at reducing the incidence of dento-periodontal trauma in these age groups.

Experience and level of confidence in the management of dental trauma among dental students and fresh graduate dentists

ABSTRACT Background: Dental trauma is one of the most serious and frequent oral problems in active children as well as adolescents worldwide. Anyone can be a victim. Hence, the level of competence in the management cannot be undermined. Aim: This study aims to evaluate the experience and confidence in the management of dental trauma among dental students and fresh graduate dentists in Benin City, Nigeria. Methodology: This questionnaire-based, analytical, and cross-sectional study utilized a self-administered questionnaire containing 15 closed- and open-ended questions to garner data from respondents. Data from 95 respondents were analyzed using the Statistical Package for the Social Studies software version 26.0 (IBM Corporation, Chicago, Illinois, USA.), and both univariate and bivariate analyses were used in this study. Results: A substantial proportion of respondents 73 (76.8%) had never managed any case of dental trauma. A relatively higher proportion of respondents were more confident in managing cases of enamel fracture 18 (18.9%), enamel infraction 17 (17.9%), and enamel-dentine fracture 12 (12.6%) as compared to other more complicated fractures. Conclusion: The experience and level of confidence in the management of dental trauma among dental students and fresh graduate dentists were found to be poor, and they were more confident in managing less complicated cases of dental trauma.

Pattern of Traumatic Dental Injuries and Treatment Receipt among Children Attending the University Dental Hospital in Saudi Arabia

ABSTRACT Objective: The aim of this study was to investigate the pattern and distribution of traumatic injuries to primary and permanent anterior teeth in 2–14-year-old pediatric dental patients in AlHassa region of Saudi Arabia. Methods: The study sample consisted of pediatric dental patients visiting the university dental complex seeking treatment for traumatic dental injuries (TDIs) during the period from February 2022 to April 2023. Data were collected by means of interviewing the children and/or parents regarding the history of trauma and clinical examination for evidence of dental trauma to primary and permanent teeth. Results: A total of 122 children (184 teeth) including 78 (63.9%) boys and 44 (36.1%) girls sustained traumatic injuries to their teeth. The most common reason for dental trauma was falls, and maxillary right central incisor was the most frequently affected permanent teeth. Enamel-dentine fractures in permanent teeth and luxation injuries among primary teeth were predominantly noted. Majority of the injuries (47.5%) have been found to have not received timely attention for treatment. Conclusions: Early treatment of dental trauma should be emphasized, and preventive strategies targeted at parents and teachers at the community level are needed to promote and reduce the burden of TDIs.

Traumatize anterior teeth, dento-facial anomalies among deaf person in the middle region of Iraq

This study was designed to determine the type and prevalence of trumatic dentalinjuries, aenterio—posterior molar relation among (519) deaf persons and (532) schoolstudents at 5-16 years of age in the middle region of Iraq. The study showed that theprevalence of traumatic dental injuries were 6.94% for deaf persons and 5.83% forschools students. Males showed a higher percentage of traumatized teeth than females ininstitutions and school students. Enamel dentine fracture without pulp exposure was themost predominant type among deaf persons while simple enamel fracture was the mostpredominant among schools students. The majority of deaf persons and schools studentsdemonstrated normal type of occlusion 57.42%, 55.64% respectively. Deaf personshowed significantly with percentage of 4.62% mesial full cusp deviation from normal.antero·postrior molar relation compared to school students 2.07%

Traumatic dental injuries over an 8-year period at a German dental center: a retrospective overview and cross-sectional analysis.

The aim of this study was to analyze a population of patients who had suffered from traumatic dental injuries (TDIs) by using different patient-, trauma- and treatment-related parameters. All dental records of patients ≥ 3years old who had presented at the dental emergency service between Jan 1, 2009 and Dec 31, 2016 for the treatment of dental trauma were analyzed. A total of 2758 patients were invited for a recall examination at the Department for Dental Surgery and Implantology, ZZMK Carolinum, Goethe University Frankfurt, Germany; of these, 269 patients attended their recall appointments. The enrolled patient population consisted of 1718 males and 1040 females, with a mean age of 19.63years (median 12.00 ± 17.354years). A total of 4909 injured teeth were assessed, with a mean of 1.78 injured teeth per patient (median 2.00 ± 1.279). Males were found to be more frequently affected by TDIs compared to females (1.65:1). The majority of these injuries occurred in the first two decades of life (66.1%; n = 1824). The majority of the patients presented for initial treatment within 24h of their accident (95.7%). The most frequent TDIs were isolated luxation injuries 49.4% (n = 2426) and isolated crown fractures 30% (n = 1472). Combination injuries were diagnosed in 20.6% of the cases (n = 1011). Based on the findings of the present analysis, it can be concluded that males were more frequently affected by TDIs than females. Most patients had suffered from TDI before they had turned 10years of age. Overall, the enamel-dentin fracture was found to be the most frequent injury, followed by concussions and lateral luxations.

A Case Report of Different Management Protocols for Uncomplicated Crown Fracture in Young Permanent Teeth; Fragment Reattachment vs. Resin Restoration

Introduction: An uncomplicated crown fracture (enamel-dentin fracture) is the most clinically reported traumatic injury. Many techniques have been reviewed to manage this traumatic injury. The literature has no consensus on the best strategy to establish optimal biological, functional, and esthetical success. Objective: This clinical case reports different management of uncomplicated crown fractures in young permanent teeth that were successfully treated using both tooth fragment reattachment and composite build-up. Case Report: A 9-year-old female presented as an emergency patient with immature fractured upper central incisors. She hit her mouth into a solid wall and broke her front teeth during playing. Upon parental advice, the fragments were stored in a container of milk since the incident. For dental management, two treatment approaches were used. Conclusion: After a two-year follow-up, the treatment is considered successful and the traumatized teeth are vital, functional and presented with a complete root development.

Epidemiology and severity of traumatic dental injuries in permanent teeth: A 20-year retrospective study.

This study aimed to assess the traumatic dental injuries (TDIs) in permanent dentition among patients who attended at the outpatient clinic of a Brazilian dental school, during the last 20 years, and to investigate factors associated with the severity of these injuries. Clinical records of patients who attended a specialized center for dental trauma care in Brazil presenting at least one TDI in a permanent tooth, between the years 2000 and 2019, were reviewed. The data recorded were sex, age, affected arch, etiology, number, and type of the teeth affected, and classification and severity of the TDIs. The diagnosis and classification of the TDIs were based on the guidelines of the International Association of Dental Traumatology (IADT). The severity of each patient's injuries was defined as mild, moderate, or severe. Descriptive statistics, chi-square and multinomial regression analyses were used to evaluate the results. The significance level was set at 5%. A total of 837 clinical records were included, totaling 2357 teeth. Males were more prevalent than females. The patients' age ranged from 5 to 71 years. The most common traumas were avulsion (n=512) and uncomplicated enamel-dentin fracture (n=488). Univariate analyses showed that there was a statistically significant association between age group (p=0.004), etiology (p=0.000) and number of teeth affected (p=0.000) with severity of dental trauma. In conclusion, TDIs that occurred in Piracicaba and region are epidemiologically similar to those found worldwide, and that more severe injuries are related to age range, etiology and number of teeth affected.

Epidemiological aspects of dental trauma associated with maxillofacial injures: Ten years of clinical experience in Trieste, Italy.

The prevalence of dental injuries in patients with facial fractures is relevant. Epidemiologically, dental trauma in association with facial fractures generally affects the age group between 20 and 40 years old, with a higher prevalence of males. The aim of this retrospective study was to identify the incidence and etiology of dental trauma associated with facial fractures over a ten years period. From January 2009 to April 2019, among 381 patients with facial fractures, 353 were included in this study. Age, gender, trauma etiology, injured teeth and dental treatment were investigated. From 353 patients, with a mean age of 49.7 ± 19.9 years, 247 (70%) were males and 106 (30%) were females. Accidental falls were the most common type of injury (n=118, 33.4%), followed by road accidents (n=90, 25.5%), assaults (n=60, 17%) and sports trauma (n=37, 10.5%). Fifty-five subjects (15.60%) had dental injuries associated with facial fractures. Of the 145 teeth involved, 48 (33,1%) were diagnosed with luxation, 22 teeth (15.2%) were avulsed, 11 teeth (7.5%) suffered concussion, and there were 10 (6,8%) alveolar wall fractures. Uncomplicated enamel-dentin fracture was the more frequent hard tissue injury (n=21, 14.5%), followed by complicated crown-root fracture (n=10, 6.9%), infraction (n=8, 5.5%), enamel fracture (n=3, 2%) and complicated enamel-dentin fracture (n=3, 2%). There was a peak in incidence between 21 and 40 years (42%). Males had a significantly higher risk of facial fractures with dental injury (75%). Maxillary incisors and canines (62.8%) were the most affected teeth. There was high prevalence of dental injuries associated with facial fractures. Maxillary incisors were the most injured teeth, with a higher prevalence in males.

Traumatic dental injuries in adults attending a London-based trauma clinic in the UK: a seven-year survey

Introduction This survey reports the incidence of traumatic dental injuries in an adult population attending an adult dental trauma clinic in a London teaching hospital.Materials and methods Retrospective data were collected from patients attending an adult dental trauma clinic between 2012 and 2018.Results In total, 1,769 patients attended, with more men seen (1,030; 58.2%) compared to women (739; 41.8%) and this was statistically significant (p <0.05). The most common aetiological factor was an accidental fall (728; 41.15%), followed by assaults (413; 23.35%), bicycle accidents (253; 14.3%), sports injuries (132; 7.46%) and road traffic accidents (84; 4.75%). Lateral luxation (833) was the most common traumatic injury and this was followed by avulsions (362; 17%). Enamel-dentine fractures were the most common type of fracture injury (1,273; 64%).Discussion This retrospective survey attempts to report on the incidence of traumatic dental injuries in a London-based cohort of patients attending a specialised dental trauma clinic. In line with other reports, there were more men than women affected, which is probably attributed to behavioural activities.Conclusion(s) Accidental falls are the most common cause of a traumatic dental injury, lateral luxation was the most common type of displacement injury and enamel-dentine fractures were the most common type of fracture injury.

Traumatic Dental Injuries among 12-Year-Old Schoolchildren in the United Arab Emirates.

Aims: This study aimed to evaluate the prevalence of the factors related to traumatic injuries to the permanent incisors of 12-year-old children in the Emirate of Ajman, United Arab Emirates. Methods: A sample of 1008 12-year-old children (510 boys and 498 girls) participated in this study. A multi-stage randomized sampling technique was used to select children from public schools for their inclusion in the sample population. An oral examination was completed by a calibrated examiner after receiving training for traumatic dental injury (TDI) to permanent incisor teeth utilizing a modified version of Ellis’s classification. Data that were related to sociodemographic factors, TDI causes, and where the TDI took place were recorded using a structured questionnaire. Results: Of all of the children that were examined, 9.8% of them had experienced dental trauma. The difference in TDI prevalence between boys (15.9%) and girls (3.9%) was statistically significant (p < 0.05). The children whose mothers had low levels of education experienced a higher prevalence of TDI (p = 0.001). The children with incisal overjets that were greater than 5 mm or with inadequate lip coverage tended to have experienced dental injuries (p < 0.01). The main causes of injury to permanent incisors were collision against an object or person (53.5%) and falling (42.4%). Most of the accidents happened at home (58.6%) and school (25.3%). The most prevalent injuries were enamel fractures (58.7%) and enamel-dentine fractures (34.3%). Conclusions: This research highlighted many predisposing factors for traumatic dental injuries among children. There is an urgent need to initiate detailed public health policies to decrease the prevalence of dental trauma cases, especially in the identified risk group.

Magnitude and pattern of combination traumatic dental injuries: An institution based retrospective study in Nepal

Introduction: Traumatic dental injuries can occur as combination injuries, where both fracture and luxation injuries occur concomitantly in the same tooth. The aim of this study was to evaluate prevalence of concomitant fracture and luxation injury (combination dental injuries) in permanent teeth. Methods: A total of 455 traumatized anterior teeth from 175 patients (131 males and 44 females; age ranged from 14 to 70 years), coming for treatment of traumatic dental injuries over a five-year period from January 2016 to December 2020 were included in the study. Patient’s age and sex, type of injury, type and number of injured teeth were recorded from the clinical and radiographic examination records. Descriptive statistical methods were used for data analysis. Results: A total of 257 teeth (56.48%) had fracture injury only, while 150 teeth (32.96%) were found to have luxation injury only. The most common isolated fracture injury was enamel-dentin fracture (n=93; 22.85%) and the most common isolated luxation injury was subluxation (n=77; 18.91%). A low prevalence of combination injury was observed in 48 teeth (10.54%). Enamel-dentin fracture (52.08%) was the most common fracture injury type presenting with a concomitant luxation injury. Similarly, the most frequent luxation injury type presenting with a concomitant crown fracture injury was subluxation (56.25%). The most common combination injury was enamel-dentin fracture in combination with subluxation injury (n=15; 31.25%). Conclusions: The magnitude of combination injury was low in this study and was frequently observed in males of young age groups. The most common combination injury was enamel-dentin fracture in combination with subluxation injury.

Traumatic dental injuries and their sequelae in visually impaired adolescents.

Traumatic dental injuries are a public health problem. Visual impairment can be considered a risk factor for traumatic dental injury given the difficulties imposed upon visually impaired patients by limited physical perception. The aim of this study was to evaluate the frequency of traumatic dental injuries and their sequelae in adolescents with visual impairment. Adolescents (12-18years) with visual impairment (blind or low vision) and no other special needs were included in the study. Data were collected after a clinical and radiographic examination. Data regarding gender, age, type of visual impairment, site of traumatic dental injury, tooth type, and affected tissues, care, and sequelae were obtained. The data were analyzed descriptively and with the chi-square test (p<.05). Among 96 adolescents (65% blind; 55% female), 20.8% (n=20) reported they had previously experienced a traumatic dental injury of 33 teeth (78.8% maxillary central incisors). Combined injuries (30.3%; n=10) were the most common traumatic dental injuries, followed by concussion (27.3%, n=9) and enamel-dentine fractures (21.2%, n=7). Sequelae were observed in 27.3% (n=9) of the teeth affected by a traumatic dental injury, and apical periodontitis (77.8%, n=7) was the most common. The frequency of traumatic dental injuries among visually impaired adolescents can be considered high, and the observed sequelae could have been minimized if adequate clinical and radiographic follow up had been carried out. These results suggest the importance of enhanced educational efforts to reduce traumatic dental injuries.

Dental fractures: types, causes, and treatment

Studies indicate that the management of dental fractures might be challenging because many cases present with minor, hard-to-discover traumas, requiring extensive evaluation and diagnostic procedures. Accordingly, adequate management can only be achieved by establishing a proper diagnosis, drawing an adequate treatment plan, and conducting regular follow-up appointments. We have discussed the different causes, types, and treatments of dental fractures. The commonest causes include impaction by trauma, whether direct or indirect. Many traumatic events were reported in the literature, and age and carious lesions are important factors to consider. Many types of dental fractures were also reported in the literature, including root fractures, crown root fractures, enamel-dentin fractures with and without pulp exposure or crown fractures, enamel infractions, and fractures. Other types include avulsion, intrusion, extrusion, lateral luxation, concussion or subluxation, splinting, and alveolar segment fractures. The treatment should be integrated based on the fracture type, and adequate follow-up should be established to achieve the best predictive outcomes.

Orthodontic treatment after intrusive dislocation and fracture of the maxillary central incisors

The treatment for intrusive dislocation is a clinical challenge and must be started soon after the intrusion injury. The affected tooth or teeth must be extruded by using light forces. This case report of traumatic intrusion of permanent central incisors aims to describe and discuss the process of repositioning the teeth in the dental arch. After a domestic accident, a 10-year-2-month-old boy suffered 11-mm intrusion of the maxillary central incisors along with enamel-dentin fracture and subluxation of the maxillary lateral incisors. Treatment started 2days after the incident with an orthodontic extrusion of the maxillary central incisors with a fixed edgewise standard appliance. Orthodontic arches were used, and the force vectors were directed to the desired locations for the repositioning of the teeth. The treatment for extrusion and stabilization of the maxillary central incisors lasted 5months and 22days. Orthodontic traction with a fixed appliance is an effective procedure for the extrusion of both permanent maxillary central incisors intruded after trauma. Correct diagnosis, a short period between the trauma and the beginning of treatment, and appropriate mechanics were determining factors for a successful treatment.

Traumatic Dental Injuries, Treatment, and Complications in Children and Adolescents: A Register-Based Study

Objective Traumatic dental injury (TDI) is a common dental concern among children worldwide. We performed a retrospective patient register study among children under 18 years to investigate TDIs with respect to causes, treatment, and complications. Materials and Methods We collected information on TDIs from the original patient records of 407 child patients visiting dental clinic of Lithuanian University of Health Sciences, Kaunas, Lithuania. We analyzed all child patients’ ( n = 407) background, cause, type of TDI, treatment, complications, and time elapsed from injury to visit to the dentist. Statistical Analysis The χ 2 -test, analysis of variance (ANOVA), and Kruskal–Wallis and Mann–Whitney tests served in the statistical analyses. Results A total of 579 TDI cases occurred during 2010 to 2016. Lateral luxation (19.8%) and intrusion (14.8%) occurred more often in the primary than the permanent dentition ( p < 0.05). The most common cause of TDI was falling (56%). Avulsion occurred in approximately 10% of cases. Follow-up (44.5%) and tooth extraction (48.3%) were the most frequent treatments in the primary and splinting (25.3%) in the permanent teeth. Pulp necrosis was the most frequent complication in primary (92%) and permanent (54%) dentition. About 1% of the patients obtained dental care during the first hour after injury. Conclusion The most frequent TDIs included lateral luxation in primary teeth and enamel-dentine fractures in permanent teeth. We observed a delay in patients obtaining emergency dental care.

Profiles of traumatic dental injuries among children aged 0-15years in Cappadocia, Turkey: A retrospective cohort study.

Traumatic dental injuries are among the most serious dental public health problems in children. The aim of this retrospective study was to evaluate the dental trauma profile of primary and permanent teeth among children aged 0-15years who presented to a university hospital. The study included 650 patients (1,000 primary and permanent teeth) who presented with a history of dental trauma to the Department of Pediatric Dentistry, Faculty of Dentistry, Erciyes University between 2016 and 2019. Traumatized teeth were assessed according to the Andreasen classification. The following information was recorded: age, gender, teeth affected by trauma, etiologies of trauma, place and season of trauma, type of trauma, type of treatment, and time between the trauma and treatment. In total, 650 patients (240 females, 410 males) and 1,000 incisors (212 primary teeth, 788 permanent teeth) were evaluated. The average age of the patients was 8.89±3.41years, and dental injuries were more frequent between 8 and 10years of age. The maxillary central incisors, both primary (40.1%) and permanent (42.8%), were the most frequently affected teeth. The main cause of traumatic dental injuries was falls. Most accidents occurred at school and home. The most common type of dental injuries recorded was luxation injuries in the primary teeth (21.5%) and enamel-dentin fractures (35.9%) in the permanent teeth. Only 48 teeth were treated during the first hour after injury. The most common type of traumatic injury affecting permanent teeth was enamel-dentin fractures, and primary teeth were luxation injury. Only 4.8% of teeth were treated within the first hour after trauma.

Assessment of various components of oral health status in different population groups of Meerut division of Western U.P.: A pathfinder survey

Introduction: Oral conditions have an impact on the quality of life of children in different ways, not just functionally, but also psychologically and socially. The diagnosis of oral diseases is thus, an essential aspect of dental practice. Aim: To estimate the prevalence of dentofacial anomalies, dental fluorosis, dental trauma, oral mucosal lesions and dental erosion. Materials and Method: The study was carried out amongst 5, 12 and 15- year old residents of urban, semi-urban and rural population of Meerut division of Western U.P, INDIA. 2100 children were examined in the study. Data was recorded in a self-designed proforma. Recordings were done according to WHO basic methods -4th and 5thedition. The collected data was subjected to statistical analysis. Results:One way ANOVA was used for statistical analysis. Severe/handicapping malocclusion was observed in 5.2% of the children examined. Prevalence of dental fluorosis was 47.5% and that of dental trauma was 5.38% with enamel-dentin fracture being the most common occurrence. Prevalence of oral mucosal lesion was 1.14% with ulceration and abscess being more common with 11% prevalence. However, dental erosion was absent in all the population groups examined. Conclusion:Malocclusion, dental fluorosis and dental trauma were found to be prevalent in the various population groups thereby emphasizing the need for regular conduct of oral health surveys and making appropriate strategies for prevention and prompt treatment. Keywords: Dentofacial anomaly, Dental fluorosis, Oral mucosal lesion, WHO, Dental trauma

Untreated dental trauma among homeless people in Midwest Brazil.

Homeless people are usually more exposed to traumatic events that may cause dental injuries than those with more stable housing. Previous studies on the oral health condition of this population group have shown high levels of dental caries, periodontal diseases, and tooth loss, but evidence on dental trauma is scarce. Furthermore, there is no report from Latin American countries. The aim of this study was to describe the prevalence of untreated traumatic dental injuries (TDI) among adult homeless people in a Brazilian capital city. A sample of 102 adults attending a public homeless shelter was clinically examined using the criteria of the 2010 Brazilian National Oral Health Survey. TDI was found in 10.8% of the participants, and the most common types of injury were enamel-dentin fractures and avulsion. The overall prevalence was relatively low, but the proportion of anterior tooth loss due to trauma and other reasons shows the need for more appropriate health care for this vulnerable population group.

Partial Pulpotomy with Mineral Trioxide Aggregate in Permanent Incisors with Complicated Crown Fracture: 5-Year Follow-Up

Traumatic dental injuries are highly prevalent among children. This article describes a case report of a patient who has experienced dental trauma at 8 years old, which has led to enamel-dentine fracture with pulp exposure in the left central incisor and crown-root fracture with pulp exposure in the right central incisor. Partial pulpotomy was performed with the aim of maintaining the neurovascular bundle, thus allowing normal radicular formation. During follow-up 5 years later, teeth were asymptomatic and with no evidence of radiolucent lesions in radiographic examinations. This report demonstrates that traumatic fractures with pulp exposure can be treated effectively by the described technique.