Dental Trauma Research Articles

Knowledge, Attitude, and Behavior toward Dental Trauma among Parents of Primary Schoolchildren Visiting College of Dentistry, Jizan

Knowledge, Attitude, and Behavior toward Dental Trauma among Parents of Primary Schoolchildren Visiting College of Dentistry, Jizan

Resistance to fracture of simulated immature teeth treated with intracanal medicaments and calcium silicate-based coronal barrier materials in endodontic regeneration

Resistance to fracture of simulated immature teeth treated with intracanal medicaments and calcium silicate-based coronal barrier materials in endodontic regeneration

Single- versus multi-visit approach for fragment reattachment in complicated crown-root fractures: a cohort study

BackgroundComplicated crown-root fractures are a type of tooth fracture that involves the enamel, dentin, and cementum and accompanied by pulp exposure. The treatment of a complicated crown-root fracture is always challenging due to the difficulties in achieving a hermetic seal and a stable restoration with a fracture level close to the crestale bone level. This study aimed to evaluate and compare the efficacy of single-visit and multi-visit approaches for fragment reattachment in complicated crown-root fractures of anterior teeth.MethodsTwo cohort consist of 10 adolescent patients in each group at both genders, who suffered from permanent anterior tooth complicated crown-root fracture were included. Fragment reattachment with root canal treatment was performed with either single or multiple-visit approach. Single visit fragment attachement combined with root cannel therapy was conducted in single-visit approach group immediately after injury. Fragment attachment, root cananel therapy and post resoration were performed during three times ‘ clinical visit in multi-visit approach group.ResultsAll the patients in both groups achieved satisfactory aesthetic results one year after fragment reattachment. Patients who underwent a multi-visit approach had a significantly shorter operative duration, less intra-operative pain and fatigue, slightly better periodontal health at an early stage, and a decreased incidence of temporomandibular joint disorders compared to those who underwent a single-visit approach. However, multiple visits approach may increase the risk of fragment detachment postoperatively.ConclusionFragment reattachment a reliable but temporary technique for adolescent patients who have suffered from complicated crown-root fractures. Multi-visit approach showed similar effecacy to single-visit approach but with slightly less complications. The choose of these two merhos should depend on the specific patient situation and patient compliance.Trial registrationThis prospective cohort study was retrospectively registered in Chinese Clinical Trial Registry (ChiCTR2300076811) on 19/10/2023.

Relationship Between Dental Trauma and Orthostatic Balance in Children.

Dental trauma (DT) and falls have shown to be associated. On the other hand, postural balance is associated with falls and depends on the integration of the body's regulatory systems. The aim of this study was to investigate the potential relationship between DT and alteration of orthostatic balance in children. This was a population-based case-control study involving 296 six-year-old schoolchildren. The case group included children with previous history of DT. The control group included children with no previous history of DT. Stabilometric measurements were the main exposure of this study. Logistic regression analyzes were performed to estimate potential differences in terms of chance of occurrence. The cases reviewed showed a 4.37 times chance of reduced balance in the measurement of the anteroposterior trajectory speed of the orthostatic center of pressure (COP), when children had their eyes closed. It also presented a chance of 3.06 times reduced balance in the measurement of the orthostatic center of pressure latero-lateral sway, with children with open eyes and stepping on a foam pad, and 4.00 times of reduced balance in the width of the latero-lateral sway of the orthostatic center of pressure, with children with open eyes and stepping on a foam pad. Children with previous history of DT showed a higher chance of experiencing a reduced orthostatic balance in different conditions when compared to children without the occurrence of trauma.

Risk of Healing Complications Following Alveolar Process Fractures in the Primary Dentition: A Retrospective Clinical Cohort Study.

Alveolar bone process fractures in preschool children are not well documented in the literature. Alveolar process fractures are located very close to primary teeth and permanent tooth germs. This study investigates the risk of healing complications following alveolar process fractures in the primary dentition and potential sequelae in the permanent dentition. A retrospective cohort study was conducted involving 21 patients with 49 primary teeth involved in an alveolar fracture. The follow-up protocol included clinical and radiographic examinations at specified intervals up to the age of 6 years. Healing complications in the primary teeth such as pulp necrosis, pulp canal obliteration, ankylosis, infection-related resorption and premature tooth loss were examined. Sequelae in the permanent dentition was also registered when the permanent incisors had erupted. Over a 3-year follow-up, the incidence of premature tooth loss was 51.2% [95% CI: 34.1%-68.4%], pulp canal obliteration was 42.5% [95% CI: 27.1%-57.8%], and pulp necrosis was 8.9% [95% CI: 0.6%-17.3%] following an alveolar process fracture. No cases of ankylosis were observed. Sequelae in the permanent dentition primarily included demarcated opacities and hypoplasia with a risk estimated at 24% [95% CI: 13%-39%] and 9% [95% CI: 2%-21%] respectively. Alveolar process fractures in primary dentition are associated with several healing complications in the primary teeth. Although the likelihood of severe complications in the permanent dentition is low, young children are still susceptible to developing sequelae in their permanent teeth. These results highlight the importance of awareness of dental injuries following alveolar process bone fractures in the primary dentition.

Nivel de conocimiento y actitud de los profesores de educación infantil y primaria sobre el manejo de los traumatismos dentales

Objective: To evaluate the level of knowledge of early childhood and primary education teachers about the management and attitude toward dental trauma in children. Material and methods: A cross-sectional descriptive study was carried out using questionnaires sent to schools in San Sebastián, Spain, to be answered by early childhood and primary education teachers between May and November 2023. The anonymous questionnaire was sent via Google Forms and consisted of three sections that included questions on demographics, history, and knowledge of dental trauma and its management. The statistical analysis of the variables was performed using the Fisher test, and the significance level was 5%. Results: A total sample of 83 teachers were included; 90% of the sample were women between 20 and 29 years old, without children, in primary school, and with less than 5 years of experience. No statistically significant differences (p>0.05) were observed in the relationship between gender, having previously taken first aid courses, or having witnessed a trauma previously about greater knowledge on the subject. On the other hand, older participants, with more years of experience and with children were those who had read or heard the most about the topic and had a higher level of knowledge. Conclusions: Teachers' knowledge and management of dental trauma is limited. There is a relationship between age, years of professional experience, and having children with better knowledge and attitudes.

Orthodontic Extrusion of Fractured Tooth with Clear Retainer

Tooth fracture at the cervical margin is frequently seen, and orthodontic extrusion of the same can be carried out to achieve a “ferrule effect” for successful restoration. Various techniques incorporating conventional removable and fixed orthodontics have been employed to facilitate orthodontic extrusion of the fractured tooth. The clear aligner can be used to facilitate the extrusion of a fractured tooth using the “bootstrap” arrangement. Bootstrap mechanics involve placing bonded buttons at the gingival margins on the facial, lingual, or both surfaces of a tooth that is lagging. In this pearl, an innovative and economical prerestorative orthodontic method, based on the biomechanical principles of the “bootstrap” arrangement used in aligners, is developed for the successful extrusion of a fractured tooth using a clear retainer and orthodontic elastics. The amount of extrusion of the fractured tooth was 2.5 mm and was achieved in a time frame of 3 weeks. The appliance is patient-friendly and cost-effective. Moreover, the appliance omitted the use of fixed orthodontic treatment mechanics.

Comparative Evaluation of Microleakage in Endodontically Treated Teeth Using an Alkasite Restorative Material Versus Resin-Modified Glass Ionomer Cement (RMGIC) as an Intraorifice Barrier: A Study Protocol.

Background The most popular approach to treating pulpal and periapical disease is endodontic therapy, but the most common failure after root canal therapy, if not followed by planned rehabilitation of the tooth, is tooth fracture, which may be so severe in some cases needing extraction. Inadequate endodontic restorations increase the risk of fracture and coronal leakage, which can disseminate bacteria and their byproducts and perhaps lead to the failure of root canal therapy. In order to offer protection against masticatory forces along with compressive obturation forces that can lead to vertical root fracture, research has also supported the use of post-endodontic treatment restorative materials with an elastic modulus that is either greater or comparable to the tooth itself for post-endodontic restorations. Restorative materials that can bond to root dentin can be used to create intraorifice barriers, which prevent coronal microleakage and reinforce the radicular dentin. The current in vitro studyaims to assess the effects of various intraorifice barriers (an alkasite restorative material versus resin-modified glass ionomer cement) on the sealing ability of the intraorifice barriers following root canal therapy. Methodology In vitro, confocal laser microscopy is used to determine the microleakage of various intraorifice barriers. Conclusion The sealing ability of a post-endodontic restoration is crucial for the overall success of endodontic treatment, and this in vitro study protocol would ultimately help in selecting the appropriate intraorifice barrier.

Treatment of Traumatic Dental Injuries in the Public Dental Services—A Qualitative Exploration of Perceived Challenges and Needs

ABSTRACTBackground/AimThis study explored perceived challenges in the management of traumatic dental injuries (TDI) among general dentists in the public dental service (PDS) of Vestland County in Western Norway and their needs for improving treatment care for TDI patients.Participants and MethodsThis qualitative study conducted three focus group discussions. We recruited a purposive sample of seven general dentists employed in the PDS in Vestland County in Western Norway. The three focus groups consisted of two, two, and three participants, respectively. The focus group discussion took place via the Microsoft electronic platform Teams, and it was visual, and audio recorded. Transcripts of the interviews were analyzed using systematic text condensation.ResultsThe general dentists in this study experienced the management of TDI as a set of complex procedures that require good theoretical knowledge, clinical experience, skills, and teamwork. We were able to group these challenges into three results categories: (1) proficiency challenges, (2) the challenge of stress and discomfort during dental procedures, and (3) the challenge of the organization of the PDS. The participants also expressed the need for practical courses, calibration, and refresher courses in dental traumatology. Their needs fell into two categories: (1) regular, clinically relevant continuing professional development and (2) collective efforts in TDI management.ConclusionIncreasing awareness of the challenges in TDI management and addressing the need for improved dental treatment for TDI patients may lead to targeted programs to enhance dentists' knowledge and skills. There is considerable potential for training dentists in dental traumatology.

Metal artifact reduction tool and mA levels impact on the diagnosis of fracture extension in endodontically treated teeth using cone-beam CT.

To evaluate the influence of different levels of metal artifact reduction (MAR) tool and milliamperage (mA) on the diagnosis of fracture extension in endodontically treated teeth using cone beam CT (CBCT). Ten maxillary premolars were endodontically treated and positioned in the empty sockets of a human maxilla covered with wax. CBCT acquisitions were performed using the Eagle Edge device (Dabi Atlante, Brazil) adjusted to 120 kVp, FOV of 4 × 6cm, exposure time of 24s and voxel size of 0.2mm in 8 different conditions with different MAR (1, 2 and 3) and mA (3.2 and 6.3) levels. Crown-root fractures were simulated in the universal testing machine, and CBCT images were acquired again. Five radiologists evaluated the presence and extension of fractures with a 5-point scale. Statistical analysis was performed by analysis of variance, Tukey and Kappa test (α = 0.05). Although different mA levels did not significantly (p > 0.05) affect the diagnosis values for fracture presence and extension, when evaluated the different levels of MAR, AUC and sensitivity showed significantly higher values (p < 0.05) for MAR 0 using 6.3mA and kappa agreement showed significantly higher values (p < 0.05) for MAR 0 and 2 using 6.3mA. Although mA levels do not have a diagnostic effect when isolating the MAR level; in 6.3mA, MAR 0 and 2 can positively influence the diagnosis of fracture extension in endodontically treated teeth using CBCT. The isolate evaluation of dental fracture presence can overlook diagnostics error of its extension.

Immediate and Successful Management of Avulsed Teeth: A Case Reports

Avulsion and midroot fractures of teeth present significant challenges in dental trauma management. These case reports outlines the successful management of avulsed after a lapse of 2hrs in 1st case report and 24hrs in 2nd case report and midroot fractured tooth, focusing on immediate steps, long-term strategies, and clinical considerations. Midroot fractures often present with compromised structural integrity, necessitating stabilization and protection of the tooth to prevent further damage. Splinting techniques stabilize the tooth and promote healing of periodontal tissues. However, careful monitoring is crucial to assess for potential complications such as inflammatory root resorption and external root resorption. In both the cases extraoral root canal treatment was done for avulsed tooth and then reimplanted into the socket and stabilisation was done using splinting. Followup up was done at regular intervals of one and 3 months which showed no resorption or perapical changes, lack of clinical symptoms In conclusion, the management of avulsed and midroot fractured teeth requires long-term treatment strategies. Favorable outcomes can be achieved, preserving tooth function, and esthetics in patients with traumatic dental injuries.

Diagnosis and management of bruxism. A literature review

Bruxism, characterized by involuntary grinding or clenching of teeth, is a widespread condition with multifaceted implications for oral health, physical well-being, and quality of life. This comprehensive review aims to provide an in-depth study of bruxism, encompassing its definition, classification, etiology, pathophysiology, clinical manifestations, and consequences. Bruxism is classified based on its timing (sleep bruxism or awake bruxism). The etiology of bruxism is multifactorial, involving physiological factors such as central nervous system (CNS) pathways, sleep disorders, and occlusal factors, as well as psychological factors like stress, anxiety, personality traits and environmental factors including medications, substances, and stressors. Clinically, bruxism can result in various dental consequences, including tooth wear, fractures and damage to restorations, as well as temporomandibular disorders (TMDs) such as myofascial pain. These manifestations can negatively impact individual's oral health, physical well-being, and overall quality of life. Management strategies include behavioral and lifestyle changes, oral appliances, dental treatments for tooth damage, and, in certain instances, pharmacological interventions. While the current understanding of bruxism has advanced, further research is needed to fully elucidate its etiology, pathophysiology, and effective management strategies.

A lightweight detection algorithm for tooth cracks in optical images

ObjectivesCracked tooth syndrome (CTS) is one of the major causes of tooth loss, presents the problem of early microcrack symptoms that are difficult to distinguish. This paper aims to investigate the practicality and feasibility of an improved object detection algorithm for automatically detecting cracks in dental optical images. MethodsA total of 286 teeth were obtained from Sun Yat-sen University and Guangdong University of Technology, and simulated cracks were generated using thermal expansion and contraction. Over 3000 images of cracked teeth were collected, including 360 real clinical images. To make the model more lightweight and better suited for deployment on embedded devices, this paper improves the YOLOv8 model for detecting tooth cracks through model pruning and backbone replacement. Additionally, the impact of image enhancement modules and coordinate attention modules on optimizing our model was analyzed. ResultsThrough experimental validation, we conclude that that model pruning reduction maintains performance better than replacing a lightweight backbone network on a tooth crack detection task. This approach achieved a reduction in parameters and GFLOPs by 16.8 % and 24.3 %, respectively, with minimal impact on performance. These results affirm the effectiveness of the proposed method in identifying and labeling tooth fractures. In addition, this paper demonstrated that the impact of image enhancement modules and coordinate attention mechanisms on YOLOv8's performance in the task of tooth crack detection was minimal. ConclusionsAn improved object detection algorithm has been proposed to reduce model parameters. This lightweight model is easier to deploy and holds potential for assisting dentists in identifying cracks on tooth surfaces.

The orthodontic-endodontic interface: trauma and pulpal considerations

The interpretation of the clinical signs and symptoms arising from the interdisciplinary relationship between orthodontics and endodontics becomes more complicated when superimposed by dental trauma. A history of dental trauma before or during orthodontic tooth movement may have implications for pulpal health and clinical outcomes. An understanding of the biology is essential for appropriate treatment planning. This review and treatment recommendations will assist dental practitioners in managing orthodontic-endodontic interactions.

Achieving excellence with interdisciplinary approaches in complex orthodontic adult patients

Over the last decades the percentage of adult orthodontic patients has substantially increased. Undeniably, an important motif for seeking orthodontic care at an older age is smile improvement, but this is not all. Frequently, impaired dentofacial aesthetics are combined with several other issues: severe dentoskeletal malocclusions; multiple tooth loss due to caries or endodontic failure; dental agenesis or trauma; periodontal breakdown; or functional problems, such as temporomandibular disorders or obstructive sleep apnoea. Therefore, comprehensive adult treatment mostly requires close collaboration of a team of equally well-trained dental specialists to select and execute the most suitable treatment option for the individual patient from day one. With joint planning, intensive communication with the patient and the involved specialists, and continuous monitoring of the treatment process, true patient-centred care can be delivered. In order to serve the individual patient best, the treating orthodontist does not only need thorough speciality training and continuing education, but furthermore, should be well-equipped with sufficient knowledge of the other dental fields of expertise. In combination with digital technology as an important tool for enhancing communication and efficient exchange of information between all involved team members, excellent joint clinical skills will take comprehensive interdisciplinary treatment to the next level.

Oral Cavity Cancer Secondary to Dental Trauma: A Scoping Review.

(1) Background: Oral cavity cancer represents the most common site of origin of head and neck mucosal malignancies. A few limited studies have suggested that chronic irritation, particularly in non-healing ulcers, and fibrotic tissue from poor dentition or ill-fitting dentures had a role in developing mouth cancer. This scoping review aims to evaluate the existing evidence concerning Oral Cavicty Cancer (OCC) in non-smokers/non-drinkers and the relationship with dental trauma. (2) Methods: A scoping review of the PubMed, Embase, and Web of Science databases was completed in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. (3) Results: Of the 33 articles that met inclusion, in 6 of them authors discussed the role of topography in dental trauma, in 11 articles authors discussed the carcinogenesis mechanism involved in chronic mucosal trauma, in 17 articles data on ill-fitting dentures was included, 4 studies dealt with the effect of broken/sharp teeth on mucosal damage, and in 7 studies the role of oral hygiene was covered. Less frequently discussed topics included gender, risk of neck nodes, and the role of potentially malignant oral disorders. (4) Conclusions: The available literature suggests a potential connection between chronic dental trauma and the development of OCC. Studies have highlighted factors such as denture use and ill-fitting dental appliances as contributors to an increased risk of oral cancer. Interestingly, we still miss data to support the hypothesis that women, particularly those without toxic habits like smoking or alcohol consumption, appear to be disproportionately affected by oral cancer related to chronic dental trauma.

Replantation After Dental Avulsion: A Scoping Review and Proposal of a Flow Chart.

Dental avulsion, the complete displacement of a tooth from its socket, is a severe dental trauma with a prevalence of 0.5% to 16% of all dental injuries. Replantation of avulsed teeth is common, yet recent studies show high failure rates and unpredictable long-term outcomes. This review examines clinical variables influencing intentional dental replantation decisions and proposes a treatment flow chart. A comprehensive literature search was conducted in PubMed-Medline, Scopus, WoS, and Cochrane databases using the keywords "tooth avulsion," "tooth replantation," and "tooth ankylosis." Inclusion criteria encompassed studies from January 2018 to February 2024. From 752 identified articles, 9 systematic reviews including 3 meta-analyses were selected for this scoping review. Immediate replantation is the gold standard for avulsed teeth, yet delayed replantation is more common in practice, impacting survival rates. Adherence to guidelines from the International Association on Dental Traumatology improves outcomes, especially in paediatric patients. Factors such as multiple caries, severe periodontal disease, advanced age, psychological conditions, immunodeficiency, and lack of cooperation are contraindications for replantation. Despite the high failure rate, replantation remains recommended in literature due to its potential advantages over prosthetic implants. This review highlights the complexities in decision-making for dental replantation, emphasising the need for a comprehensive approach considering individual clinical cases. A proposed treatment flow chart aims to support clinicians in predicting prognosis and making informed decisions. The review also underscores the link between dental trauma, poor oral health, and potential neglect in children, highlighting the importance of preventive measures and parental awareness.

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.

Initial screening for dental abnormalities identified by labial and buccal photographs in dogs and cats.

To evaluate the dental abnormalities by visually assessing the labial and buccal photographs in dogs and cats and analyze their prevalence based on age and breed. 1,096 client-owned dogs and 775 client-owned cats. Data were collected from patients who visited 26 private veterinary clinics from January to December 2022. Each animal was evaluated through dental photographs taken from the labial and buccal sides. Correlations between the prevalence of the identified dental abnormalities and age, craniofacial type, and breed, were analyzed. Calculus, discoloration, epulis, fractured teeth, gingival recession, gingivitis, malocclusion, missing teeth, and persistent deciduous teeth could be identified by analyzing the dental photographs in both dogs and cats. Enamel defects in dogs and tooth resorption in cats could be identified. Brachycephalic dogs had a significantly higher prevalence of malocclusion (OR, 1.93; 95% CI, 1.36 to 2.75) and missing teeth (OR, 3.63; 95% CI, 2.71 to 4.91) compared to nonbrachycephalic dogs. Brachycephalic cats had a significantly higher prevalence of fractured teeth (OR, 1.95; 95% CI, 1.24 to 3.04) and a lower prevalence of gingival recession (OR, 0.30; 95% CI, 0.15 to 0.55) compared to nonbrachycephalic cats. Calculus, persistent deciduous teeth, and possibly gingivitis could be identified in dogs and cats by analyzing labial and buccal photographs. The assessment of some dental abnormalities such as fractured teeth, missing teeth, and tooth resorption can be limited without a complete dental examination under anesthesia. Although the assessment of dental conditions may be underestimated, the data on the prevalence of the dental abnormalities evaluated through the photographs could be utilized for screening dental diseases.

Fragment Reattachment of Maxillary Anterior Tooth- A Case Report

Dental trauma often results in fracture of the tooth. Reattaching the fractured fragment is one among the treatment modalities in the management of fractured tooth. The procedure is simple and relatively inexpensive. However, understanding the limitations of the procedure is essential. Also, patient cooperation is essential for long term success of the treatment. The case report highlights the management of fractured maxillary anterior tooth in a elderly patient.