Incisors Research Articles

Electric Pulp Test Threshold Responses in Healthy Mature Permanent Teeth

Electric pulp testers assess only the neural component of pulp sensibility in dental practice, while vascular status is evaluated with laser Doppler flowmeters and pulp oximeters, which are more reliable for determining vitality in traumatic teeth. Objective: To determine the accuracy of the electric pulp test in healthy mature permanent teeth. Methods: This cross-sectional study was conducted at the Liaquat University of Medical and Health Sciences Jamshoro by consecutive sampling on 220 participants aged 18-35, who had healthy, mature permanent central incisors, canines, first premolars, and first molars, with no history of cardiac pacemakers and metallic restorations. Teeth were isolated, dried, and tested with a COXO C-Pulse electric pulp tester using toothpaste as a conducting medium. Threshold responses were recorded at increasing currents, with each tooth tested twice to determine the mean value. Accuracy was assessed using additional metrics post-therapy. Chi-square tests were employed to compare accuracy across gender and age groups, with significance set at p<0.05. Results: The mean age of the patients was 25.55 ± 5.41 years. 132 (60%) subjects were female, 88 (40%) subjects were male in this study. Accuracy of the electric pulp test in healthy mature permanent teeth was detected in 181 (82.3%) subjects in this study. Conclusion: It was concluded that the electric pulp tester method seems to be a reliable way to evaluate how sensitive the live nerve tissue inside a tooth is for healthy permanent teeth that have fully formed.

Assessment of Severity and Pattern of Early Childhood Caries Using ICDAS II Criteria: A Descriptive Cross-sectional Study

Introduction: Early childhood caries is highly prevalent worldwide. The International Caries Detection and Assessment System incorporates both the non-cavitated and cavitated carious lesions with acceptable reliability. The objective of the present study was to assess the severity and pattern of early childhood caries among children visiting outpatient department of a dental college in Nepal. The study also aimed to compare the severity and pattern based on individual tooth type. Methods: A cross-sectional study was conducted among children of age group 24-71 months in primary dentition stage. The International Caries Detection and Assessment System II criteria was used to detect dental caries, and its severity and pattern. The ethical approval was taken from the institutional ethical committee (IRC Ref. No.: 1, 36, 2079/2080 IRC PDCH 2022 21).Results: The dental cries in children of age group 48-60 months was 1338 (33.46%) and dentinal caries (Code 5) was observed in 112 (8.37%). Multi-surface caries was 644 (16.15%), and occlusal surface caries was 481 (12.06%). Among the study population, 227 (5.69%) of the teeth assessed were associated with restoration and sealants. Enamel caries among the maxillary second molars (55/65) (Code 3) was in 94 (23.5%), and the dentinal caries (Code 5) in maxillary central incisors (51/61)was in 90 (22.78%). Conclusions: Majority of the children enrolled in the study had multiple cavitated and non-cavitated carious teeth involving different surfaces. Severity and pattern of caries also varied among individual tooth type.

Morphology and root canal configuration of maxillary lateral incisors: a systematic review and meta-analysis.

The purpose of this study was to explore maxillary lateral incisors (MxLI) intern morphology by analyzing existing literature. We searched five electronical databases (Cochrane, Embase, LILACS, Scopus, MEDLINE via PubMed) using keywords and predefined search terms. Additional studies were identified by cross-referencing and reviewing bibliographies of relevant articles. From 92 initial studies, 27 duplicates were removed, and 65 records screened. After full-text review and hand searching were 19 studies included. The most reported root canal configurations (RCC) of MxLI were Vertucci (Ve) I (1-1-1/1; 78.1-100%), Ve II (2-2-1/1; 0.2-5%), Ve III (1-2-1/1; 0.1-14.6%), Ve IV (2-2-2/2; 0.5%), and Ve V (1-1-2/2; 0.5-4.9%). A meta-analysis of six studies from Europe and Asia indicated sex-differentiated patterns in RCC prevalence: higher occurrences of Ve II (2-2-1/1; OR [95%CI] = 1.19 [0.51, 2.73]), Ve III (1-2-1/1; (OR [95%CI] = 1.72 [0.61, 4.85]), and Ve V (1-1-2/2; (OR [95%CI] = 2.95 [1.02, 8.55]) configurations were noted in males, whereas females predominantly exhibited Ve I (1-1-1/1; [95%CI] = 0.99 [0.97, 1.02]), and Ve IV (2-2-2/2; (OR [95%CI] = 0.11 [0.01, 2.02]). Examination methods varied, with cone beam computed tomography (CBCT) being most commonly (n = 11), followed by staining & clearing (n = 5), and radiographic analysis (n = 1). The predominant RCC in MxLI is type Vertucci I. CBCT is the most common method for assessing the morphology of root canals. However, up to 20% of cases may present with complex and sex-specific patterns, highlighting the need for clinicians to be aware of these differences to prevent complications during endodontic treatments.

A Case Report of Root Resorption after Tooth Dislocation Replantation

The complete dislocation of the right upper central incisor lasted for more than 2 hours. After 2 weeks of replantation, the ligature was removed. After 1.5 months of reexamination, it was found that the internal and external root absorption of the affected tooth could be slowed down through infection control in the root canal and apical barrier. Reexamination 2.5 months later showed increased bone density around the root of the affected tooth.

EDA Variants Are Responsible for Approximately 90% of Deciduous Tooth Agenesis

Deciduous tooth agenesis is a severe craniofacial developmental defect because it affects masticatory function from infancy and may result in delayed growth and development. Here, we aimed to identify the crucial pathogenic genes and clinical features of patients with deciduous tooth agenesis. We recruited 84 patients with severe deciduous tooth agenesis. Whole-exome and Sanger sequencing were used to identify the causative variants. Phenotype–genotype correlation analysis was conducted. We identified 54 different variants in 8 genes in 84 patients, including EDA (73, 86.9%), PAX9 (2, 2.4%), LRP6 (2, 2.4%), MSX1 (2, 2.4%), BMP4 (1, 1.2%), WNT10A (1, 1.2%), PITX2 (1, 1.2%), and EDARADD (1, 1.2%). Variants in ectodysplasin A (EDA) accounted for 86.9% of patients with deciduous tooth agenesis. Patients with the EDA variants had an average of 15.4 missing deciduous teeth. Mandibular deciduous central incisors had the highest missing rate (100%), followed by maxillary deciduous lateral incisors (98.8%) and mandibular deciduous lateral incisors (97.7%). Our results indicated that EDA gene variants are major pathogenic factors for deciduous tooth agenesis, and EDA is specifically required for deciduous tooth development. The results provide guidance for clinical diagnosis and genetic counseling of deciduous tooth agenesis.

Effectiveness of Chloroform and Orange Oil as Gutta-percha Solvents used in Endodontic Retreatment: An In Vitro Study

The aim of this study was to assess and compare the effectiveness of chloroform and orange oil to dissolve obturated materials during endodontic retreatment. Thirty extracted human permanent maxillary anterior teeth (10 central incisor, 10 lateral incisor and 10 canine) which fulfilled specific inclusion criteria were de-coronated and after biomechanical preparation using step-back technique obturated with gutta-percha and AH plus sealer and stored in 370C in 100% humidity for 2 weeks. Then the teeth were assigned into 2 groups randomly: Chloroform (n= 15) and Orange oil (n= 15). Solvents were applied to reservoir created on the coronal root third for 2 minutes. Then instrumentation was initiated to remove obturated materials using Hedstrom file until the master apical file size 40 for central incisor and canine and 35 for lateral incisor reach the working length. The time to reach the working length and the time to obtain the last debris were recorded. Data were collected and analyzed by using SPSS version 22. The results showed no statistically significant difference (P>0.05) between two gutta-percha solvent groups in relation to time required to reach the working length by master apical file and time required to remove total obturated material from root canal. In conclusion, there was no statistically significant difference in effectiveness between chloroform and orange oil as gutta-percha solvent during retreatment procedure. So, orange oil can be used in retreatment procedure with the same efficacy of chloroform to dissolve obturated material in the root canal.

Utilizing the Open Space Approach in Interdisciplinary Management of Bilateral Congenital Lateral Incisor Agenesis: A Case Report

Tooth agenesis, particularly the bilateral absence of maxillary lateral incisors, is a prevalent condition with notable aesthetic and functional implications. This anomaly, impacting approximately 62% of individuals with genetic predisposition, poses significant challenges in both orthodontics and prosthetic rehabilitation. The treatment of bilateral congenital lateral incisor agenesis is a multidisciplinary approach that requires a thorough clinical examination. Implant-based solutions face challenges due to narrow alveolar dimensions and adjacent root orientations. Successful implant placement often requires pre-treatment orthodontic space creation, ridge augmentation, and careful timing to accommodate continued alveolar growth. Advanced orthodontic techniques and precise implant placement protocols are critical for achieving optimal outcomes. This case report illustrates a time-sequenced interdisciplinary approach combining mesialization of canines with space opening and implant-supported rehabilitation. An interdisciplinary approach, leveraging advancements in orthodontics, implantology, and digital prosthetics, is essential for successful outcomes.

Bacterial Contamination as an Important Prognostic Factor in Tooth Avulsion and Replantation - Case Series

Tooth Avulsion is a significant traumatic injury in children, replantation and follow up care is the treatment of choice. Maxillary incisors are most affected and sometimes over treated or left untreated. Aim: To understand the role of bacterial contamination for the survival of permanent maxillary incisors in cases of avulsion in children Case Report: This paper presents 3 case reports outlining the treatment stages for the survival of avulsed permanent incisors. Pulp & periodontal damage and its tissue responses are discussed through various clinical factors responsible for good prognosis. Result & Observations: Preserving alveolar bone width, retaining aesthetics and function even for an interim period is a favorable outcome. It helps in the replacement of tooth at a convenient period of late adolescence or young adult stage. Conclusion: Immediate replantation is always recommended for good prognosis of tooth avulsion in children.

Diagnosis and management of impacted dilacerated maxillary central incisors

Diagnosis and management of impacted dilacerated maxillary central incisors

Tooth Eruption Disorders: Literature Review and Clinical Case Reports

Introduction and purpose: Tooth eruption disorders are complex issues that can affect both primary and permanent teeth. The process of tooth eruption is a natural stage of development, but it can sometimes be disrupted. Common eruption disorders include delayed eruption, tooth impaction, premature eruption, and abnormalities in the location and direction of eruption. In each case, consultation with a specialist is required, along with early diagnosis and subsequent planning of appropriate treatment. State of knowledge: Impacted teeth are a common occurrence in dentistry and they occur in 0.8–3.6% of the general population The most frequently impacted teeth, in decreasing order of prevalence, are third molars, maxillary canines, mandibular premolars, and maxillary central incisors. Factors contributing to tooth impaction can be general, local, or genetic. Impacted teeth and difficulties with eruption may be associated with complications such as follicular cysts and a variant of these cysts known as eruption cysts. Summary: Tooth eruption disorders require an individualized diagnostic and therapeutic approach. Depending on the issue, treatment may involve observation, orthodontic interventions, and in some cases, surgical procedures. Early diagnosis and appropriate treatment are crucial to prevent complications such as malocclusion, damage to adjacent teeth, or unsatisfactory aesthetics. Radiographs can help confirm the presence of impacted teeth or in some cases, CBCT may be used for more detailed imaging.

Assessment of different treatment alternatives for patients with total maxillectomy.

To assess the biomechanical advantages of combining zygoma and partial subperiosteal implants for maxillary reconstruction in severely atrophic maxillae, offering potential solutions to the challenges posed by traditional reconstruction methods. A finite element analysis used a craniofacial model simulating a totally resected maxilla. Four treatment scenarios (SCs) were evaluated: SC-1, the quad zygoma approach; SC-2, two zygoma implants (ZIs) and a one-piece subperiosteal implant (SI); SC-3, two ZI and a two-piece SI; and SC-4, four ZI and a one-piece SI. Stress distributions on bone, implants, abutments, and metal frameworks were compared under occlusal forces. For the simulated bone regions under vertical and oblique forces, SC-4 values were higher than SC-1, while SC-2 and SC-3 values were comparable for pmax and pmin. In addition, SC-2 and SC-3 values were lower than those of SC-1 and SC-4. The most balanced von Mises stress values on the ZIsand were observed in SC-3 under vertical and oblique forces. Furthermore, lower von Mises stress values on the abutments were seen in SC-3 under oblique and vertical forces. Although the lower von Mises stress values on the metal frameworks at the lateral incisor and first premolar side were seen in SC-3, lower von Mises values were observed in SC-4 in the first molar region. Overall, this study suggests that combining zygoma and partial subperiosteal implants may be a promising approach for reconstructing severely atrophic maxillae. These implants may offer improved biomechanical properties compared to ZIs alone.

Efficacy of planned moderate to severe torque changes in mandibular central incisors with an initial series of Invisalign aligners: a retrospective cohort study.

To determine whether the achieved mandibular central incisor lingual root torque (LRT) changes matched the planned changes after treatment with an initial series of Invisalign aligners when ≥10° of torque change was planned. A sample of adult patients who underwent treatment with the Invisalign appliance between 2013 and 2021 were evaluated. The pretreatment, planned, and achieved posttreatment digital models were measured using Geomagic Control X metrology software. The effect of age, number of prescribed aligners, sex, the presence of power ridges (PRs), and differing weekly wear protocols (WPs) in relation to the achieved LRT changes were determined. Seventy mandibular central incisors from 35 patients satisfied inclusion criteria. The accuracy of the achieved lower incisor LRT compared with that planned was 58.2%. Underexpression of planned torque changes was observed in most incisors (N = 66; 94.3%), with a clinically significant shortfall (≥5°) observed in 68.6% (N = 42) teeth. Patient age, sex, the WP, or the presence of PRs did not influence the differences between planned and achieved outcomes (P > .05). The prescribed number of aligners was influential in the difference between the planned and achieved torque outcomes (P < .01). Underexpression of mandibular central incisor root torque was observed in most incisors in patients when ≥10° change in LRT was planned. Lower incisor LRT was not significantly affected by the presence of PRs or differences in WPs.

Can deep learning-designed anterior tooth-borne crown fulfill morphologic, aesthetic, and functional criteria in clinical practice?

ObjectivesThis study aimed to compare the design outcomes of anterior crowns generated using deep learning (DL)-based software with those fabricated by a technician using conventional dental computer-assisted design (CAD) software without DL support, with a focus on the evaluation of crown morphology, function, and aesthetics. MethodsTwenty-five in vivo datasets comprising maxillary and mandibular arch scans of prepared maxillary central incisors were utilized to design anterior crowns by using three methods: 1) a DL-based method resulting in as-generated outcome (DB), 2) a DL-based method further optimized by a technician (DM), and 3) a conventional CAD-based method (NC, control). Evaluations were conducted for crown morphology (total discrepancy volume (TDV), root mean square (RMS), positive average (PA) and negative average (NA) deviations), functional aspects (incisal path: deviations, length, and mean inclination), and aesthetics (crown width, height, width-to-height ratio, angular radius of mesioincisal line angle, proximal contact length, and tooth axis angle). ResultsSignificant differences in TDV ratio were noted between the DB–NC (32.3 ± 8.5 %) and DM–NC (26.5 ± 5.4 %) pairs (P = 0.006). No significant differences were observed in TDV between the DB–NC (65.3 ± 24.4 mm3) and DM–NC (54.3 ± 21.0 mm3) pairs (P = 0.095). For the entire palatal surface, significant differences in RMS and PA values were observed between the DB–NC and DM–NC pairs (P < 0.037). Significant differences in RMS values for the incisal half (P = 0.021) and in PA values for the cervical half (P = 0.047) of the palatal surface were also noted between these pairs. Significant differences in the deviation of the incisal path were observed between the DB–NC (290.4 ± 212.4 μm) and DM–NC (132.0 ± 122.3 μm) pairs (P < 0.001). However, no significant differences were found among the groups (DB, DM, and NC) in terms of the length and mean inclination of incisal paths or in aesthetic outcomes. ConclusionsA DL-based method can result in promising outcomes with clinically acceptable morphology and aesthetics for anterior crowns. Minor deviations in incisal path of the crowns may lead to anterior guidance discrepancies, which can be corrected by the dental technician at the design stage. Clinical significanceWith the potential of DL-based design methods in dental applications, integrating AI technology into dental CAD workflow can enhance the clinical efficiency and consistency of anterior crown design, although human intervention may be required to refine functional aspect.

Surgical Management of Palatally Impacted Mesiodens in a Pediatric Patient: A Case Report

Supernumerary teeth are additional teeth or tooth-like structures that can develop either erupted or unerupted, beyond the normal complement of 20 primary teeth and 32 permanent teeth. A mesiodens is a specific type of supernumerary tooth located in the midline between the two central incisors. The presence of these extra teeth can lead to various clinical complications. This paper presents a case involving a palatally positioned, impacted mesiodens that was associated with an unerupted permanent left maxillary central incisor. Surgical removal of the mesiodens was performed, resulting in the successful eruption of the permanent incisor.

Measurement of Anterior Maxillary Alveolar Ridge Dimension and Assessment of Sagittal Root Position by Cone Beam Computerized Tomography (CBCT)

Maxillary anterior region is the implant site that may require the most rigorous pre-operative assessment as it will have a direct influence on aesthetic outcome and stability of the dental implant. In the present study, CBCT (cone beam computerized tomography) images were used to evaluate alveolar ridge dimension in the maxillary anterior region. This observational radiographic study was done at Nepal Medical College Teaching Hospital. The width of the alveolar bone was measured from the labial cortex to the palatal cortex of the maxillary anterior teeth in mm at the alveolar crest (L1), mid-root (L2), and apical root region (L3) for each tooth. Alveolar height was also measured from the alveolar crest to the floor of the nasal fossa. The Sagittal Root Position (SRP) of the maxillary anterior teeth was also assessed. Results showed that the maximum width of the alveolar bone was seen at L3 of canine and lateral incisor showed least width of alveolar bone width at L1. Maximum alveolar bone height was seen in canines. Males were seen to have increased width of the alveolar bone as compared to the females in all anterior teeth. The most frequent sagittal root position was class I which was seen in 270 (51.4%) of the total teeth examined, which was followed by class IV observed in 210 (40%) of the teeth examined. It could be concluded that for maxillary anterior region, additional regeneration therapy maybe required since class I is the most frequent SRP observed.

Comparative Evaluation of Platelet-rich Fibrin and Treated Dentin Matrix in Regenerative Endodontic Treatment of Nonvital Immature Permanent Teeth: A Randomized Clinical Trial.

Clinical and radiographic evaluation of the efficacy of platelet-rich fibrin (PRF) and treated dentin matrix (TDM) in regenerative endodontic treatment and periapical healing of nonvital immature permanent teeth with chronic apical periodontitis. Twenty-four children aged between 7 and 11 years, each presenting with a nonvital immature permanent upper central incisor, were selected. They were randomly allocated into two groups (n = 12), group I (PRF) and group II (TDM). Baseline clinical findings were recorded, and preoperative cone-beam computed tomography (CBCT) was taken. Follow-up was done clinically for 15 months at 3-month intervals (3, 6, 9, 12, and 15 months), and CBCT was taken at the end of the 15-month follow-up. Root length, apical diameter, radiographic root area (RRA), and size of the periapical lesion were quantitively assessed at the end of follow-up period and compared to the preoperative CBCT. Clinical success was 100% in both groups by the end of the follow-up period. Radiographically, after a 15-month follow-up, there was a significant increase in root length and RRA, and there was also a significant reduction in apical diameter and lesion size within each group (p < 0.05). However, there was no statistically significant difference between both groups regarding the mean percentage of increase in root length and mean percentage of reduction of apical diameter (p > 0.05). On the other hand, PRF showed more increase in RRA and more reduction in lesion size, with a statistically significant difference between both groups (p < 0.05). Both PRF and TDM were clinically successful. Platelet-rich fibrin showed better radiographic outcomes and periapical healing. Platelet-rich fibrin is a viable scaffold to aid further root development and resolution of periapical lesions of nonvital immature permanent teeth. Further studies with different forms of TDM are needed to assess the efficacy of TDM in regenerative endodontic treatment of nonvital immature permanent teeth. How to cite this article: Asal MA, Elkalla IH, Awad SM, et al. Comparative Evaluation of Platelet-rich Fibrin and Treated Dentin Matrix in Regenerative Endodontic Treatment of Nonvital Immature Permanent Teeth: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(6):563-574.

Validation of finite-element-simulated orthodontic forces produced by thermoplastic aligners: Effect of aligner geometry and creep

PurposeFinite element (FE) models for determining the orthodontic forces delivered by clear aligners often lack validation. The aim of this study was to develop and validate accurate FE models for clear aligners, considering the small but important geometrical variations from the thermoforming process and the creep behavior of the aligner material. Methods and materialsThe tooth misalignment considered was a 2.4° torque aberration (rotation about the mesial-distal axis at the level of the center of resistance) of the maxillary left central incisor. FE models were created from Micro-CT scans of a model dental arch and five nominally identical aligners with the aforementioned misfit. Fitting of the aligners onto the dental arch was simulated using Abaqus's Interference Fit function, followed by surface-to-surface frictional interaction. Stress relaxation of the aligner material was measured using double-cantilever beam bending and modeled with a Prony series. The assembled FE models were validated by comparing the predicted forces and moments delivered to the maxillary left central incisor with experimental data, obtained with a custom-built but fully calibrated apparatus. ResultsGood agreement between prediction and measurement was obtained for both the short- and long-term forces and moments. In the short-term, i.e., after 30 s, the dominant force in the labial-lingual direction had a maximum difference of 2.9% between experiment and simulation, and the dominant moment about the mesial-distal axis had a maximum difference of 8.3%. In the long-term, i.e., after 4 h, the experimental and numerical forces had a maximum difference of 8.4%. There were statistically significant differences in the forces delivered among the nominally identical aligners, which were predicted by the geometrically accurate FE models and attributed to the variations in the points of contact between the aligners and the dental arch. The decay in force applied was affected by both the viscoelastic material behavior and friction between the aligner and arch. ConclusionFor accurate prediction of the forces and moments delivered by thermoplastic aligners, FE models that can accurately capture the point contacts between the aligners and the underlying teeth are essential. Stress relaxation of the aligners could be adequately modeled using the Prony series to represent the temporal changes of their elastic modulus.

Reinforcing simulated vital pulpotomized teeth as an alternate to invasive procedures: An in vitro study

ABSTRACT Background/Aim: The aim is to compare and evaluate the fracture resistance of simulated pulpotomy-treated tooth reinforced with different reinforcing materials. Methodology: Forty-five extracted human permanent central incisors were collected of approximately similar dimensions for this in vitro study. To simulate pulpotomy procedure, each tooth was sectioned through the middle third of the crown perpendicular to the long axis of the tooth, resulting in 6 mm cervicoincisal height (mimicking Ellis Class III fracture). Later, all the teeth were divided into four experimental (n = 10 each) and a control group (n = 5), according to the reinforcing materials used: Group A – microhybrid composite, Group B – stainless steel, Group C – polypropylene mesh, Group D – Rebilda post, and Group E – control group (natural tooth). The reinforcing materials were placed parallel to the long axis of the tooth, such that it lies 3 mm into the pulp chamber and 3 mm in the coronal portion, over which the composite restorations were placed. All the specimens were subjected to the universal testing machine for fracture resistance. Results and Conclusion: The data obtained were tabulated and statistically analyzed using Kruskal–Wallis and Tukey’s post hoc test. Stainless steel material exhibited statistically significant values among the experimental groups and the control group, whereas the values of polypropylene mesh, microhybrid composite, and Rebilda post were nonsignificant.

Mandibular Advancement and Skeletal Anchorage in Class II Malocclusion Patients: A Systematic Review with Meta-Analysis

(1) Objectives: The purpose of this review was to compare the effects of combining skeletal anchorage and Class II devices, both from an overall perspective and individually for each type of appliance, considering as main outcomes the vertical dimensions and the inclination of the mandibular and maxillary incisors. (2) Materials and Methods: A search without time restrictions was performed up to February 2024 in PubMed, PubMed Central, Scopus, and Medline for randomized controlled trials, as well as prospective and retrospective cohort studies, considering Class II patients treated with and without skeletal anchorage. The effect measure used for the meta-analytic evaluation was the standardized mean difference (SMD). The SMD calculation was obtained by subtracting the mean values of T1–T0 for each individual treatment and then calculating the SMD between the treatments involved. The meta-analysis was performed using the standardized mean difference of the mean difference of the T1–T0 change in the outcome between the different treatments evaluated as the effect size. (3) Results: A total of 1217 documents were initially retrieved. According to the PRISMA protocol, 18 studies comparing different skeletal anchorage protocols (upper/lower miniscrews and miniplates), combined with four appliances (Herbst, Forsus, Carriere Motion, and elastics), were included in the analysis. No significant difference in skeletal divergence was found between groups from an overall point of view (SMD: 0.19 (−0.48 to 0.83) according to the random-effects model). A statistically significant reduction in IMPA° was found in patients treated with temporary anchorage devices (TADs) (SMD of 5.58 (3.40 to 7.75)), except for the elastics group (SMD: 3.76 (−0.91 to 8.43)). The effect on the upper incisors’ inclination appeared to be strictly dependent on the type of anchorage (TADs in one or both of the arches). Some limitations must be considered when interpreting the results: the small number of studies included and the heterogeneity among them are among the limitations, and the temporal disparity among some studies; the ages of the patients were not always comparable; and, finally, the clinical relevance of the effects of TADs is sometimes questionable. (4) Conclusions: The vertical dimension seems not to be significantly affected by skeletal anchorage; instead, the proclination of mandibular incisors is generally reduced when TADs are used. Skeletal anchorage might be useful if lingual tipping of the upper incisors is required; however, it is influenced by the anchorage protocol.

Permanent tooth avulsions: A retrospective analysis of the demographics and aetiology of cases at a tertiary hospital in Sydney, Australia

AbstractThis retrospective analysis reviewed the demographics of patients sustaining dental avulsion injuries at a tertiary dental hospital in Sydney, Australia. Data were extracted from dental records of patients who presented with avulsed permanent anterior teeth and were treated between 1 January 2001 and 30 June 2021. Demographic, clinical and radiographic data from 91 patients with 117 avulsed permanent anterior teeth were available for analysis. The median age of the patients was 12 years (IQR 9.0–17.0). Males accounted for 68.4% of avulsion injuries. Non‐organised sports were the most common cause of injury (42.7%). Maxillary central incisors were the most frequently avulsed tooth (83.3%). Peak prevalence of injuries occurred on the weekend. The findings from this study may reflect regional factors such as climate and participation in sport. Anticipatory guidance should be provided to patients at elevated risk of dental avulsion.