Hard Tissue Injury Research Articles

Oral piercings: what implications do these have on our oral health?

Searches were carried out across scientific databases including PubMed, Scopus, Cochrane and Google Scholar for all studies published until April 2023. Primary research including cross-sectional, cohort, and case-control studies that met the inclusion criteria were included in the systematic review. This criteria included papers that measured public/professional awareness, periodontal/peri-implant complications, microbiological analyses, general and hard/soft tissue complications, and frequency of complications. Exclusion criteria including those not published in English, all in vitro and in vivo research, case reports, interventional studies, correspondence, comments, letters to the editor, and editorials. Data was extracted from 34 studies which met the inclusion criteria. A data collection form was used to collate the extracted information on bibliographic details, research methodology, patient demographics, piercing types, health assessments, research findings, and conclusions. The risk of bias in the selected studies was also assessed. The study demonstrates a large disparity between the public's and dental health professionals' awareness of oral health complications following oral/perioral piercing. The results also show that piercings are more common in women than men, and that piercings have been linked to several adverse consequences including both hard and soft tissue injury, and the type of complication commonly relates to the position of the piercing. Oral piercings have been linked to several oral health complications including caries, plaque accumulation, gingivitis/periodontitis, dental fractures, bleeding, inflammation and swelling of the surrounding soft tissues. Public knowledge of these risks is limited, and therefore public health authorities should implement and support initiatives to raise awareness.

Emergency Management of Symphysis and Right Angle of Mandible Fracture with Laceration Wound at Buccal and Submental Region: A Case Report

Introduction: Fracture of the mandible is a case that is quite commonly found in the ER of The Oral and Maxillofacial Surgery Department at Dr. Hasan Sadikin General Hospital Bandung, fractures of the mandible rank second to fractures of the facial area because it is a prominent bone that is located at the edge and position in the lower third of the face. Emergency management aims to take any appropriate action, prevent complications, and consult other departments involved. Objective: To explain the emergency management of symphysis and right angle of mandible fracture with laceration wound at buccal and submental region. Case report: A manage 21 year came with bleeding from the mouth due to a motorcycle accident approximately 24 hours before admission to the hospital. Physical examination showed asymmetrical face, edema at right cheek region, laceration wound at right cheek and chin region, and multiple abrasive wound at facial region. There were steps, crepitus on symphysis, and right angle of mandible region. Intraoral examination showed laceration wounds on the gingiva. Case management: The laceration area is then sutured both intraoral and extraoral followed by the application of closed reduction in the mandible with interdental wiring at the lower jaw aiming to prevent infection and malunion. The management of soft tissue and hard tissue injury is by reduction, fixation, and immobilization of fractures, management of pain, and administration of antibiotics. Conclusion: The emergency management of symphysis and right angle of mandible fracture with laceration wound at the buccal and submental region is promptly and rapidly carried out with minimal intervention by using closed reduction method gave good results in stability and function before definitive treatment.

The effect of individual drilling sleeves on the precision of coronectomy tooth sections. An in vitro 3D-printed jaw model experiment

ObjectivesThe aim of this in vitro study was to evaluate the effect of a 3D-printed drill sleeve (DS) on the precision and duration of coronectomy sections.Materials and methodsThirty-six trainees and oral surgeons performed 72 coronectomy cuts in a 3D-printed, entirely symmetric mandible model. Coronectomy was performed freehand (FH) on one side and with a DS on the other side. The occurrence of “too superficial” (≥ 4 mm unprepared lingual tooth tissue) and “too deep” (drilling ≥ 1 mm deeper as tooth contour) cuts and sectioning times were registered.ResultsIn 7 cases, the sections were “too deep” with FH, while none with DS (OR: 18.56; 95%CI: 1.02–338.5; p = 0.048). The deviation between virtually planned and real cut depths was significantly greater in the FH group (1.91 ± 1.62 mm) than in DS group (1.21 ± 0.72 mm) (p < 0.001). A total of 18 “too superficial” buccolingual sections occurred with FH, while 8 cases with DS (OR: 3.50; 95%CI: 1.26–9.72; p = 0.016). Suboptimal sections did not correlate with experience (p = 0.983; p = 0.697). Shortest, suboptimal drillings were most frequently seen distolingually (OR: 6.76; 95% CI: 1.57–29.07; p = 0.01). In the inexperienced group, sectioning time was significantly longer with FH (158.95 ± 125.61 s vs. 106.92 ± 100.79 s; p = 0.038).ConclusionsThe DS effectively reduced tooth sectioning times by less experienced colleagues. Independently from the level of experience, the use of DS obviated the need for any preparation outside the lingual tooth contour and significantly decreased the occurrence of “too superficial” cuts, leaving thinner unprepared residual tooth tissue lingually.Clinical relevanceCoronectomy sections may result in lingual hard and soft tissue injury with the possibility of damaging the lingual nerve. The precision of the buccolingual depth-control can be improved, while surgical time can be reduced when applying a drilling sleeve.

Identifying Contributing Factors Associated With Dental Adverse Events Through a Pragmatic Electronic Health Record-Based Root Cause Analysis.

This study assessed contributing factors associated with dental adverse events (AEs). Seven electronic health record-based triggers were deployed identifying potential AEs at 2 dental institutions. From 4106 flagged charts, 2 reviewers examined 439 charts selected randomly to identify and classify AEs using our dental AE type and severity classification systems. Based on information captured in the electronic health record, we analyzed harmful AEs to assess potential contributing factors; harmful AEs were defined as those that resulted in temporary moderate to severe harm, required hospitalization, or resulted in permanent moderate to severe harm. We classified potential contributing factors according to (1) who was involved (person), (2) what were they doing (tasks), (3) what tools/technologies were they using (tools/technologies), (4) where did the event take place (environment), (5) what organizational conditions contributed to the event? (organization), (6) patient (including parents), and (7) professional-professional collaboration. A blinded panel of dental experts conducted a second review to confirm the presence of an AE. Fifty-nine cases had 1 or more harmful AEs. Pain occurred most frequently (27.1%), followed by nerve injury (16.9%), hard tissue injury (15.2%), and soft tissue injury (15.2%). Forty percent of the cases were classified as "temporary not moderate to severe harm." Person (training, supervision, and fatigue) was the most common contributing factor (31.5%), followed by patient (noncompliance, unsafe practices at home, low health literacy, 17.1%), and professional-professional collaboration (15.3%). Pain was the most common harmful AE identified. Person, patient, and professional-professional collaboration were the most frequently assessed factors associated with harmful AEs.

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.

Development of an Inventory of Dental Harms: Methods and Rationale.

While adverse events (AEs) are all too prevalent, their underlying causes are difficult to assess because they are often multifactorial. Standardizing the language of dental AEs is an important first step toward increasing patient safety for the dental patient. We followed a multimodal approach building a dental AE inventory, which included a literature review; review of the MAUDE database; a cross-sectional, self-administered patient survey; focus groups; interviews with providers and domain experts; and chart reviews. One hundred eight unique allergy/toxicity/foreign body response, 70 aspiration/ingestion of foreign body, 70 infection, 52 wrong site/wrong patient/wrong procedure, 23 bleeding, 48 pain, 149 hard tissue injury, 127 soft tissue injury, 91 nerve injury, 171 other systemic complication, and 177 other orofacial complication were identified. Subtype AEs within the categories revealed that allergic reaction, aspiration, pain, and wrong procedure were the most common AEs identified among known (i.e., chart reviews) and hypothetical (i.e., interviews) sources. Using a multimodal approach, a broad list of dental AEs was developed, in which the AEs were classed into 12 categories. Hard tissue injury was noted frequently during interviews and in actuality. Pain was the unexpected AE that was consistently identified with every modality used. Most AEs result in temporary harm with hard tissue injury being a common AE identified through interviews and in actuality through chart reviews. Acknowledging that AEs happen is an important step toward mitigating them and assuring quality of care for our patients.

Management of dental trauma by school teachers of private and government schools in Lucknow City

Introduction: Smile reveals an individual’s self- confidence. It is also a means of socialization where teeth play a vital role in a pleasant smile. Dental trauma is described in the literature as a common problem among children and adolescents throughout the world where teacher plays a major role in managing dental trauma. Aim: The aim of this study was to evaluate school teacher’s knowledge regarding emergency management of dental trauma in Lucknow city. Materials and Methods: The present study was conducted among the teachers of both private and government schools of Lucknow city, Uttar Pradesh and they were selected using cluster random sampling method. A pretested or predesigned questionnaire was used in the study which was divided into four parts. Statistical analysis of the study was done using SPSS software version 17.0 and the data was analysed using descriptive statistics. Results: It was found that 100% of the respondents had received first aid component in their teacher training but none of the respondents had covered the management of traumatic dental injuries in their first aid course. 55.6% of the respondents had come across soft tissue injury in children while 44.4% had come across hard tissue injury.

Diagnostics of tissue involved injury occurrence of top-level judokas during the competition: suggestion for prevention.

BackgroundJudo, as a high-intensity contact sport, may lead to the occurrence of injuries, especially in competitions. This work aims to assess the likelihood of soft and hard tissue injuries in top-level judokas during competition with defining factors that determine the probability of injury occurrence.MethodsThe injuries that occurred in 123 official international competitions from 2005–2019 were recorded by the European Judo Union (EJU) Medical Commission as a survey that was a part of the EJU Injury Registration form with internal consistency shown by a Crombach Alpha of 0.69. This survey data identified factors such as: sex, anatomical localisation of injury, type of injury, tissue involved and mechanisms of the injury. A total of 650 tissue injuries were reported correctly in terms of tissue injury definition.ResultsThe most frequent soft tissue injury (STI) reported was a ligament STI (48.15%), closely followed by skin STI (12.15%) and muscles STI (11.38%). In turn, the most frequent hard tissue injury occurred in bones (8.56%). The highest rates of injuries occurred during the fight in the standing position (78%). Injuries in the standing position mainly occurred while executing a throw (25.85%) and followed by the attempt to throw, i.e., the action of reaching the throwing position (22.30%), grip fighting (15.07%), and during falls (14.77%). Opposite to this, fight in groundwork reached only 18.30% soft and hard tissue injuries combined. The ongoing registration of injuries during judo combat and training and the early diagnosis of risk factors for injuries are the basis for the development of effective strategies for injury prevention and further treatment.

Impact of Lockdown Measures During the COVID-19 Pandemic on the Number and Nature of Trauma Presentations to Oral and Maxillofacial Surgery of a Level I Trauma Center—A Study

Introduction: The COVID-19 pandemic triggered unprecedented nationwide regulations aimed primarily at slowing the spread of the virus. The objective of this study was to describe the effect of these regulations on the number and natures of trauma presentations to oral and maxillofacial department of level I trauma center in the city of Lucknow, Uttar Pradesh. Methods: A retrospective cohort study of the triage register at Trauma Centre of King George Medical University, Lucknow was conducted, comparing all trauma presentations from March 23, 2020 to July 31, 2020 with those from the preceding 5 months. The number of patients, mechanism of trauma, and severity of illness was recorded and compared. Results: A reduction in the number of trauma cases was recorded for the particular period. The statistical analysis was done with SPSS software (version 1.1). The incidence of maxillofacial trauma was more in males than females. During the study period, data shows that road traffic accidents (91.68%) was the most common cause of trauma followed by fall from height (4.06%) and physical assault (2.34%), respectively. The most common injury was soft tissue lacerations (38.07%), followed by hard tissue injury (LeFort: 20.6%, zygomaticomaxillary complex fractures: 9.44%, parasymphysis: 8.02%), respectively. Conclusion: This study shows that the burden of trauma presenting to the emergency department was decreased during lockdown period by the regulations implemented in response to the COVID-19 pandemic.

Validation of Noncontact Anterior Cruciate Ligament Tears Produced by a Mechanical Impact Simulator Against the Clinical Presentation of Injury

Background: Anterior cruciate ligament (ACL) injuries are catastrophic events that affect athletic careers and lead to long-term degenerative knee changes. As injuries are believed to occur within the first 50 milliseconds after initial contact during a rapid deceleration task, impact simulators that rapidly deliver impulse loads to cadaveric specimens have been developed. However, no impactor has reproducibly and reliably created ACL injures in a distribution that mimics clinical observation. Purpose: To better understand ACL injury patterns through a cadaveric investigation that applied in vivo–measured external loads to the knee during simulated landings. Study Design: Controlled laboratory study. Methods: A novel mechanical impact simulator reproduced kinetics from in vivo–recorded drop landing tasks on 45 cadaveric knees. Specimens were exposed to a randomized order of variable knee abduction moment, anterior tibial shear, and internal tibial rotation loads before the introduction of an impulse load at the foot. This process was repeated until a hard or soft tissue injury was induced on the joint. Injuries were assessed by an orthopaedic surgeon, and ligament strain was recorded by implanted strain gauges. Results: The mechanical impact simulator induced ACL injuries in 87% of specimens, with medial collateral ligament (MCL) injuries in 31%. ACL tear locations were 71% femoral side, 21% midsubstance, and 9% tibial side. Peak strain before failure for ACL-injured specimens was 15.3% ± 8.7% for the ACL and 5.1% ± 5.6% for the MCL (P < .001). Conclusion: The ACL injuries induced by the mechanical impact simulator in the present study have provided clinically relevant in vitro representations of in vivo ACL injury patterns as cited in the literature. Additionally, current ligament strains corroborate the literature to support disproportionate loading of the ACL relative to the MCL during athletic tasks. Clinical Relevance: These findings indicate that the mechanical impact simulator is an appropriate model for examining independent mechanical variables, treatment techniques, and preventive interventions during athletic tasks leading up to and including an ACL injury. Accordingly, this system can be utilized to further parse out contributing factors to an ACL injury as well as assess the shortcomings of ACL reconstruction techniques in a dynamic, simulated environment that is better representative of in vivo injury scenarios.

Unusual cause for maxillofacial injury

Penetrating facial injuries are potentially dangerous and may require emergency management because of the presence of vital structures in the face, and it may be life-threatening especially when the injury involves airway, major blood vessels, spinal cord, and cervical spines. Penetrating injuries of the facial region can occur due to missile injuries, blast injuries, motor vehicle accidents, and accidental fall on sharp objects. However, injury to face caused by the shattering of a protective helmet itself is extremely rare. Primary management is targeted to deal with life-threatening conditions and stabilize the patient followed by subsequent care in a well-equipped setting. We present a case of a 30-year-old male, who suffered extensive soft and hard tissue injury of the maxillofacial region due to shattering of a protective helmet causing a ballistic effect.

Vitamin D and Athletes, Part I: A Growing Interest

Part I of this Pearls of Practice series highlights the growing interest in the status and needs of athletes in relation to vitamin D. Part II of the series will outline the relationship between vitamin D and injury prevention and identifi es take-home practice points for clinicians. Scientifi c inquiry involving vitamin D has sparked both public interest and controversy surrounding how much vitamin D is needed to promote good health. Vitamin D appears not only to maintain bone health but also to impact extraskeletal health by mediating infl ammatory and immune pathways and contributing to optimal muscle function. Given these fi ndings, it is no surprise that athletes’ interest in vitamin D supplementation has increased. It is conceivable that reversing compromised vitamin D status may affect muscle function, creating signifi cant implications for individuals in the highly competitive world of athletics. Conversely, athletes with chronic vitamin D defi ciency or insuffi ciency may experience impaired strength-gaining potential and increased risk of both hard and soft tissue injury. What are the key aspects of the vitamin D literature that clinicians should understand to help guide responsible supplementation decisions?

Summary of: A study of factors that influence the number of visits following traumatic dental injuries

To investigate in children the factors that influence the number of visits per tooth following traumatic dental injuries (TDI) to the permanent dentition. A retrospective convenient sample of 100 children who had been treated for TDI at Leeds Dental Institute was identified. A multilevel negative binomial regression model was developed to identify factors influencing the number of visits per tooth. Data including age, gender, postcode, number of visits, treatment provided, number of teeth injured, type of periodontal and hard tissue diagnoses, healing modality, root maturity, pulp and tooth survival, and any history of previous or subsequent trauma to same tooth were analysed using SPSS 18.0 and MLWIN. 186 teeth were affected by trauma in 100 patients. Median total number of visits per tooth was six visits with a range of 1-22 visits. The factors that were found to influence number of visits included: distance travelled, hard tissue diagnosis, periodontal injury diagnosis and pulp survival (P < 0.05). A mile increase in distance travelled from home to clinic led to a 1.2% reduction in the number of visits per month (-0.012; SE 0.005), a diagnosis of a severe hard tissue injury was associated with 44% increase (0.362; SE 0.105) compared to no hard tissue injury, a diagnosis of a complicated periodontal injury compared to no periodontal injury was associated with a 30% increase (0.260; SE 0.124), a diagnosis of a uncomplicated periodontal injury compared to no periodontal injury was associated with a 31% increase (0.271; SE 0.124) and a diagnosis and treatment for a non-vital tooth in comparison to a vital tooth led to a 26% increase (0.230; SE 0.080) in the number of visits. There was a significant variation in the number of treatment visits at patient level (0.260; SE 0.048). CONCLUSION Complicated hard tissue injuries, complicated and uncomplicated periodontal injuries, diagnosis and treatment for pulp necrosis and the distance between clinic and patient's home all significantly influenced the number of visits needed to treat TDI.

A study of factors that influence the number of visits following traumatic dental injuries

To investigate in children the factors that influence the number of visits per tooth following traumatic dental injuries (TDI) to the permanent dentition. A retrospective convenient sample of 100 children who had been treated for TDI at Leeds Dental Institute was identified. A multilevel negative binomial regression model was developed to identify factors influencing the number of visits per tooth. Data including age, gender, postcode, number of visits, treatment provided, number of teeth injured, type of periodontal and hard tissue diagnoses, healing modality, root maturity, pulp and tooth survival, and any history of previous or subsequent trauma to same tooth were analysed using SPSS 18.0 and MLWIN. 186 teeth were affected by trauma in 100 patients. Median total number of visits per tooth was six visits with a range of 1-22 visits. The factors that were found to influence number of visits included: distance travelled, hard tissue diagnosis, periodontal injury diagnosis and pulp survival (P < 0.05). A mile increase in distance travelled from home to clinic led to a 1.2% reduction in the number of visits per month (-0.012; SE 0.005), a diagnosis of a severe hard tissue injury was associated with 44% increase (0.362; SE 0.105) compared to no hard tissue injury, a diagnosis of a complicated periodontal injury compared to no periodontal injury was associated with a 30% increase (0.260; SE 0.124), a diagnosis of a uncomplicated periodontal injury compared to no periodontal injury was associated with a 31% increase (0.271; SE 0.124) and a diagnosis and treatment for a non-vital tooth in comparison to a vital tooth led to a 26% increase (0.230; SE 0.080) in the number of visits. There was a significant variation in the number of treatment visits at patient level (0.260; SE 0.048). Complicated hard tissue injuries, complicated and uncomplicated periodontal injuries, diagnosis and treatment for pulp necrosis and the distance between clinic and patient's home all significantly influenced the number of visits needed to treat TDI.

Pattern of assault-induced oral and maxillofacial injuries in Ado-Ekiti, Nigeria

Background:Assault, though a major cause of maxillofacial injuries in the developed nations, has not been adequately investigated among Nigerian population. This study aimed to analyze the pattern of maxillofacial injuries caused by assault in our institution.Methods:A descriptive clinical survey of patients with assault-induced oral and maxillofacial injuries presenting to our maxillofacial surgery clinic/emergency ward was carried out. Demographic data and pattern of injuries obtained from patients’ record and department trauma database were analyzed.Results:156 patients presented with oral and maxillofacial injuries between October 2009 and December 2010. Thirty-four cases were due to assault and male to female ratio was 1.8:1. The mean age of the patients was 21.4±6.26 years (age range 2–48 years). 23.6% (n=8) of the injuries were due to domestic violence between spouses while 35.3% (n=12) resulted from fight. Students unrest and armed robbery attack accounted for six cases each (17.7%, n=6), while there were two cases due to child battering. 64.3% (n=22) of the injuries sustained involved soft tissues while 35.7% involved hard tissues. Contusion was the most common isolated soft tissue injury accounting for 56% (n=10) while dentoalveolar fracture was the most encountered hard tissue injury (62.5%, n=16).Conclusion:There is need for preventive strategies to reduce the incidence of assault-induced maxillofacial injuries.

A Parametric Study of Hard Tissue Injury Prediction Using Finite Elements: Consideration of Geometric Complexity, Subfailure Material Properties, CT-Thresholding, and Element Characteristics

Objective: The objectives of this study were to examine the axial response of the clavicle under quasistatic compressions replicating the body boundary conditions and to quantify the sensitivity of finite element–predicted fracture in the clavicle to several parameters. Methods: Clavicles were harvested from 14 donors (age range 14–56 years). Quasistatic axial compression tests were performed using a custom rig designed to replicate in situ boundary conditions. Prior to testing, high-resolution computed tomography (CT) scans were taken of each clavicle. From those images, finite element models were constructed. Factors varied parametrically included the density used to threshold cortical bone in the CT scans, the presence of trabecular bone, the mesh density, Young's modulus, the maximum stress, and the element type (shell vs. solid, triangular vs. quadrilateral surface elements). Results: The experiments revealed significant variability in the peak force (2.41 ± 0.72 kN) and displacement to peak force (4.9 ± 1.1 mm), with age (p < .05) and with some geometrical traits of the specimens. In the finite element models, the failure force and location were moderately dependent upon the Young's modulus. The fracture force was highly sensitive to the yield stress (80–110 MPa). Conclusion: Neither fracture location nor force was strongly dependent on mesh density as long as the element size was less than 5 × 5 mm2. Both the fracture location and force were strongly dependent upon the threshold density used to define the thickness of the cortical shell.

NEW MECHANICS OF SPINAL INJURY

The prediction and prevention of spinal injury is an important aspect of preventive medical science. The spine, or vertebral column, represents a chain of 26 movable vertebral bodies, joint together by transversal viscoelastic intervertebral discs and longitudinal elastic tendons. This paper proposes a new locally–coupled loading–rate hypothesis, which states that the main cause of both soft- and hard-tissue spinal injury is a localized Euclidean jolt, or SE(3)-jolt, an impulsive loading that strikes a localized spinal section in several coupled degrees-of-freedom simultaneously. To show this, based on the previously defined covariant force law, we formulate the coupled Newton–Euler dynamics of the local spinal motions and derive from it the corresponding coupled SE(3)-jolt dynamics (see our recent papers on new mechanics of traumatic brain injury [V. G. Ivancevic, New mechanics of traumatic brain injury, Cogn. Neurodyn. Springer (Online)]. and generic musculo-skeletal injury [V. G. Ivancevic, New mechanics of generic musculo-skeletal injury, Biophys. Rev. Let. (2009) (in press)]). The SE(3)-jolt is the main cause of two basic forms of spinal injury: (i) hard-tissue injury of local translational dislocations; and (ii) soft-tissue injury of local rotational disclinations. Both the spinal dislocations and disclinations, as caused by the SE(3)-jolt, are described using the Cosserat multipolar viscoelastic continuum model.

Traumatic injuries to permanent teeth in Turkish children, Ankara

The aim of this study was to identify the types and etiologies of dento-alveolar injuries among patients who were treated for injuries to maxillary and/or mandibular permanent teeth at the Gulhane Medical Academy, Department of Pediatric Dentistry, Center of Dental Sciences in Ankara, Turkey to provide a basis for determining optimal treatment approaches and educational needs. From a total of 4956 children aged 6-12 years (mean age: 8.91 +/- 1.95) applying to the Center, 472 children (9.5%) were found to have suffered dental injuries during a period of 2 years. Injuries were classified according to drawings and texts based on the WHO classification system, as modified by Andreasen and Andreasen. Injury rates were highest among children age 6 and ages 8-10. The most frequently injured permanent teeth were the maxillary central incisors (88.2%), and the maxillary right central permanent incisor made up 47.2% of all injured teeth. The most common cause of dental trauma was falling while walking or running (40.3%). Most injuries involved a single tooth (64.8%). The most common type of injury was enamel fracture (44.6%). There was a significant difference in gender, where boys more often suffered from a dental hard tissue and pulp injury than girls (P = 0.019), whereas there was no difference in gender (P = 0.248) in the distribution of periodontal injuries. Injuries were found to occur more frequently during the summer (P < 0.001). Children with increased overjet were 2.19 times more likely to have dental injuries than other children. Considering that the incidence of traumatic dental injury is highest among children ages 6 and ages 8-10 as well as the fact that patients with increased overjet are more prone to dental trauma, preventive orthodontic treatment in early mixed dentition may play an important role in reducing traumatic dental injuries.

The Role of Metallothionein in Hard Tissue

We studied the metallothionein (MT) induction by cadmium (Cd) in the dental pulp and bone in rats. In order to clarify the cell response to Cd in the hard tissue, the isoform-specific expression of MT mRNAs (MT-I and MT-II) was examined by reverse transcriptase-polymerase chain reaction (RT-PCR) method, and the localization of MT was confirmed by immunohistochemical studies. Both MT-I and MT-II mRNA levels were increased within 3 hours by Cd administration in both the dental pulp and bone. In the dental pulp, MT protein was localized in the specific cell type of odontoblasts (secretory odontoblasts and resting odontoblasts). In the bone, MT-positive cells were time-dependently increased, and the positive cells were mainly localized in osteocytes. The cell-specific induction of MT may be associated with Cd accumulation and Cd-induced the hard tissue injury in vivo.

SOFT TISSUE CONTRACTURES ABOUT THE ELBOW

Hard and soft tissue injury to the elbow may be complicated by progressive secondary joint contracture. Motion-directed therapy often improves or eliminates elbow contracture if it is recognized early in treatment. Progressive soft tissue contracture, with or without the concomitant development of heterotopic ossification, is best treated by surgical release. This article discusses the operative technique and the results of treatment.