Injured Teeth Research Articles

Endodontic-periodontal continuum of tooth: Systematic literature review

INTRODUCTION. The pathogenetic relationship between periodontal and pulp diseases was first described by Simring and Goldberg in 1964. Since then, the term “endodontic-periodontal” lesion (or “endo-perio”) has been used to describe lesions caused by inflammatory products found to varying degrees in both the periodontal and dental pulp tissues. The pulp and periodontium have embryonic, anatomical and functional relationships. The simultaneous presence of changes in pulp tissue and inflammatory periodontal diseases can complicate diagnosis and treatment planning. The etiology, pathogenesis and treatment methods of endodontic-periodontal lesions can vary from quite simple to relatively complex aspects. Knowledge of the basis of concomitant inflammatory processes in the pulp and periodontium is important for making the correct diagnosis.AIM. Carry out a systematic analysis of the literature and summarize the available data on etiopatogenetic relations, diagnostic features and clinical history of endodontic periodontal dental lesions. MATERIAL AND METHODS. A systematic literature analysis was carried out, as well as a manual search in the databases PubMed, Google Search, eLibrary, disserCat, Cyberleninka. Among national and foreign publications corresponding to the topic of this review, 28 publications were selected for systematic analysis, the results of literature review are presented in this article.CONCLUSION. This systematic review found that dental anatomy and the etiology of endodontic periodontal lesions are the basis for difficulties in the diagnosis and treatment of patients with endo-periodontal lesions. Determining the prevalence of infection and the individual characteristics of EPP pathogenesis in patients in this group remains a challenge. In the future, it is necessary to develop new methods of diagnosis, prophylaxis and complex treatment of combined periodontal tissue and tooth pulp, which will improve the prognosis of treatment of injured teeth in the long term.

Traumatic Dental Injuries Among 6 – 13 – Year - Old - School Children in Tikrit City

Background: An injury to both primary and permanent teeth and the supportingstructures is one of the most common dental problems seen in children. The extentof injury may vary from mild chipping of enamel to sever maxillofacial injury.The aim of this study was to find out the prevalence of traumatized anterior teethamong primary school children.Materials and methods: This study is a cross-sectional survey was carried outthrough clinical examination of anterior teeth among 720, 6-13 year old childrenenrolled in primary public schools of tikrit city. The prevalence of traumatizedanterior teeth was studied in relation to age, gender, type of injury in addition tothe cause of fracture. Recording and diagnosis of dental fracture were assessedaccording to Garcia-Godoy classification.Results: Males were more affected than females with odds ratio was 2.53 andstatistically was significant. The higher prevalence of dental trauma was recordedamong the age 10-11 year old. The permanent maxillary central incisors were themost frequent injured tooth and the most frequent type of fracture was the Class IIEnamel-Dentine, fracture without pulp exposure. Fall and playing were the mostfrequent causes of dental injury.Conclusion: data of the present study clearly show the need for dental healtheducation of children and their parents, so prevention programs are needed toimprove the dental health of Iraqi children.

A Case of Surgical Treatment of Lower Molars in a Mesolithic Sample from a Cemetery on the Yuzhny Oleniy Ostrov, Karelia, Russia

Here, we present the earliest case of surgical treatment of mandibular permanent molars known in Northern Eurasia. It concerns an aged woman buried at a Mesolithic cemetery on the Yuzhny Oleniy Ostrov (Island) in Lake Onega, southern Karelia, 8250–8050 cal BP. Our objective was to reconstruct the technology of surgical intervention, and to diagnose and describe the underlying condition. To do this, we carried out an examination of teeth and bone tissues of the upper and lower jaws and a traceological analysis of identified lesions. As we found, in the last few months of her life, the woman underwent several dental operations, including the extraction of the lower left third molar and, in a stepwise fashion, of fragments of the distal part of crown and lingual part of the distal root of the lower right first molar. The first operation was successful—the woman survived for at least two months after it had been performed. The second operation was also successfully performed at least two months before death, likely immediately after the trauma. The mesial part of the crown was removed just before death. No ancient cases where fragments of an injured tooth were removed are known to us. The removal of the lower third molar can be compared only with the earliest previously known case, described in a sample from the Pucará de Tilcara fortress in Northern Argentina (15th–16th centuries AD). Indications for surgery partly coincide in both cases, and include complications of apical periodontitis and the development of osteomyelitis. However, the technology of surgery and its logistics are different.

Associations between child abuse and neglect, and dento-alveolar injuries in a Children's hospital population.

The purpose of this study was to identify social variables common to children with dento-alveolar trauma (DAT) and child abuse and neglect (CAN) in a large children's hospital population. Emergency department data from an urban trauma Level 1 children's hospital were queried between December 02, 2017 and September 30, 2022 to identify children with both DAT and CAN. Patients with DAT and CAN were compared to DAT-only children in a case-control study design. Descriptive statistics were used to report characteristics of children in case and control groups. Chi-Squared and Fisher's exact tests were used to compare cases and controls. The level of significance was set at p ≤ .05. In total, 14 children who had DAT and CAN reported simultaneously comprised the case group. A total of 42 children with DAT-only, age/sex matched with cases, comprised the control group. Mean (SD) age of cases was 10.4 (±4) and controls was 10.1 (±3.9) years-old. Eight cases (57.1%) and 24 controls (57.1%) were female. No statistical differences (p = .05) were present for language, race, insurance coverage, parental custody, legal guardianship, and type of residence for cases versus controls. Five (35.7%) cases had a special need versus 4 (9.5%) controls and was statistically different (p = .03). Nine (64.3%) cases had behavioral problems versus 13 (31%) controls (p = .05). Cases were more likely to have facial injuries than controls (74.3 vs. 31%), however no significant differences were present for total number of injured teeth, head injury or neck injury between cases and controls. In half of cases, the perpetrator reported was the sibling. Demographics did not predict CAN in children with dental injuries. Sibling violence should be considered in suspected CAN children.

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

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

The impact of COVID-19 pandemic on the epidemiological characteristics of permanent dental injury in Xi'an of China: A retrospective study.

The coronavirus disease 2019 (COVID-19) has become a major global concern, seriously affecting the lives and health of the population. This retrospective study aimed to investigate changes in permanent tooth injury in the Xi'an area of China influenced by the COVID-19 pandemic. The medical records of 466 dental emergency patients in 2019 and 2020 were retrospectively analyzed. The number of injured teeth in a single patient, the number of injury types, the time from injury to hospital visit and follow-up visits within 1 year before and after the pandemic were analyzed using the chi-squared test and the paired t-test. There was significant difference in the number of emergency patients and trauma types before and during COVID-19 pandemic (P < .05). The time from injury to hospital visit and the interval between the trauma event and visit showed longer during the COVID-19 pandemic (P < .05). The rate of on-time follow-up in the following year was significantly decreased, and the rates of delayed visits and patients lost to follow-up were significantly increased (P < .05). The outbreak of the COVID-19 pandemic brought a certain change in the epidemiological characteristics of dental injury in the Xi'an area of China. Dental emergency departments should provide even more timely and effective treatments. It is also necessary to strengthen public education, with emphasis on the importance of timely medical treatment and regular follow-up for dental trauma.

Risk of concomitant traumatic brain injuries in children with traumatic dental injuries in a pediatric emergency department: A case-control study

BackgroundChildren with traumatic dental injuries (TDIs) may simultaneously sustain a traumatic brain injury (TBI). The aim of this study was to investigate the risk of concomitant TBI in children with TDIs. MethodsChildren (≤ 18 years) who sought treatment at the emergency department of a major children’s hospital for TDIs from 2010 through 2019 were identified. Children with a concomitant TBI were assigned as case patients (TDI and TBI). Two control patients (TDI only) were randomly age- and sex-matched with each case patient. Associations between variables of TDI and concomitant TBI were tested using 6 logistic regression models. ResultsOf 2,126 children with TDIs, 119 had concomitant TBIs (case patients). The control group consisted of 238 children with TDIs only who were age- and sex-matched with case patients. Mean (SD) age of children was 8.9 (4.8) years. Twenty-seven percent of case patients were female vs 32% of control patients. There was a statistically significant direct association between total number of injured teeth and concomitant TBIs (P = .01; odds ratio, 2.42; 95% CI, 1.22 to 4.79). For every tooth injured, the odds of concomitant TBI increased by 45% (P < .001; odds ratio, 1.45; 95% CI, 1.18 to 1.79). Number of displaced teeth, presence of avulsion or intrusion, number of fractured teeth, presence of complicated tooth fracture, and presence of alveolar fracture were not significantly associated with the odds of concomitant TBI. ConclusionsThe total number of injured teeth was positively associated with higher odds of concomitant TBI in this setting. Practical ImplicationsIn an emergency department setting, children with various types of TDIs sustained concomitant TBIs. For every tooth injured, the odds of concomitant TBI increased by 45%. Clinicians must systematically evaluate children with any TDI to rule out the possibility of concomitant TBI.

Factors predicting oral and maxillofacial fractures after falling and factors predicting the duration of treatment.

The first objective of this study was to identify predictive factors for oral and maxillofacial fractures at the initial response to the patient. The second objective was to determine the factors influencing the incidence of treatment duration of more than 1 month using the information shown in the medical record. Hospital records from 2011 to 2019 were reviewed to identify patients who had sustained oral and maxillofacial injuries by falling or falling from a height. Patterns and types of oral and maxillofacial injury, injury severity, and background of the injury were collected from the hospital records. The variables independently associated with a treatment duration of more than 1 month were determined by logistic regression analysis. In total, 282 patients (150 men, 132 women; median age, 17.5 years) were selected for analysis. Maxillofacial fractures were observed in 20.9% of patients (59/282); among these, mandibular fractures were the most common (47/59). Logistic regression analysis showed that age (odds ratio [OR], 1.026), nighttime occurrence (OR, 2.192), and upper face injury (OR, 20.704) were independent predictive factors for having a maxillofacial fracture. Additionally, the number of injured teeth (OR, 1.515) and the use of intermaxillary fixation (OR, 16.091) were independent predictors of treatment duration of more than 1 month. These results may be useful in the initial management of maxillofacial injuries in terms of better-informing patients injured by falling their expected treatment duration and managing the psychological impacts of a long treatment duration.

Global status of knowledge of parents for emergency management of traumatic dental injuries: a systematic review and meta-analysis.

The protocol was developed as per the recommendations of the Cochrane-handbook and PRISMA and was registered in PROSPERO. Search was performed by using MeSH-Terms and keywords in PubMed, Scopus, Embase, Web of Sciences, Lilacs, and Cochrane databases and gray literature sources 15th July 2022. There were no limits regarding the year of publication and language. Hand-searching of included articles was also performed. Titles and abstracts and later full texts were screened as per strict inclusion and exclusion criteria. Self-designed pilot-tested form was used. Risk of bias was analyzed through Joanna-Brigg's-Institute's-critical appraisal checklist. The evidence analysis was done by using the GRADE approach. Qualitative synthesis was performed for describing the study characteristics, details of sampling, and results of various questionnaires. It was discussed by the expert group and presented using KAP heat map. Meta-analysis was done by using Random Effects Model. The risk of bias was found to be low in seven and moderate in one study. It was observed that >50% of parents knew about the urgency to seek professional advice after TDI. Only <50% of parents were confident of their ability to identify the injured tooth, clean the soiled avulsed tooth, and perform the replantation. Appropriate responses regarding immediate action after tooth avulsion were given by 54.5% (95% CI: 50.2-58.8, p = 0.042) of parents. The knowledge of the parents regarding the emergency management of TDI was found to be inadequate. The majority of them were interested in obtaining information about dental trauma first aid.

Dental Root Injuries Caused by Osteosynthesis Screws in Orthognathic Surgery-Comparison of Conventional Osteosynthesis and Osteosynthesis by CAD/CAM Drill Guides and Patient-Specific Implants.

The primary aim was to evaluate the prevalence and localisation of dental injuries caused by osteosynthesis screws during orthognathic surgery, comparing two different CAD/CAM planning/surgical approaches through retrospective evaluation of post-operative computed tomography. This study considered all patients who underwent orthognathic surgery from 2010-2019. The examination for dental root injuries between conventional osteosynthesis (Maxilla conventional cohort) and osteosynthesis with patient-specific implant (Maxilla PSI cohort) was performed by evaluating the post-operative CT scans. A total of 126 patients were included in the study. Among the 61 patients of the Maxilla conventional cohort, 10 dental root injuries in 8 patients (13.1%) were detected in the post-operative CT scan, representing 1.5% (n = 10/651) of the osteosynthesis screws inserted in proximity of the alveolar crest. No dental injury occurred following osteosynthesis in the 65 patients of the Maxillary PSI cohort (n = 0/773 screws) (p < 0.001). During a mean follow-up period of 13 months after primary surgery, none of the injured teeth showed evidence of periapical alterations and no endodontic treatments were necessary. Maxillary positioning using CAD/CAM-fabricated drill/osteotomy guide and osteosynthesis with PSI can significantly reduce the risk for dental injury compared to the conventional procedure. However, the clinical significance of the detected dental injuries was rather minor.

Management of a complex dentoalveolar trauma: a case report

This paper describes the case of a 33-year-old male patient with a severe lateral and canine luxation of the maxillary incisors who felt down the stairs. Treatment involved suture of the soft tissues lacerations, and repositioning and splinting of the injured teeth, followed by endodontic treatment, periodontal surgery and prosthetic restorations. After a 1-year follow-up, clinical and radiographic evaluation revealed that the incisors presented satisfactory esthetic and functional demands.

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.

MTORC1 signaling pathway regulates tooth repair

Tooth germ injury can lead to abnormal tooth development and even tooth loss, affecting various aspects of the stomatognathic system including form, function, and appearance. However, the research about tooth germ injury model on cellular and molecule mechanism of tooth germ repair is still very limited. Therefore, it is of great importance for the prevention and treatment of tooth germ injury to study the important mechanism of tooth germ repair by a tooth germ injury model. Here, we constructed a Tg(dlx2b:Dendra2-NTR) transgenic line that labeled tooth germ specifically. Taking advantage of the NTR/Mtz system, the dlx2b+ tooth germ cells were depleted by Mtz effectively. The process of tooth germ repair was evaluated by antibody staining, in situ hybridization, EdU staining and alizarin red staining. The severely injured tooth germ was repaired in several days after Mtz treatment was stopped. In the early stage of tooth germ repair, the expression of phosphorylated 4E-BP1 was increased, indicating that mTORC1 is activated. Inhibition of mTORC1 signaling in vitro or knockdown of mTORC1 signaling in vivo could inhibit the repair of injured tooth germ. Normally, mouse incisors were repaired after damage, but inhibition/promotion of mTORC1 signaling inhibited/promoted this repair progress. Overall, we are the first to construct a stable and repeatable repair model of severe tooth germ injury, and our results reveal that mTORC1 signaling plays a crucial role during tooth germ repair, providing a potential target for clinical treatment of tooth germ injury.

Evaluation of intern’s knowledge of dental trauma using mobile phone app: An institution-based study

Aim: The aim of this study was to evaluate dental interns’ knowledge regarding the treatment of traumatic dental injuries. Materials and methods: A total of 110 dental interns participated in the study.Quiz questions from the INJURED TOOTH mobile app were given to the interns of a dental college. They were asked to attempt the quiz at the beginning of their clinical posting in paediatric dentistry. A second quiz with the same questions was conducted after the completion of their clinical posting. The quiz was in English language and consisted of 37 questions based on crown fracture, crown root fracture, luxation injury, root fracture, avulsion, and others. The data available from filled forms were entered in Microsoft Excel. Quantitative analysis was done using IBM SPSS version 22.0 (IBM Corporation, Chicago, US), the p-value of less than 0.05 was considered significant. Results: The knowledge of interns before their clinical postings were insufficient (65.47%). The knowledge was significantly improved after the completion of their clinical posting (76.13%). The mean score of knowledge on crown fracture among the participants before and after the clinical postings was 69.17% and 80.48% respectively. For crown root fracture- 82.17% and 84.33% , for luxation Injuries- 53.83% and 70%, for root fracture - 56.55% and 74.52%, for avulsion 67.71 and 75.21% and for other traumatic injuries - 64.17% and 71.67% Conclusion: The results of the current study demonstrate that dental interns lack the necessary knowledge to treat dental injuries. This highlights the need to introduce subjects relevant to dental trauma into the curriculum and use a variety of teaching strategies, such as problem-based learning, to increase the understanding of dental interns about dental trauma and its management.

Evaluation of primary teeth affected by dental trauma in patients visiting a university clinic, part 2: dental injury types, treatment strategies, and complications.

This article focuses on treatments and complications in patients presenting dental trauma in primary teeth. Treatment alternatives begin with the decision of performing a procedure under clinical settings or pharmacological techniques (PC) in young children. Correct diagnosis and treatment are crucial to maximize the chances of a favorable outcome. The files of 320 patients aged 0-9years who presented to the Erciyes University Faculty of Dentistry Department for dental trauma management in primary teeth were evaluated in between 2018 and 2021 for 3-year period. The following information were extracted from patients' records: injury type, affected teeth, caries condition of the teeth, treatment preferences of the dentists. Additionally postoperative complications and their management were evaluated. While 63.1% of the traumatized teeth were caries-free, 35.8% of the teeth had caries. The most frequent dental injuries was simple crown fractures (42.9%), followed by complicated crown fractures (38.5%). Treatments were mostly done in clinical conditions (67.9%) and mostly patients attend regularly to follow-up visits (85.6%). Clinicians prefer more radical treatments under sedation or GA (92.4% extraction of injured tooth). Coronal discoloration was the most common complication, and 35.3% had pulp necrosis for longer term results. Follow-up decisions made after concussion in the primary teeth might be appropriate for the patient. Examination of the complication status of primary teeth with simple crown fracture injury revealed that 59.5% of patients did not have any complications. Follow-up decisions were found to be appropriate for crowns with coloration alone. All options should be considered to provide the best care for children after primary tooth trauma; this can be achieved by being informed about the treatment and its consequences, and if necessary, a positive prognosis can be achieved with an interdisciplinary approach.

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

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

Expert consensus on stabilization with splint in traumatic dental injuries of permanent tooth

Stabilization with splint is an important surgical technology in traumatic dental injuries of permanent tooth. In order to standardize the clinical application of the technique and to improve the therapeutic effects of traumatic injured teeth, the Society of Stomatological Emergency, Chinese Stomatological Association organized relevant professional experts and put forward an expert consensus on the basis of considerable discussion. The contents of the present expert consensus covered indications for tooth fixation, material selection of splints and operation methods, applying to the treatment of tooth loosening, tooth displacement and tooth avulsion replantation caused by traumatic injuries. It is also suitable for preoperative and prognosis evaluations of traumatic injured teeth before tooth fixation.

Реставрация передних зубов после травмы композитными частичными коронками

The dentist-therapist in clinical practice often has to carry out aesthetic restoration of the teeth of the frontal group using composite materials. The requirements for dental treatment of the frontal group increase with the improvement of materials and tools. The methods of recreating the aesthetics of the tooth used in the conditions of the dental laboratory are not always suitable for use in the clinic of therapeutic dentistry. This is due to the peculiarities of performing restoration in the oral cavity, the properties of composite materials, as well as the limited working time of the doctor. The improvement of materials and restoration techniques made it possible to meet the high aesthetic requirements of patients. So, the vast majority of people expect a dentist to create so-called invisible restorations. Patients are interested in preserving more tooth tissues and want to take part in choosing the color and shape of future work. They also set the dentist the task of predicting the final result even before the start of treatment. Therefore, it is important for a doctor to keep up with the development of new technologies and improve his manual skills, improving the quality of restorations. Dentists often face a choice between direct and indirect methods of restoring the teeth of the frontal group. The most common causes of dental injuries are falls and bumps. Mainly the upper central incisors suffer, most often there is an uncomplicated fracture of the crown parts of these teeth (without opening the tooth cavity). Many materials and methods are used to restore the front teeth after injury. The possibilities of adhesive dentistry allow to restore the natural appearance of teeth with almost complete preservation of intact hard tissues. We describe recommendations for the use of composite restorations for conservative restoration of injured teeth.

Emergency management of maxillary dentoalveolar fracture: A case report

Dentoalveolar trauma occurs in relation to injuries of fall, road traffic accidents, sports injury or physical violence. There may be injury limited to the tooth, or may involve the periodontium around, or in severe cases, alveolar bone or oral mucosa may be traumatised. There can be myriad injuries of the same structure depending upon the severity of impact. The injuries of tooth most commonly being crown fractures, followed by root fractures, luxation or complete avulsion of the tooth. Every type of dentoalveolar injury requires a specific set of clinical protocols to be followed in order to successfully diagnose and manage the particular case.We hereby report a case of a 29-year-old male patient with a history of fall under the influence of alcohol, who had fallen flat on his face and had suffered intrusive luxation of permanent maxillary right central incisor and avulsion of permanent maxillary left central and lateral incisors. The exarticulated teeth still had slight soft tissue attachment to the socket. On the patients first visit to dental OPD, being a dental emergency, the avulsed teeth were immediately restored back into the socket under local anaesthesia after adequately irrigating and debriding the socket, followed by repositioning of the internally luxated tooth, so that all were in their correct anatomical position. After checking for occlusion, they were splinted in position with Erich’s arch bar and 26 gauge SS wire and after giving post-operative instructions patient was asked to follow up after 6 weeks. At 6 weeks, the affected teeth were found to be firm and so arch bar were removed. Patient was advised to follow up further. At periodic follow ups, the patient was asymptomatic and maintained adequate oral functioning of the injured teeth, thus with good patient compliance and proper diagnosis and treatment, dentoalveolar fractures can be managed successfully. The main purpose of this article is to lay emphasis on the timing of treatment of the dentoalveolar injuries. The earlier they are managed, the better is the outcome.

Dental Trauma at a University Dental Clinic in Milan including the SARS-CoV-2 Period.

The aim of this study i.e., is to present the distribution of traumatic dental injuries (TDI) in 306 patients registered at the Unit of Dental Emergencies at a University Dental Clinic in Milan, Italy, between June 2019 and May 2021. This time frame includes the beginning of the SARS-CoV-2 pandemic. Information regarding age, gender, number and type of injured teeth, type of traumatic injury, and data on where or how the injury happened were recorded. Seventy-nine percent of patients can be classified as pediatric (under 14 years old), and in all age groups, male patients were found to be more susceptible (1.6:1). A total of 480 teeth were involved, 59% of which were deciduous, and 41% permanent. The most affected teeth in both dentitions were upper central incisors. In deciduous teeth, periodontal lesions were more common, whereas in permanent dentitions, dental fractures were diagnosed more often. Most data found in this study confirms the results found in the literature. The biggest difference, due to changes in daily routine during the SARS-CoV-2 pandemic, can be found by analyzing the incidence and etiology. As a matter of fact, there was a decrease in school accidents, whereas domestic falls remained constant.