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| 11/16/2009 10:20 PM |
| Factors related to treatment and outcomes of avulsed teeth |
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Abstract [ndash] Background: The aim of this study was to examine factors associated with avulsion injury and to specify the association between these factors and the treatment, as well as the outcomes of avulsed permanent incisors in children. Materials and methods: The sample consisted of 51 children with 62 avulsed permanent incisors, whose injuries had been managed in the period 1998[ndash]2006. The study was prospective, recording the history of the accident, concomitant injuries, age, gender, apical maturity of the root, replantation rate, storage media, extra-alveolar duration, endodontic treatment, compliance and recall appointments response. Factors were analysed in relation to postoperative outcomes, classified as functional healing (FH), infection-related (inflammatory) resorption (IRR) and replacement resorption (RR). Results: The average age of patients was 10.7 years (range 7[ndash]19). In 16/51 patients, tooth avulsion was caused by a road traffic accident. Avulsion was accompanied by concomitant injuries in all cases. Thirty of 62 avulsed teeth were not replanted and 32 incisors were replanted after dry storage. Time until replantation ranged between 15 min and 9 h (median 60 min). The observation period ranged from 1 to 6 years (median 2 years). FH was observed in 5/32, IRR in 20/32 and RR in 7/32 incisors. Ten teeth were extracted during 5-years of observation. Immature incisors exhibited significantly more complications compared with mature teeth (P = 0.04). Storage media and extra-alveolar duration did not significantly affect the survival of replanted teeth (P = 0.253, P = 0.350). Teeth in which endodontic treatment was in temporary phase exhibited significantly more complications in comparison with teeth with completed endodontic treatment (P = 0.0l6). Conclusion: The combination of delayed replantation and unphysiological storage is followed by low survival. Incisors with open apices exhibited lower survival compared with incisors with closed apices. Replanted incisors that required prolonged treatment with calcium hydroxide exhibited more complications compared with incisors with completed root canal treatment.
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| 11/16/2009 10:19 PM |
| The effects of short-term calcium hydroxide application on the strength of dentine |
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Abstract [ndash] Background: Studies have suggested that the long-term exposure of dentin from immature teeth to calcium hydroxide may weaken the dentin but the effects of short-term exposure of dentin from mature teeth have not been reported. The aim of this study was to evaluate the effects of a short term application of calcium hydroxide on the strength of dentine from mature human permanent teeth. Materials and methods: 50 human extracted single rooted disease-free permanent mandibular premolars were chosen. The root canals were prepared with rotary instruments and randomly assigned to two groups. In one group, the root canals were filled with a calcium hydroxide paste. Canals of teeth in the control group were left empty. All teeth were stored in normal saline for 30 days and then coronal third root dentin cylinders were created by removing the crown and apical portions of the teeth. An Instron machine was used to measure the compressive forces needed to break the dentin cylinders and data were analysed using the Student's t-test. Results: The mean compressive force in the calcium hydroxide-filled teeth was significantly lower than that in the control teeth (210.6 ± 32.3 kg cm[minus]1 vs 246.2 ± 29.0 kg cm[minus]1 respectively, P < 0.001). Conclusion: Teeth subjected to 30 days application of calcium hydroxide required less compressive force to break root dentin cylinders. Further studies are necessary to determine whether similar effects would result if impact tests were performed.
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| 11/16/2009 10:19 PM |
| The unmet treatment need of traumatized anterior teeth in selected secondary school children in Ibadan, Nigeria |
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Abstract [ndash] Treatment of traumatized anterior teeth is highly desirable to relieve pain, maintain esthetics and to preserve the balance of the anterior part of the mouth; however many may go untreated. The aim of this study was to assess the prevalence of damage to permanent anterior teeth in school adolescents, the average duration of trauma and to ascertain the level of the unmet treatment need. A total of 1532 secondary school children between the ages 12 and 19 years participated in the study. They were randomly selected from public secondary schools in five local government areas in Ibadan using a multistage sampling method. Participants were examined with the aid of mouth mirrors and probes under natural light. Traumatic anterior dental injuries were recorded by the same investigator (DMA) according to WHO classification. One hundred and sixty-five participants sustained injuries to their anterior teeth. Their mean age was 15.47 ± 2.09 years, with a male to female ratio of 1.5:1. The commonest cause was fall (78.8%) with road traffic accident being the least (1.8%). The tooth most commonly injured is the upper left incisor (48.0%) closely followed by upper right central (43.1%). Enamel fracture was seen in 46.5% and enamel[ndash]dentine in 42.6% of the traumatized teeth. Most (79.4%) of the children sustained injury to one tooth only. Of the participants, only 30 (18.2%) had previous dental consultation while only nine (5.5%) consulted the dentist following the trauma; however, none of the teeth had any form of restoration. Average time elapsed between trauma and dental examination was about 3.5 years. Many participants had had injury for about 2 years before dental examination. In conclusion, there is a high unmet treatment need of traumatized anterior teeth in the study population.
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| 10/06/2009 10:07 PM |
| Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research* |
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Abstract [ndash] Almost all treatment procedures used for dental traumas are still today not evidence-based, a fact, which makes it difficult to analyse the long-term outcome of healing and its relationship to treatment. Crown fractures with extensive dentin exposure represent a dominant injury in the permanent dentition. Accepted treatment philosophy is dentin coverage (dental liner and/or dentin bonded restoration) to prevent bacteria penetration into the pulp. Today there is, apart from deep proximal fractures, no evidence that this treatment is necessary to protect the pulp. In case of luxation injuries, the accepted treatment principles appear to be anatomically correct repositioning, stabilization with a splint and sometimes antibiotic coverage. In clinical studies, these principles could not be proven to optimize either periodontal or pulpal healing, the explanation possibly being that both reposition and application of splints in certain cases add extra damage to the pulp and periodontal ligament. In case of root fractures with dislocation, fast and optimal repositioning and rigid long-term splinting (i.e. 3 months) have been considered the principle of treatment. However, a recent clinical study has shown that short-term splinting with a semi-rigid splint appears to optimize fracture healing. In tooth avulsion with subsequent replantation, cleansing of the root surface for contamination and systemic antibiotics has been considered essential for pulp and periodontal healing. These treatment concepts have been derived from experimental studies in animals. However, their importance could not be verified in large clinical studies. Ideally, randomized clinical studies are needed in the future for selected trauma types. The influences of repositioning, splinting and the role of infection and antibiotics should be further investigated. However, for ethical reasons, it will be difficult to perform randomized studies on trauma victims and we will be forced in the future to rely on experimental animal studies supported by clinical observational studies.
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| 10/14/2009 05:33 PM |
| The three-dimension finite element analysis of stress in posterior tooth residual root restored with postcore crown |
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Abstract [ndash] Objective: Teeth that have been endodontically treated and restored with postcore crown may experience fracture sometimes. Some researchers have analyzed the stress of the anterior teeth after postcore crown restoration, but the stress of the posterior teeth after such restoration has not been reported. We used three-dimension finite element methods to analyze the stress magnitude and distribution of remaining dentin in posterior tooth residual root restored with postcore crown. The binding material, loading direction, number, length and material of posts were studied.Methods: The models of residual root of maxillary first molar restored with postcore crown were created by CT scanning, mimics software and abaqus software. Different number, length and material of posts were used in the modeling. The posts were cemented with zinc-phosphate cement or composited resin. A load of 240 N was applied to the occlusal surface in four directions and tensile, shear, and von Mises stresses were calculated.Result: (i) The maximum stress on remaining dentin changed irregularly as the number and length of posts changed. (ii) The maximum stress on remaining dentin decreased slightly as elastic modulus of the material of posts increased. (iii) The maximum stress on bonding layer and remaining dentin was lower when bonded with resin luting agent than with zinc-phosphate cement. (iv) The maximum stress on remaining dentin increased markedly as loading angle increased.Conclusion: The number, length, material of posts, bonding material and loading angle all have influence on the magnitude and distribution of stress. The influence of loading angle is most apparent.
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| 10/14/2009 05:32 PM |
| Rationale for esthetic tissue preservation of a fresh extraction socket by an implant treatment concept simulating a tooth replantation |
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Abstract [ndash] In cases of an immediate insertion and loading of implants after a traumatic loss of the patient's own dentition or due to an inevitable extraction of an anterior tooth, it is essential to provide the patient with an adequate provisional crown. A soft-tissue recession must be avoided, whether it is due to a compression of the peri-implant soft-tissue caused by an over-dimensioned restoration in the cervical collar of the provisional crown or to a too small dimensioned sulcus former. A simulation of the exact dimension of the lost tooth [ndash] especially on the cervical part of the new provisional restoration [ndash] is expected to preserve all relevant information and allows the design of a naturally looking emergence profile. Based on theoretical considerations and a case report, the authors intend to demonstrate that a near-naturally dimensioned sealing of the dento-gingival soft-tissue collar may initiate a tissue-maintaining healing process, similar to a tooth replantation. The natural dental crown, connected to an implant instead of the root, is applied for a tight sealing of the wound. If due to traumatic impact the tooth is no longer available, a naturally dimensioned crown restoration will serve as an alternative wound sealant.
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| 09/24/2009 06:37 PM |
| Fracture of the tympanic plate with soft tissue extension into the auditory canal resulting from an unfavorable chewing experience |
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Abstract [ndash] We present a case where a patient sustained a tympanic plate fracture of the right side while chewing a sandwich. Intense pain with temporomandibular joint (TMJ) symptoms such as restrained painful mouth opening and functional pain in full occlusion followed the incident and the fracture was diagnosed after ocular and CT-examination of the right external auditory canal. Non-ruptured soft tissue could be seen protruding into the external auditory canal and the size of the mass changed during movement of the TMJ. Treatment was not needed to resolve the situation and at 3-year follow-up the patient has no clinical symptoms.
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| 10/31/2007 07:00 PM |
| Effect of storage media on human periodontal ligament cell apoptosis |
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Abstract [ndash] The ability of storage media to preserve periodontal ligament (PDL) cell vitality has been previously evaluated. However, the mechanisms by which different storage conditions alter the functional status of PDL cells have not been determined. The purpose of the present study was to investigate, in vitro, the level of programed cell death or apoptosis in a population of PDL cells following storage under different conditions. Primary human PDL cells were plated into 24-well-culture plates and allowed to attach for 24 h. Cells were then exposed for 1 h to milk, Hank's balanced salt solution (HBSS), Soft Wear contact lens solution or Gatorade at room temperature or on ice. Culture medium was used as a negative control. Apoptosis was evaluated at 24, 48, and 72 h after treatment on quadruplicate samples by using the ST 160 ApopTag Fluorescein Direct In Situ Detection Kit. The total number of cells and the total number of apoptotic cells were counted. The results indicated that at 24 and 72 h, PDL treated with Gatorade and the contact lens solution displayed the highest percentages of apoptotic cells when compared with the other treatment groups at room temperature. Overall, cells treated on ice showed significantly lower levels of apoptosis when compared with treatments at room temperature. In conclusion, the results indicated that apoptosis plays a major role in cell death in cells treated with Gatorade and contact lens solutions in comparison to other storage solutions and that storage on ice can inhibit programed cell death.
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| 10/31/2007 07:00 PM |
| A clinical evaluation of mineral trioxide aggregate for root-end closure of non-vital immature permanent incisors in children-a pilot study |
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Abstract [ndash] The aim of this pilot study was to evaluate the clinical efficacy of mineral trioxide aggregate (MTA) as an apexification material when used in non-vital immature permanent incisors in children. Fifteen children with a mean age of 11.7 years and 17 non-vital permanent incisors were ajudged suitable for inclusion. Standard endodontic procedures were followed and an apical plug of 3[ndash]4 mm was created by using MTA after a calcium hydroxide intracanal dressing had been applied for at least 1 week. Final obturation was completed by using thermoplastisized Gutta[ndash]Percha (Obtura II) at least 1 week following MTA placement. Subjects were reviewed clinically and radiographically at 3-month intervals. Mean follow-up time for MTA was 12.53 months (±2.94 SD). Of the total of 17 teeth treated, MTA placement was considered to be adequate in 13 teeth. The procedure showed clinical success in 94.1% of the cases, radiographic success was found to be 76.5% and in further three cases (17.6%) the outcome was considered to be uncertain. This is one of the very few studies that have reported the out coming of MTA as an apexification material in children with non-vital teeth and incomplete root development. However, larger clinical studies are required to evaluate the long-term success of this procedure.
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