Survival of avulsed permanent incisors in children following delayed replantation.

BACKGROUND: Replantation of avulsed teeth is an invasive treatment approach where patient cooperation is required after the risks are explained to the patient or family. Although replantation of an avulsed permanent teeth is an accepted treatment approach, the long-term prognosis of the replanted teeth is still controversial. This report describes the survival of delayed replanted 15 incisors that was stored in unfavorable conditions after avulsion. MATERIALS AND METHODS: Nine patients, aged 8-12 years, were referred to the Inonu University, Pediatric Dentistry Department with traumatically avulsed incisors. The parents were informed about the possible complications of a delayed replantation. RESULTS: Forty percent of the teeth were splinted with flexible orthodontic wire and composite. The follow-up periods were varied from 24 to 48 months. The mean follow-up periods were 33.3 ± 8 months. 40% of the teeth were retained in the mouth for at least 3 years and contributed to alveolar bone development. In these cases, the most common complication (9 teeth, 60%) was replacement root resorption. Two of the 15 teeth which had wide open apices, continued to the root development. CONCLUSION: In this study, replanted teeth were retained in the mouth for at least 2 years and contributed to the patient's development. Therefore, this study has shown that delayed replantation of an avulsed tooth for a child is still worthwhile, even in cases of poor prognosis where the tooth had extended extra-alveolar dry storage. We believe that delayed replantation should be done because of its importance for the child's jaw and facial development.

Survival and complication analyses of avulsed and replanted permanent teeth.

This retrospective clinical study investigated the survival probability of avulsed and replanted permanent teeth in relation to functional healing, replacement and inflammatory resorption. The explorative data analysis included data from 36 patients and 49 replanted permanent teeth with a minimum observation time of 60 days; the patients were generally treated according to the current guidelines of the International Association of Dental Traumatology at the university hospital in Munich, Germany, between 2004 and 2017. The mean observation period was 3.5 years. Functional healing was observed in 26.5% (N = 13/49) of the included avulsion cases. In comparison, replacement resorption affected 51.0% (N = 25/49) of the replanted teeth, of which 24.0% (N = 6/25) were lost over the course of years (mean, 6.1 years). In contrast, inflammatory resorption resulted in the early loss of all replanted teeth (mean, 1.7 years) and affected 22.5% (N = 11/49) of all the monitored teeth. Therefore, it can be concluded that tooth avulsion remains a severe dental injury with an unpredictable prognosis. This topic demands further fundamental research aiming to maintain and/or regenerate the periodontal ligament after tooth avulsion, particularly in association with non-physiological tooth rescue.

Effects of Occlusion on Periodontal Wound Healing.

Trauma from occlusion remains an important concept in dentistry. Traumatic occlusion affects the biological system through a series of events that induces an aseptic inflammatory response and bone resorption. Clinical evidence of these biological events is present in the form of active traumatic lesions or adaptive mechanisms. If these clinical signs are not identified prior to periodontal surgery, failure of the procedure could result due to an exacerbated leukocyte presence and unresolving wound. However, if traumatic occlusion is adjusted, evidence demonstrates that even large inflammatory events such as replantation of an avulsed tooth can be successful. Thus, harmony of occlusal contacts without interference is essential in achieving predictable periodontal/implant bone regeneration.

Regenerative endodontics after front tooth trauma. A case report / Regenerative endodontische Therapie nach Frontzahntrauma. Ein Fallbericht

In the context of tooth trauma, mostly the maxillary central front teeth are involved, whereby their roots are in some cases still in the developing stage (immature). Depending on the type of trauma, a necrosis of the pulp is the consequence or at least foreseeable. In order to preserve such a tooth, an endodontic therapy is inevitable. The disadvantage of conventional endodontic therapy methods of immature teeth (apexification, apexogenesis) is the root growth stop. Alternatively, the regeneration/revascularisation of the dental pulp (RP) was suggested, that allows a further root growth. The aim of this case report is to present the procedure of a RP-therapy and to suggest a step-by-step manual.

Cling film as storage medium for avulsed teeth. An in vitro pilot study

The long-term prognosis of avulsed teeth primarily depends on the behavior at the scene of the accident. Lay people are not able to perform an immediate replantation. Therefore, particular significance belongs to the cellphysiologic storage of avulsed teeth. The aim of this pilot study was to evaluate whether cling film facilitates the survival of periodontal ligament cells in vitro. For this purpose, healthy human third molars were used. They were cut into root slices, which were stored in one of five test media: SOS Zahnbox ® , UHT milk (4 °C), sterile isotonic saline solution, tap water, and cling film. Following storage periods of 2 hours, 6 hours, and 24 hours in the respective medium, slices were cultivated at 37 °C and 5% CO 2 . After 2 days, 7 days, and 14 days in culture, surviving periodontal ligament cells of each slice were assessed quantitatively. Apart from tap water, all investigated media promoted cell survival. At the time of 2 hours, storage in cling film facilitated the highest cell growth compared to all other media. At the time of 6 hours, teeth stored in cling film sho wed cell growth comparable to that observed in the SOS Zahnbox ®. The results of this pilot study indicate that cling film possibly could be used as an alternative transport medium for a storage period of up to 6 hours.

Relationship between Initial Attendance after Dental Trauma and Development of External Inflammatory Root Resorption.

This clinical study aimed to evaluate the relationship of the delay between dental trauma and the initial attendance to the development of external inflammatory root resorption in permanent teeth affected by severe luxation. Sixty-seven patients, aged between 11 and 56 years, presenting 133 injured teeth with closed apex (56 extrusive luxation, 69 lateral luxation and 8 intrusive luxation) were followed up for a minimum of 24 months. The time elapsed between dental trauma and the initial attendance was recorded. The presence of necrotic pulp and external inflammatory resorption for each type of trauma was verified. Fisher's exact test was used to verify the influence of the initial attendance date at the Dental Trauma Center and the development of inflammatory resorption (p<0.05). The odds ratio was used to check the risk of developing external inflammatory resorption due to delay in seeking treatment. Pulp necrosis was observed in 105 teeth (78.9%) and external inflammatory resorption was detected in 17.8% cases of extrusive luxation (10 teeth), 15.9% of lateral luxation (11 teeth) and 25% of intrusive luxation (2 teeth). For lateral luxation, extended delay between the date of injury and initial attendance influenced the occurrence of external inflammatory resorption (p=0.0174). Patients who began treatment 45 days after the injury were 3.4 times more likely to develop external inflammatory resorption than patients who sought treatment after the trauma. Treatment late after the occurrence of dental trauma can impair the prognosis and result in the development of external inflammatory resorption in luxated teeth.

Relationship between Initial Attendance after Dental Trauma and Development of External Inflammatory Root Resorption

Abstract This clinical study aimed to evaluate the relationship of the delay between dental trauma and the initial attendance to the development of external inflammatory root resorption in permanent teeth affected by severe luxation. Sixty-seven patients, aged between 11 and 56 years, presenting 133 injured teeth with closed apex (56 extrusive luxation, 69 lateral luxation and 8 intrusive luxation) were followed up for a minimum of 24 months. The time elapsed between dental trauma and the initial attendance was recorded. The presence of necrotic pulp and external inflammatory resorption for each type of trauma was verified. Fisher’s exact test was used to verify the influence of the initial attendance date at the Dental Trauma Center and the development of inflammatory resorption (p<0.05). The odds ratio was used to check the risk of developing external inflammatory resorption due to delay in seeking treatment. Pulp necrosis was observed in 105 teeth (78.9%) and external inflammatory resorption was detected in 17.8% cases of extrusive luxation (10 teeth), 15.9% of lateral luxation (11 teeth) and 25% of intrusive luxation (2 teeth). For lateral luxation, extended delay between the date of injury and initial attendance influenced the occurrence of external inflammatory resorption (p=0.0174). Patients who began treatment 45 days after the injury were 3.4 times more likely to develop external inflammatory resorption than patients who sought treatment after the trauma. Treatment late after the occurrence of dental trauma can impair the prognosis and result in the development of external inflammatory resorption in luxated teeth.

Resumo O objetivo deste estudo clínico foi avaliar a relação entre a demora na procura por tratamento e o desenvolvimento de reabsorções inflamatórias externas em dentes luxados com ápice fechado. A amostra desta pesquisa foi constituída por 67 pacientes que apresentaram 133 dentes traumatizados, dos quais 56 foram acometidos por luxação extrusiva, 69 por luxação lateral e 8 por luxação intrusiva, proservados por no mínimo 24 meses. Foi registrado o tempo decorrido entre a data do trauma e o primeiro atendimento. Verificou-se a ocorrência de necrose pulpar e reabsorções inflamatórias externas em cada tipo de traumatismo. O Teste Exato de Fisher foi aplicado para verificar a influência da data do atendimento inicial e o desenvolvimento de reabsorções inflamatórias externas em cada tipo de luxação e o teste de Odds Ratio foi aplicado para verificar o risco do desenvolvimento de reabsorções inflamatórias externas em função da demora na procura por tratamento. Os resultados revelaram que a necrose pulpar foi verificada em 105 dentes luxados (78,9%) e a reabsorção inflamatória externa foi verificada em 17.8% das luxações extrusivas (10), sendo 15,9% das luxações laterais (11) e 25% das luxações intrusivas (2). A demora na procura por tratamento influenciou o desenvolvimento de reabsorções infamatórias externas nas luxações laterais (p=0,0174). Os pacientes que procuraram tratamento após 45 dias da data do trauma apresentaram 3,4 vezes mais chance de desenvolver reabsorção inflamatória externa do que os pacientes que procuraram tratamento logo após o traumatismo. Conclui-se que o tratamento tardio após a ocorrência do traumatismo pode prejudicar o prognóstico e favorecer o desenvolvimento de reabsorções inflamatórias externas em dentes luxados com ápice fechado.

Life cycles of traumatized teeth: long-term observations from a cohort of dental trauma victims - series 2.

In this the second of a series of life cycles of dental trauma victims, the short and particularly long-term responses of four survivors of either multiple luxation injuries or avulsions have been documented over periods varying up to 41 years. The development of ankylosis, either in the short or longer term post trauma, proved a common feature in the series and management strategies have been outlined. External invasive resorption was also identified as a complicating response for which the topical application of trichloracetic acid, intracanal dressing and root canal obturation proved effective in resorption management. Long-term observations indicate that some compromised teeth can be functionally and aesthetically retained for extended periods, but follow-up examinations are important so that treatment interventions can be implemented if adverse responses are diagnosed.

Life cycles of traumatized teeth: long-term observations from a cohort of dental trauma victims.

Life cycles of dental trauma victims can provide important clinical information, especially when viewed over many years. In this first series of life cycles, the pulp and periodontal responses to traumatic injuries of four patients are documented over periods varying from 26 to 51 years. The dynamics of pulp survival following an intrusive luxation and two avulsions are followed, with particular reference to pulp canal calcification to which a new term, root canal stenosis, has been proposed. The life cycles include the successful management of inflammatory root resorption in a replanted tooth with an open apex contrasting with the early prophylactic endodontic treatment of two replanted teeth in a patient with mature apices. The long-term development of invasive cervical resorption in one of the patient's life cycle highlights the importance of ongoing follow-up examinations for dental trauma victims.

Pulp and Periodontal Regeneration of an Avulsed Permanent Mature Incisor Using Platelet-rich Plasma after Delayed Replantation: A 12-month Clinical Case Study.

Numerous publications have reported revascularization of necrotic immature permanent teeth, but the regenerative potential of pulp in mature teeth has rarely been considered. Platelet-rich plasma (PRP) meets many requirements of a scaffold for regenerative endodontics. To the best of our knowledge, no clinical study has evaluated PRP for endodontic regeneration in a mature avulsed tooth. The present case evaluated PRP for pulpal regeneration in an avulsed mature incisor (>8 hours extraoral dry time) of an 11-year-old boy after delayed replantation. The canal was disinfected after extraoral access cavity preparation and pulp extirpation. The root apex was enlarged, and the tooth was placed in doxycycline solution for 20 minutes. After tooth replantation and splinting, PRP was injected up to the level of the cementoenamel junction and sealed with glass ionomer cement. The 6-month follow-up revealed evidence of internal and external root resorption with periapical radiolucency and an apparent periodontal ligament space. Access was reopened; slurry of 2 antibiotics (minocycline and metronidazole) was inserted into the canal and sealed. Nine- and 12-month radiographs revealed resolution of periapical radiolucency with no further progression of internal resorption. The tooth showed a positive response to thermal and electric pulp tests. The findings observed in this case warrant further research under controlled conditions to evaluate endodontic and periodontal regeneration in a tooth that would otherwise be expected to have an unfavorable prognosis.

Intrusive luxation of primary upper incisors and sequelae on permanent successors: a clinical follow-up study.

AIM: The purpose of this report is to evaluate the epidemiological aspects of intrusion that occur against upper incisors in primary dentition, to determine the statistic correlation of developmental disturbances to permanent teeth in relation to age of children at the time of trauma. MATERIALS AND METHODS: A retrospective study was performed based on radiographic and clinical data of 34 intruded incisors in 30 patients aged between 12 and 60 months. Baseline data were collected in a questionnaire designed following the guidelines of the IADT-Italy. The descriptive statistical analysis between the different variables was performed with the Chi-squared test and the level of significance was set at 5%. The following parameters were considered: gender, age of patient at the time of injury, emergency treatment, clinical signs (vitality, mobility, spontaneous pain, colour change), presence of complications, degree of spontaneous re-eruption and possible developmental disorders to the following tooth. RESULTS: Intrusive luxation is not statistically related to gender. During the first 6-month follow-ups, 20 incisors belonging to 12 subjects aged between 12-24 months at the time of intrusion exhibited pulpal necrosis. The highest rate of total spontaneous re-eruption occurred in incisors intruded at 12-24 months. The likelihood of spontaneous re-eruption decreased with the child's age. A significant correlation between mobility at clinical follow-up and developmental disorders in permanent teeth was found, whereas a statistical correlation between age of patient at the time of trauma and sequelae was not pointed out, even if 17 primary incisors intruded at 12-24 months did not develop an arrest of root formation. CONCLUSION: The most traumatic intrusions in primary dentition occurs between 12 and 24 months of age, the most common cause being fall while walking. Intruded incisors with moderate mobility developed enamel hypoplasia and ectopic eruption. There was no significant correlation between age at the time of intrusion and type of subsequent developmental disturbances.

The impact of tooth avulsion on daily life performance using the Brazilian OIDP index in children and young adults.

INTRODUCTION: The evaluation of orofacial damage is an emerging branch in the forensic sciences, specifically in forensic odontology and medicine. One of the major limitations during the evaluation of forensic orofacial damages is establishing the consolidation date of acquired lesions. The consolidation date is defined as the moment from which orofacial damages are considered irreversible. AIM: To stress the relevance of knowing the consolidation date in children who underwent orofacial trauma, and to enhance forensic expertise on the evaluation of dentomaxillofacial damages. MATERIAL AND METHODS: Ninety-six patients, aged between 11 and 31 years old, treated at the dental clinics of the Federal University of Minas Gerais, Brazil, were selected for forensic orofacial evaluation. All the patients presented at least one traumatically avulsed tooth and a temporary partial denture. RESULTS: The mean age for the traumatic avulsion was 10,3 years old. The mean time for the placement of a prosthesis was 2,9 years after the initial consultation. The mean time for the use of prosthesis was 2,2 years. No significant differences were observed regarding orofacial damage outcomes between patients younger or older than 18 years of age. It was observed that patients using temporary removable partial dentures presented a 3,6-fold greater possibility of developing socially significant sequels if compared with patients using temporary fixed partial dentures. CONCLUSION: Knowing the consolidation date of orofacial damageenables the prediction of the potential development of social sequels in children and adolescents who isaster victim identification (DVI) is an intensive and demanding task involving specialists from various disciplines. The forensic dentist is one of the key persons who underwent traumatic dental avulsion.

Transport media for avulsed teeth: a review.

Management protocols for avulsed teeth should include management of the pulp and periodontal ligament (PDL) cells in order to improve the long-term prognosis and survival of these teeth. The use of an inappropriate transport or storage medium potentially increases the risk of PDL cell necrosis, which can result in ankylosis and replacement resorption of the tooth root. Considering the critical role of these media, an informed choice of a suitable medium is essential for a favourable outcome. The literature regarding transport media for avulsed teeth was reviewed using PubMed/MEDLINE up to February 2010. This review outlines the common storage media that are available and highlights their specific features or problems. Although HBSS, ViaSpan and Eagle's medium have great potential to maintain the PDL cells in a viable state after avulsion, the practicalities of using these solutions, the costs and the lack of ready availability to the general public make them less than ideal. Milk remains the most convenient, cheapest and readily available solution in most situations while also being capable of keeping PDL cells alive. Hence, milk remains the storage medium of choice for avulsed teeth that cannot be replanted immediately or very soon after the avulsion.

Periodontal healing complications following concussion and subluxation injuries in the permanent dentition: a longitudinal cohort study.

PURPOSE: The purpose of the study was to analyze the risk of periodontal ligament (PDL) healing complications following concussion and subluxation injuries in the permanent dentition. MATERIAL AND METHOD: A total 469 permanent teeth (358 patients) with concussion and 404 permanent teeth with subluxation were included in the study. All teeth were examined according to a standardized protocol including clinical, photographic, and radiographic registration. STATISTICS: The risk of repair-related resorption (surface resorption), infection-related resorption (inflammatory resorption), replacement-related resorption (ankylosis), marginal bone loss, and tooth loss were analyzed with the Kaplan-Meier method. RESULTS: Concussion: In teeth with immature root development, no healing complications were observed. For teeth with mature root development, the risk of repair related resorption after 3 years was 3.2% (95% CI: 0.3-6.0%) and occurred only in cases where several teeth were injured simultaneously (multiple-trauma cases). The risk of marginal bone loss in teeth with mature root development was 0.7% (95% CI: 0-1.6%). Infection-related resorption, replacement resorption, and tooth loss were not observed among teeth with concussion. Subluxation: In teeth with immature root development, the risk of infection-related resorption after 3 years was 1.7% [95% confidence interval (CI): 0-3.8%]. Infection-related resorption occurred significantly more often in teeth with concomitant crown fracture (P = 0.004). For teeth with mature root development, the risk of periodontal healing complications after 3 years was: repair-related resorption, 3.6% (95% CI: 0-7.6%); infection-related resorption, 0.6% (95% CI: 0-1.7%); replacement-related resorption, 0.6% (95% CI: 0-1.7%); and marginal bone loss, 0.6% (95% CI: 0-1.7%). No teeth were lost in the observation period. CONCLUSION: The risk of periodontal healing complications after concussion as well as subluxation injuries in permanent teeth is very low.

[Bony regrowth after major erosion of the maxillary following silastic malar augmentation. Case report]. / Régénération osseuse après érosion majeure du maxillaire sur implants malaires en silicone. Cas clinique.

Alloplastic malar augmentation has become a routine procedure associated with few complications. Among them, authors have described bony erosion and resorption. The case presented here illustrates an unusual case of maxillary bone erosion after silastic malar augmentation. Implants were surgically removed and no more surgical intervention was performed. After 15 months, contrast-enhanced CT scan has showed nearly complete bony regrowth to an almost normal state. Considering resorption phenomenons following silastic chin implants, Peled et al. reported no long-term sequellae after implant removal and bony regrowth to the presurgical state after 9 months. Accordingly, we conclude that these phenomenons, even spectacular, are always reversible after implants removal and that treatment should just consist in ablation of the offending prosthetic material.

Microscopic evaluation of induced tooth movement in traumatized teeth: an experimental study in rats.

The clinical management of orthodontic patients with dental trauma before or during the treatment is mainly founded on clinical experience, expert opinions, and individual case reports. It is proposed in the literature that teeth sustaining mild trauma with minor damage to the periodontium (e.g. subluxation) should be followed for a period of time before being subjected to orthodontic forces. A minimum period of 3 months has been proposed. In this study, we used an animal model to investigate whether shorter observation periods could be established in case of mild trauma. The periradicular region of rat molars was examined microscopically to determine the biological events of tooth movement started 15 and 30 days after intentional subluxation using an experimental method to induce dentoalveolar trauma. Thirty adult male Wistar rats were assigned to 6 groups (n = 5): Group 1 (control - no trauma/orthodontic movement); Group 2: the animals received an orthodontic device and were sacrificed after 7 days; Groups 3 and 4: dentoalveolar trauma (subluxation) was experimentally induced by the application of an axial force of 900 cN on the occlusal surface of the maxillary right first molar, and the animals were sacrificed after 22 and 37 days, respectively; and Groups 5 and 6: 15 and 30 days, respectively, after force application, an orthodontic device was installed and the rats were sacrificed 7 days later. In G5 and G6, the periodontal ligament and pulp tissue were rich in cellular elements and blood vessels, the alveolar bone was preserved, and the root surface presented only very small areas of surface resorption (cementum), maintaining the characteristics of normality. In conclusion, the microscopic alterations in the gingival and periodontal tissues in response to an experimentally induced mild dentoalveolar trauma simulating subluxation were not sufficient to contraindicate starting the orthodontic movement 15 and 30 days after trauma.

In vitro splint rigidity evaluation--comparison of a dynamic and a static measuring method.

OBJECTIVES: The aim of this in vitro study was to investigate a dynamic and static tooth mobility assessment method in terms of reproducibility and correlation. MATERIALS AND METHODS: A custom-made artificial model was used. The central incisors simulated 'injured' teeth with increased mobility, and the lateral incisors served as 'uninjured' teeth with physiological mobility. To assess tooth mobility, three consecutively repeated measurements were taken, in the vertical and horizontal dimensions before and after splinting, using the Periotest method as well as the Zwick universal testing machine. Reproducibility of the measurements was tested using anova and the Bonferroni post hoc test (α = 0.05). Correlation was analysed using Spearman's rank correlation (α = 0.05). RESULTS: No significant differences were found when comparing the three consecutively taken Periotest values and the vertical Zwick values (P > 0.05). In the horizontal dimension, the first Zwick values differed from the second and third values (P < 0.05). Only a few random correlations (P < 0.05) were found when comparing the two assessment methods. Horizontal and vertical measurements within one method did not correlate (P > 0.05). CONCLUSIONS: The Periotest and vertical Zwick values are highly reproducible. The measurements of the two methods do not correlate; therefore, a conversion of Periotest values into metric displacement data is not feasible. The two methods provide different valuable information about tooth mobility. The Periotest method describes the damping characteristics of the periodontal ligament while the Zwick method reveals quantitative metric values.

Pulp and periodontal healing of laterally luxated permanent teeth: results after 4 years.

AIM: To evaluate the pulp and periodontal healing of laterally luxated permanent teeth. MATERIAL AND METHODS: Patients presenting with lateral luxation of permanent teeth during 2001-2002 were enrolled in this clinical study. Laterally luxated teeth were repositioned and splinted with a TTS/composite resin splint for 4 weeks. Immediate (prophylactic) root-canal treatment was performed in severely luxated teeth with radiographically closed apices. All patients received tetracycline for 10 days. Re-examinations were performed after 1, 2, 3, 6, 12 and 48 months. RESULTS: All 47 laterally luxated permanent teeth that could be followed over the entire study period survived. In 10 teeth (21.3%), a prophylactic root-canal treatment was performed within 2 weeks following injury. The remaining 37 teeth showed the following characteristics at the 4-year re-examination: 19 teeth (51.4%) had pulp survival (no clinical or radiographic signs or symptoms), nine teeth (24.3%) presented with pulp canal calcification, and pulp necrosis was seen in another nine teeth (24.3%), within the first year after trauma. None of the teeth with a radiographically open apex at the time of lateral luxation showed complications. External root resorption was only seen in one tooth. CONCLUSIONS: Laterally luxated permanent teeth with incomplete root formation have a good prognosis, with all teeth surviving in this study. The most frequent complication was pulp necrosis that was only seen in teeth with closed apices.

Biomechanical model of incisor avulsion: a preliminary report.

The aim of the current study was to produce a two-dimensional finite-element model (FEM) of a maxillary incisor being palatally displaced with sufficient force to result in avulsion. The viscosity and elastic coefficient of bone were chosen from previous studies to model the properties of the periodontal complex. A ramped impact of 100 N was applied over a period of 1.5 ms in the direction perpendicular to the labial surface of the incisor model. Changes in the periodontal ligament (PDL) length (elongation and compression) started immediately after the impact and progressed to strain developing in the alveolar bone. In accordance with these changes in the PDL length, the tooth started to rotate with the center of rotation located at the edge of the palatal alveolar bone, combining the stress concentrations at the labial and cervical edges of the bone. When the elongation reached the designated limit, PDL disconnection occurred, leading to tooth avulsion. The resulting two-dimensional FEM is capable of modeling changes in the PDL length and compression, rotation and avulsion.