European Society of Endodontology position statement: endodontic management of traumatized permanent teeth.

This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on the endodontic management of traumatized permanent teeth. A recent comprehensive review with detailed background information provides the basis for this position statement (Krastl et al. 2021, International Endodontic Journal, https://doi.org/10.1111/iej.13508). The statement is based on current scientific evidence as well as the expertise of the committee. Complementing the recently revised guidelines of the International Association of Dental Traumatology, this position statement aims to provide clinical guidance for the choice of the appropriate endodontic approach for traumatized permanent teeth. Given the dynamic nature of research in this area, this position statement will be updated at appropriate intervals.

Endodontic management of traumatized permanent teeth: a comprehensive review.

The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Hebrew edition].

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and follow up are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented. The Hebrew Edition is part of the IADT global effort to provide accessibility to these guidelines worldwide.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Hebrew edition].

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This scond part of the guidelines will focus on avulsion of permanent teeth.

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Hebrew edition].

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This third part will discuss injuries in the primary dentition.

Treatment of invasive cervical resorption with sandwich technique using mineral trioxide aggregate: a case report.

This article presents two cases of large invasive cervical resorption (ICR) with maintenance of pulp vitality after treatment with mineral trioxide aggregate (MTA) in a sandwich technique.Invasive cervical resorption is a relatively uncommon but aggressive form of external resorption, primarily caused by dental trauma or injury of the cervical periodontal attachment. The resorptive process does not penetrate into the root canal, and the pulp is not involved in the first phase of the resorption. This feature differentiates external resorption from internal resorption. In most cases, invasive cervical resorption is found during routine radiographic or clinical examination. Different materials have been proposed for the treatment of external cervical resorption. Therapy can be effective when it 1) removes the etiological factors and 2) interrupts the progressive resorption mechanism.The key learning points of this article are the following: treatment strategy to arrest the cervical resorption process and to prevent further resorption without changing pulpal vitality and successful seal of invasive cervical resorption defect using MTA with a sandwich technique.

A retrospective classification of tooth injuries using a new scoring system.

The WHO classification presently in use categories dental trauma only according to the main injury. A new scoring system will now enable more precise and complete diagnosis of tooth injuries. In an initial retrospective investigation, 100 traumatised teeth were classified according to the WHO and the new scoring systems. Clinical and radiological examinations and another evaluations using the new scoring system were made at the time of follow-up examination. Avulsion, intrusion, and root fractures (score < 30) showed the most unfavourable findings at the time of the accident. In comparison, the most favourable findings were shown by concussion and first degree crown fracture (score > 70). A comparison to the WHO classification occasionally revealed noticeable score variations within a single WHO type of injury. Generally, a strong interdependence was observed between the evaluations at the time of the accident and at the time of the follow-up examination (P < 0.001). If the score at the time of the accident was equal to or larger than 57, a successful therapy was usually ensured (P < 0.001). The new scoring system enables more complete diagnosis as well as permitting statements to be made concerning prognosis.

An analysis of 58 traumatically intruded and surgically extruded permanent teeth.

Fifty-eight traumatically intruded and mainly surgically extruded permanent teeth were followed up for 3 years and 4 months (mid-term results: 29 teeth) and 9 months (short-term results: 29 teeth) on average. Statistically, the mid-term results showed more cases of severe crown discoloration (54%) than the short-term results (9%), but no difference in pulpal and periodontal healing. Three teeth (5%) were lost. Factors which positively influenced pulpal healing were shallow intrusion depth, intact crown and immaturity of the root. Factors which positively influenced periodontal healing were shallow intrusion depth and minimal surgical manipulation. Alveolar bone healing was positively influenced only by shallow intrusion depth.

Contemporary treatment of the resorbed avulsed tooth: a case report.

This report describes the treatment sequence after traumatic loss of a maxillary central incisor in a 15-year-old patient. Following extraoral root canal treatment and initially successful replantation, the case presented 9 years later with complete root resorption. After augmentation with an autologous mandibular corticocancellous graft, a dental implant was placed in a second stage surgery. The case highlights the challenge facing clinicians in providing the appropriate standard of care for today's treatment options.

Five-year follow-up of internal bleaching.

A 5-year clinical follow-up study was conducted to determine the longevity of originally acceptable results for internal bleaching. The "walking internal bleaching" method is an acceptable technique of lightening discolored anterior teeth to provide an esthetically pleasing match with adjacent teeth. This follow-up study revealed a success rate of 79% for all indications after 5 years. If the indication is limited to one palatal endodontic opening, the total success rate can reach 91%. However, a 98% success rate is common when subjective evaluation of patients is considered. The results clearly indicated that internal bleaching provides long-term success for treatment of discolored nonvital anterior teeth over a period of years and does not have any detrimental effect on dental hard tissue. In ideal cases, if the procedure is performed precisely, the success rate can exceed 90% after five years.

Intrapulpal temperature during preparation with the Er:YAG laser compared to the conventional burr: an in vitro study.

OBJECTIVE: The authors explored whether the preparation with the Er:YAG laser showed a difference in increase of intrapulpal temperature in comparison to the conventional burr. SUMMARY BACKGROUND DATA: The effect of preparation with the Er:YAG laser on the temperature in the pulp is probably the biggest problem in using the laser for preparation of dental hard tissue. METHODS: The effect on the temperature in the pulp was studied on extracted human incisors and canines in vitro in palatinal class I cavities. The temperature during preparation with the Er:YAG laser was compared to that recorded during conventional tactile preparation with a diamond burr. The study was designed so that the pulpal cavity and the measuring probe were kept at a constant temperature of 37 degrees C from the root upward while the crown, which was thermally isolated, was exposed to preparation and cooling agents. RESULTS: During preparation with the laser, there was a temperature drop after a few seconds from 37 degrees C to 25 degrees C to 30 degrees C due to cooling with water and air. Even with trepanation, there was only an increase in temperature in the pulp when the temperature measuring probe was hit directly by the laser beam. With conventional preparation in comparison, even before trepanation there was a rise in temperature to more than 60 degrees C. CONCLUSIONS: The reduction in pain with clinical use of the Er:YAG laser for class V cavities has already been mentioned in publications and could, in addition to the nontactile preparation, be due to the lesser increase in intrapulpal temperature during the laser preparation in comparison to the conventional burr.

Secretoneurin, a novel neuropeptide, in the human dental pulp.

Secretoneurin is a neuropeptide that is stored in and released from primary afferent neurones. By radioimmunoassay and immunohistochemistry, secretoneurin was here demonstrated in the human dental pulp and localized in varicose nerve fibres that were frequently associated with blood vessels. No significant correlation was found between the levels of immunoreactive secretoneurin and immunoreactive calcitonin-gene related peptide. The results suggest that primary afferent neurones of the human dental pulp contain secretoneurin, which may influence local inflammatory responses if it is released together with other neuropeptides.

A study of replanted permanent teeth in different age groups.

The purpose of this study was to evaluate the benefits of replanting avulsed permanent teeth in different age groups. Of the 112 replanted teeth, 103 could be examined after 2.5 years on average. The teeth were divided into three groups: immature teeth (group A), mature teeth in children and adolescents (group B), and mature teeth in adults (group C). Concomitant injuries did not differ statistically between the groups. Extra-alveolar time with unphysiologic storage was longer than 15 min in 81 teeth. The results were statistically different for pulpal healing (A >> B > C), loss of marginal bone (C > A), amount of replacement resorption (A and B > C), alveolar growth inhibition (A > B >> C), local gingivitis (B > A and C) and buccal gingival retraction (C > A and B). Only 3 of 23 extracted teeth were lost because of replacement resorption alone. Only 2 of the 23 extracted teeth showed revascularization of the pulp. The results suggested that replanting avulsed teeth should be considered a temporary solution in children and adolescents. In these patients, the benefit of tooth replantation is mainly the time gained to establish an optimal treatment plan. Mature teeth with a necrotic periodontal ligament replanted in children before the pubertal growth spurt seemed to have the poorest prognosis.

[Replantation of avulsed immature permanent teeth. Results in 39 cases after an average of 2.5 years]. / Replantation totalluxierter unreifer bleibender Zähne. Durchschnittliche 2,5-Jahres-Ergebnisse in 39 Fällen.

The aim of this investigation was a critical assessment of the short- and medium-term results of replantation of immature, avulsed permanent teeth. Thirty-nine teeth were investigated after 2.5 years on average. Only 7 teeth (18%) had been replanted within 5 min after avulsion. Sixteen teeth (41%) showed revascularisation or ingrowth of alveolar bone into the pulp. Twenty-two teeth (56%) showed signs of ankylosis, 6 (15%) had been exfoliated or extracted. Seventeen teeth (77% of the ankylotic ones) exhibited an alveolar growth arrest of 1.5 mm per 10 cm body growth. By planimetric assessment, the yearly loss of root dentin by replacement resorption was about 15%. The appearance was compromised in 11 cases (33%) by severe discoloration. In spite of intense therapeutic effort and partial success, the results must be classified as unsatisfactory. In avulsions of immature permanent teeth, replantation therefore has to be considered an intermediate solution. Since the main reason for a failure is extended extra-oral unphysiologic storage, replantation by lay helpers immediately after the accident should be propagated as a first-aid treatment to improve the situation of the replanted tooth. In addition, more attention should be paid to preserving teeth in tissue cultures before replantation.

Splints made of wire and composite: an investigation of lateral tooth mobility in vivo.

In 103 posttraumatic splints, later tooth mobility was measured with Periotest immediately before and after the routine splint removal. The splints were made of composite resin and an 0.017 X 0.025" orthodontic steel wire. 481 teeth were measured. A statistic evaluation revealed that the immobilisation effect did not exceed normal tooth firmness. Fixation to one neighbouring tooth had less effect than fixation to two. Adjacent tooth gaps reduced the effect. Splint extensions had no influence. With the use of the Periotest device, more than 50% of all teeth with a true mobility of 20 Periotest-units or more were detectable as mobile in spite of the fixed splint.