Cone beam computed tomography indications for interdisciplinary therapy planning of impacted canines.

OBJECTIVE: To investigate how cone beam computed tomography (CBCT) affects the therapeutic planning of impacted maxillary canines. STUDY DESIGN: A total of 132 impacted canines from 89 pediatric patients were collected from 3 specialist clinics in Stockholm, Sweden. An interdisciplinary therapy planning team consisting of 5 dental specialists evaluated each case and chose their preferred treatment alternative, initially without and later with CBCT images, to decide whether CBCT was justified for therapy planning. Predefined variables measurable using only 2-dimensional (2D) assessments were analyzed using stepwise logistic regression analyses. RESULTS: The CBCT was considered indicated in 47% of the cases. Additional information from CBCT led to a treatment decision change in 9.8%. Significant 2D predictors for CBCT justification were horizontal canine angulation compared with vertical angulation (odds ratio [OR] = 10.9), extraction strategy involvement (OR = 6.7), and buccally positioned canines compared with palatal (OR = 5.3), central (OR = 25.0), and distal or uncertain positions (OR = 7.7). CONCLUSIONS: The benefit-risk assessment of CBCT for impacted canines may be reinforced by performing and applying justification decisions for CBCT acquisition at the therapeutic thinking level. If preliminary treatment planning motivates further in-depth investigation of either root status or tooth location, a CBCT is indicated.

What are the important outcomes in traumatic dental injuries? An international approach to the development of a core outcome set.

BACKGROUND/AIMS: There are numerous treatment options following traumatic dental injury (TDI). Systematic reviews of different treatments are challenging owing to the diversity of outcomes reported between clinical studies. This issue could be addressed through the development and implementation of a agreed and standardized collection of outcomes known as a core outcome set (COS). The aim of this study was to develop a COS for TDI in children and adults. The secondary aim was to establish what, how, when and by whom these outcomes should be measured. MATERIALS AND METHOD: The project was registered with Core Outcomes Measures in Effectiveness Trials (COMET). A web-based survey was developed to capture the opinions of dentists globally as to which outcomes should be recorded. A list of outcomes was entered into a Delphi Survey and scored by an Expert Working Group (EWG). The scoring was repeated, followed by conference calls to discuss, refine and finalize the COS. The EWG split into small groups of subject-specific experts to determine how, when and by whom each outcome would be measured. RESULTS: The questionnaire was completed by 1476 dentists. The EWG identified 13 core outcomes to be recorded for all TDI's. An additional 10 injury-specific outcomes were identified. A table has been produced for each outcome detailing what, when, and how each outcome should be recorded. CONCLUSIONS: A robust consensus process was used to develop an international COS for TDI in children and adults. This includes both generic and injury-specific outcomes across all identified domains.

Guidelines for the Management of Traumatic Dental Injuries: 3. Injuries in the Primary Dentition.

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.

Guidelines for the Management of Traumatic Dental Injuries: 3. Injuries in the Primary Dentition.

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.

Scandinavian multicenter study on the treatment of 168 patients with 230 intruded permanent teeth - a retrospective cohort study.

BACKGROUND/AIM: The aim of the study was to evaluate the survival of intruded permanent teeth related to treatment in a large number of patients, with special focus on development of pulp necrosis and replacement resorption (ankylosis-related resorption). MATERIALS AND METHODS: The material consisted of 168 patients (mean age 9.6 years) with 230 intruded permanent teeth from dental trauma clinics in Copenhagen, Denmark, Stockholm, Sweden, and Oslo, Norway. The degree of intrusion was classified as mild (1-<3 mm), moderate (3-7 mm), and severe (>7 mm). Root development was categorized with respect to root formation and development of the apex into three groups of increasing tooth maturity: very immature, immature, and mature. RESULTS: Awaiting re-eruption was the treatment of choice in 107 teeth (47%), orthodontic repositioning in 28 (12%) and surgical repositioning in 95 (41%) teeth. Pulp necrosis was diagnosed in 173 teeth (75%), infection-related root resorption in 57 (25%) and replacement resorption in 50 teeth (22%). Very immature teeth, teeth diagnosed with mild intrusion, and teeth awaiting re-eruption had significantly (P < 0.05) fewer complications. In a stepwise discriminant function analysis, choice of treatment, root development, and degree of intrusion were significantly (P < 0.05) associated with the development of replacement resorption. Root development and degree of intrusion were significantly (P < 0.05) associated with the development of pulp necrosis. CONCLUSION: This study indicates that root development and degree of intrusion may be important for the development of pulp necrosis as well as replacement resorption, whereas choice of treatment only seems to influence the development of replacement resorption in intruded permanent teeth. Awaiting re-eruption resulted in the lowest risk for developing replacement resorption.

Long-term follow up of 103 ankylosed permanent incisors surgically treated with decoronation--a retrospective cohort study.

BACKGROUND/AIM: Decoronation is a technique developed in 1984 to remove ankylosed teeth and increase marginal bone levels in young, growing individuals. This retrospective cohort study evaluates marginal bone development after decoronation in relation to gender and age at treatment. MATERIALS AND METHODS: The study evaluated all 95 patients with 103 ankylosed permanent incisors treated with decoronation at the Eastmaninstitutet Department of Pediatric Dentistry during 1978-1999. Mean age of the patients was 10.7 years (6.8-17.8) at the time of trauma and 14.9 years (9.3-22.0) at decoronation. The mean follow-up period was 4.6 years (1.0-19.3 years). The study evaluated development of the marginal alveolar bone level with a three-point scoring system: 1 = Unchanged or reduced alveolar bone level, 2 = A moderate increase in alveolar bone level, and 3 = A considerable increase in alveolar bone level. The final group for statistical evaluation comprised 75 patients: 56 boys and 19 girls who had only one tooth decoronated. Kappa statistics showed almost complete agreement between the two observers (κ = 0.90). RESULTS: Bone level changes were significantly correlated (P < 0.05) to gender and age at treatment. In decoronations performed after the age of 16, bone levels were unchanged or reduced, while decoronations performed at a mean age of 14.6 years in boys and 13 years in girls yielded a considerable increase in bone levels. CONCLUSION: This study indicates that age at decoronation is an important factor for favorable development of the alveolar ridge and that decoronation should be performed earlier in girls.

The effect of topical treatment with doxycycline compared to saline on 66 avulsed permanent teeth--a retrospective case-control study.

BACKGROUND/AIM: Tooth avulsion in young growing individuals is an uncommon but very severe dental trauma. The aim of this retrospective case-control study was to evaluate the effect of topical treatment with doxycycline on avulsed permanent teeth compared with treatment with only saline regarding pulp survival and periodontal healing. MATERIAL AND METHOD: Sixty-six avulsed teeth in 50 patients (34 boys and 16 girls) between the ages six and 18 years were included in this study. Thirty teeth were soaked in a 0.05 mg ml(-1) doxycycline solution for 5 min, before replantation and 36 teeth in saline solution. Root development was categorized with respect to root formation and development of the apex into three groups, one-half-root formation to full root formation with open apex, full root formation with half-closed apex and full root formation with closed apex. Pulp survival and periodontal healing were assessed as successful when at the end of the observation period no pulp necrosis or ankylosis-related resorption was diagnosed. The mean observation time was 48 months. RESULTS: In the doxycycline group, 27 were diagnosed with pulp necrosis, 15 with ankylosis-related resorption and nine were extracted. In the saline group, 30 were diagnosed with pulp necrosis, 23 with ankylosis-related resorption and 11 were extracted. Regarding pulp survival and periodontal healing, no significant differences were found between the two groups. Teeth with immature root development showed significantly less pulp necrosis (P < 0.05) compared to teeth with full root formation regardless if treated topically with doxycycline or not. No significant differences were found between the two groups regarding age, storage, root development, splinting duration and observation time although the saline group had significantly longer extra-oral time (P < 0.001) than the doxycycline group. CONCLUSIONS: This study indicates that avulsed permanent teeth soaked in doxycycline do not show a better treatment outcome regarding pulp survival and periodontal healing compared with avulsed teeth placed only in saline solution. This finding is consistent regardless of root development, storage and extra-oral time.

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

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.

Intrusive luxation of 60 permanent incisors: a retrospective study of treatment and outcome.

BACKGROUND/AIM: Intrusive luxation in the permanent dentition is an uncommon injury but it is considered one of the most severe types of dental trauma because of the risk for damage to the periodontal ligament, pulp and alveolar bone. Management of intrusive luxation in the permanent dentition is controversial. The purpose of this study was to evaluate pulp survival and periodontal healing in intrusive luxated permanent teeth in relation to treatment alternatives, degree of intrusion and root development. MATERIAL AND METHOD: The material consisted of 60 intruded permanent teeth in 48 patients (32 boys and 16 girls) aged 6-16 years (mean 9.4, median 9.0). The observation time was 6-130 months (mean 47.8, median 40.0). The analysed treatments were spontaneous re-eruption (17 teeth), orthodontic extrusion (12 teeth) and surgical reposition (31 teeth). The degree of intrusion was registered as mild (0-3 mm), moderate (4-6 mm) and severe (≥7 mm). Root development was categorized with respect to root formation and development of the apex into four stages; one-quarter to three-quarters root formation, full root formation with open apex, full root formation with half-closed apex and full root formation with apex closed. Ankylosis-related resorption with pulp necrosis was diagnosed in 20 teeth, ingrowth of bone apically in two teeth, pulp necrosis without ankylosis-related resorption in 23 teeth and pulp revitalization occurred in 15 teeth. RESULTS: Significant correlations to the treatment outcome were root development (P = 0.03) and degree of intrusion (P = 0.03). CONCLUSIONS: No firm conclusion could be drawn for the difference in outcome between orthodontic extrusion and surgical reposition. To conclude, evaluation of the prognosis for intruded teeth should be based on the stage of root development and degree of intrusion. In teeth with immature root development, no active treatment appears to result in fewer healing complications.

Long-term follow-up of tooth mobility in maxillary incisors with orthodontically induced apical root resorption.

The aim of the study was to evaluate tooth mobility in relation to root length and alveolar bone support in maxillary incisors 10-25 years after orthodontic treatment, and to monitor the development during 5 years in a sub-sample. Thirty-six patients, seven males and 29 females with one or more severely resorbed maxillary incisors, a total of 139 teeth, were examined. At re-examination, 11 patients were older than 40 years, 20 were between 30 and 39, and five younger than 30 years. Root length, alveolar bone height, and crestal alveolar bone level were measured on standardized intraoral radiographs. Tooth mobility was registered using Miller's index and the periotest method. Statistical analysis was undertaken using a t-test for dependent and independent samples, and chi-square tests for comparison of the relationship between the periotest values (PTVs) and the variables periodontal pocket depth, gingival index, incisal facets, interferences, and anamnesis. The majority of the teeth were stable. The correlation between root length and alveolar bone height was high, with minimal changes of marginal bone support. Extremely resorbed incisors with a root length less than 10 mm had significantly higher PTV than teeth with longer roots and greater bone support. In the sub-sample, tooth mobility was followed in 16 patients, two males and 14 females, with 62 maxillary incisors over a 5-year period. The PTV increased significantly on average, particularly in teeth with extreme resorption. Increasing mobility can be expected with age in teeth with extremely resorbed roots. Teeth with a root length > or =10 mm and a healthy periodontium remain stable.

Rate of infraposition of reimplanted ankylosed incisors related to age and growth in children and adolescents.

In growing individuals, infraposition of a reimplanted, ankylosed tooth may disrupt normal alveolar development and compromise prosthetic treatment. The aims of this study were to analyze the rate of infraposition of ankylosed incisors in growing subjects and to provide guidelines for the timing of extraction. The subjects comprised 30 boys and 12 girls, selected consecutively from patients on annual post-trauma follow-up, and observed for periods ranging from 1 to 10 years. Only patients with one replanted ankylosed maxillary central incisor were included, the homologous teeth with healthy periodontal ligaments serving as controls. Growth intensity was evaluated from analyses of annual body height measurements. The following four periods were established: before the growth spurt, from initial to maximal growth spurt, from maximal growth spurt to the end and after the growth spurt. In 11 patients, cephalograms were taken at diagnosis and at extraction. Progression of infraposition varied individually. Diagnosis before the age of 10 or before the growth spurt was associated with very high risk of severe infraposition. In these cases the ankylosed tooth should be removed within 2-3 years. If ankylosis develops during the growth spurt, the tooth should be monitored regularly, but no intervention is indicated provided the adjacent teeth do not tilt and infraposition is minor or stable. Annual body height measurements, indicating the intensity of skeletal growth, are an aid to assessment. Cephalometric radiographs are important for evaluating the direction of growth of the jaws since there is a difference between horizontal and vertical growers.

Estimativa de reabsorçäo radicular em relaçäo a duas condutas de tratamento ortodôntico: um estudo clínico experimental / Evaluation of root resorption in relation to two orthodontic treatment regimes: a clinical experimental study

O propósito desta pesquisa consistiu em avaliar o efeito que uma interrupçäo temporaria no tratamento ortodontico exerce sobre os dentes nos quais foi diagnosticada uma reabsorçäo radicular apical após um período inicial de 6 meses de tratamento com aparelho ortodôntico fixo. Quarenta pacientes com reabsorçäo radicular apical inicial em 62 incisivos superiores foram incluídos no estudo. Em 20 pacientes a mecanoterapia obedeceu o planejamento original e em 20 pacientes o tratamento ativo foi interrompido durante um período de 2-3 meses. Após este período de pausa, o tratamento ativo foi reiniciado. A avaliaçäo da reabsorçäo radicular apical foi realizada por intermedio de radiografias periapicais padronizadas tiradas com posicionadores individuais de filme. A magnitude da reabsorçäo radicular foi significantemente menor nos pacientes tratados sem interrupçäo da mecanoterapia