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European Journal of Paediatric Dentistry Sep 2020Pre-eruptive intra-coronal resorption (PEIR) is a rare condition that can affect children's dentition. Showing the same aspect of dental caries, these lesions are... (Review)
Review
AIM
Pre-eruptive intra-coronal resorption (PEIR) is a rare condition that can affect children's dentition. Showing the same aspect of dental caries, these lesions are diagnosed in non-erupted teeth. The aetiology is not yet defined and no consensus on their treatment is available. Thus, the aim of the present scoping review of the literature was to try to establish a protocol for treatment and management of PEIR defects.
METHODS
The search was performed on Medline via PubMed, Science Direct and EBSCOhost' databases using the appropriate Medical Subject Headings (MESH) terms. Studies that described the PEIR were considered eligible and the data from the selected papers were extracted and analysed independently by two authors.
RESULTS
Out of 172 articles identified in initial research, 15 articles were selected for reviewing. Interventions varied from preventive treatment to extraction, depending on the lesion severity and its proximity to the pulp.
CONCLUSION
Non-operative procedures, conservative approaches and extractions were recommended for the management of PEIR, depending on the extent of the lesions. Overall, further researches should be conducted to explore the effectiveness of the approaches of PEIR management.
Topics: Child; Dental Caries; Dental Pulp; Humans; Tooth Eruption; Tooth Resorption; Tooth, Unerupted
PubMed: 32893657
DOI: 10.23804/ejpd.2020.21.03.13 -
Evidence-based Dentistry Sep 2022Introduction A systematic review of existing evidence to determine if trauma in the primary dentition causes alteration in the development of the underlying permanent... (Review)
Review
Introduction A systematic review of existing evidence to determine if trauma in the primary dentition causes alteration in the development of the underlying permanent dentition.Data sources Six electronic databases (PubMed, Medline, MEDES, Scopus, Lilacs and Embase) were used to search a range of dental terms relating to dental trauma to locate studies between 1972-2020.Study selection Study selection was carried out by two authors by reviewing title, abstract and then full articles. A third author was consulted if consensus for inclusion was needed. Eligibility criteria included all scientific articles concerning sequalae to the human permanent dentition following trauma to the primary dentition. Only English, German and Spanish languages were included. For evaluation, the studies must have satisfied the following: a) minimum sample of 50 children to be representative; b) radiographic examination; and c) appropriate follow-up period up to permanent successor eruption.From 537 studies, 18 studies were identified for consideration in the review, comprising of 13 cross-sectional studies, two cohort studies and three case control studies.Data extraction and synthesis The Newcastle-Ottawa Scale was used to extract data and determine study quality. Only studies determined as high quality were included in the review. Four cross-sectional studies and three case control studies, totalling seven studies, were used. Data from these high-quality studies was summarised into table format.Results Large variation in study sample size existed from 138-753 traumatised teeth and 78-879 children. Both sexes were included in all studies and the children were aged between 0-17 years.Some studies found there was no difference in rate of trauma between girls and boys, while others found there was a higher incidence of trauma in boys than girls. The most frequently traumatised teeth were the upper primary central incisors. Whilst most studies covered all types of primary trauma, two only studied intrusion and one specified the type of primary trauma as luxation or fracture injuries.Whilst some of the studies concluded a higher frequency of defects to permanent teeth following primary intrusion trauma aged four and under, others showed no significant differences between the age of intrusion and the effect to the successor incisor.Enamel defects of the permanent teeth were the most common sequalae with a wide prevalence reported between 4.5-68.8%. Enamel defects were classified as hypoplasia and hypocalcification. Ectopic or altered eruption, crown or root dilacerations and odontoma development were observed less often, with the latter very rarely.Conclusions Primary tooth intrusion trauma causes the highest proportion of sequalae presenting as enamel defects. Younger patients experiencing primary trauma are more likely to obtain damage to the succeeding dentition. The existing quality of evidence is limited due to the observational nature of the studies available.
Topics: Adolescent; Child; Child, Preschool; Cross-Sectional Studies; Dental Enamel Hypoplasia; Dentition, Permanent; Female; Humans; Incisor; Infant; Infant, Newborn; Male; Tooth Injuries; Tooth, Deciduous
PubMed: 36151286
DOI: 10.1038/s41432-022-0808-z -
British Dental Journal Apr 2021
Topics: Dentition; Esthetics, Dental; Smiling
PubMed: 33837314
DOI: 10.1038/s41415-021-2906-2 -
Dental Clinics of North America Jul 2021This article emphasizes the selection criteria for radiographic acquisition in children due to the greater sensitivity of children for radiation compared with adults.... (Review)
Review
This article emphasizes the selection criteria for radiographic acquisition in children due to the greater sensitivity of children for radiation compared with adults. Diagnosis of common pediatric dental conditions, including dental caries, periodontitis, dental anomalies, cysts, tumors, and traumatic dental conditions, are discussed with relevant clinical scenarios.
Topics: Adult; Child; Dental Caries; Dentition, Permanent; Humans; Tooth, Deciduous
PubMed: 34051934
DOI: 10.1016/j.cden.2021.02.009 -
Progress in Orthodontics Sep 2023Clear aligner therapy has become increasingly popular in recent years, although it has encountered several difficulties in premolar extraction treatment. These...
INTRODUCTION
Clear aligner therapy has become increasingly popular in recent years, although it has encountered several difficulties in premolar extraction treatment. These difficulties include anterior dentition, lingual tipping and extrusion. The design of the present clinical scheme usually set a tiny space between the anterior teeth before retraction in order to obtain an ideal outcome. The objective of our research was to analyze the effect of the existing spaces during retraction.
METHODS
Models including maxillary dentition without first premolars, maxilla, periodontal ligaments, gingiva, or aligners were constructed and imported to an ANSYS workbench. Five groups of models were created: without spaces and with 0.25, 0.50, 0.75 and 1.00 mm spaces between the anterior dentition. A 0.20 mm retraction step was applied to all the groups.
RESULTS
As the spaces between the anterior dentition increased, the bowing effect of the aligner caused by the passive forces decreased gradually. Accordingly, the degree of extrusion of the anterior dentition was alleviated significantly, while sagittal movement was reduced. However, the overall movement tended to be a bodily displacement rather than tipping. Meanwhile, maximum Von Mises stress of the periodontal ligaments (PDLs) was markedly decreased.
CONCLUSION
These analyses indicate that spaces between the anterior dentition during anterior retraction are beneficial for decreasing the tendency for extrusion of the anterior dentition and require provision of anchorage. Appropriate spaces can be designed to lest the lingual tipping and extrusion effect of the anterior teeth while simultaneously reducing the maximum stresses on PDLs.
Topics: Humans; Bicuspid; Incisor; Finite Element Analysis; Tooth Movement Techniques; Malocclusion; Orthodontic Appliances, Removable
PubMed: 37747552
DOI: 10.1186/s40510-023-00484-1 -
The Journal of Craniofacial Surgery Jun 2021The stage of maturation of the pediatric facial skeleton at the time of injury has a significant impact on both facial fracture patterns and management strategies. For...
INTRODUCTION
The stage of maturation of the pediatric facial skeleton at the time of injury has a significant impact on both facial fracture patterns and management strategies. For instance, the relative prominence of the pediatric cranium during the early years of life affords protection to the structures of the midface, whereas delayed aeration of the frontal sinuses may predispose younger patients to frontal bone fractures. The dentition status of a pediatric patient may have similar implications in the setting of facial fracture. In this study, the authors examine the effect of dentition status on facial fracture patterns and management strategies at an urban, level 1 trauma center.
METHODS
A retrospective chart review was performed for all cases of facial fracture occurring in the pediatric patient population at a level 1 trauma center (University Hospital in Newark, NJ) between 2002 and 2014. A database including patient demographics, facial fracture, and concomitant injury patterns, and operative management data was constructed and analyzed.
RESULTS
A total of 72 patients with mixed dentition met inclusion criteria for our study and were compared against patients with primary (n = 35) and permanent (n = 349) dentition. The mean age at presentation was 9.2 years, with a male predominance of 68%. The most common fracture etiology was pedestrian struck accident (n = 23), fall (n = 21), motor vehicle collision (n = 12), and assault (n = 9). The most frequently identified facial fractures were that of the orbit (n = 31), mandible (n = 21), nasal bone (n = 19), and frontal sinus (n = 14). Additionally, 8 Le Fort and 4 nasoorbitoethmoid fractures were identified. Twenty-one patients (29%) required operative management for 1 or more facial fractures. Operative intervention was required in 38% of mandibular fractures, with 6 patients requiring only maxillomandibular fixation and 2 requiring open reduction and internal fixation with titanium plating. Nine cases of orbital fracture (29%) were managed operatively - 4 with absorbable plates, 3 with Medpor implants, and 8 with titanium plating. Management of all nasal fractures requiring operative intervention was accomplished through closed reduction. Concomitant injuries included traumatic brain injury (TBI) (n = 35), skull fracture (n = 24), intracranial hemorrhage (ICH) (n = 20), and long bone fracture (n = 12). Seventeen patients required admission to the intensive care unit. Patients with mixed dentition were significantly more likely to sustain frontal sinus and Le Fort fractures (P < 0.01), as well as skull fracture, ICH, and TBI (P < 0.01) as compared to those with permanent dentition.
CONCLUSIONS
The dentition status of a pediatric patient may have significant implications in both patterns of injury and operative management strategies in the setting of acute facial trauma. Our study finds that Le Fort and frontal sinus fractures were significantly more common in patients with mixed dentition. Severe concomitant injuries such as ICH and TBI were also significantly more likely in this cohort. A patient's dentition status may also play a role in the decision for ridged fixation of mandibular and orbital fractures, as well as the method of maxillomandibular fixation in maxillary and mandibular alveolar fracture.
Topics: Dentition; Dentition, Mixed; Facial Bones; Female; Humans; Male; Retrospective Studies; Skull Fractures
PubMed: 33427769
DOI: 10.1097/SCS.0000000000007424 -
Evidence-based Dentistry Mar 2024Searches were carried out using PubMed/MEDLINE and Web of Science databases between January 2008 and January 2023. Only articles in English language were included....
DATA SOURCES
Searches were carried out using PubMed/MEDLINE and Web of Science databases between January 2008 and January 2023. Only articles in English language were included. Boolean operators were used to search: "permanent teeth" OR "permanent tooth" OR "permanent dentition" AND "deep caries" OR "stepwise" AND "partial caries removal OR "stepwise caries removal" OR "pulp vitality" OR "healing rate".
STUDY SELECTION
Inclusion criteria were randomised controlled trials, which compared the total removal of carious tissue with either a selective or stepwise removal in permanent teeth with deep carious lesions. Criteria also required a follow up of at least 6 months and publications in English. Exclusion criteria were articles in other languages, articles not comparing different types of total or selective caries removal and articles published before January 2008.
DATA EXTRACTION AND SYNTHESIS
Data extraction followed PRISMA guidelines. Two reviewers independently screened articles, analysing titles and abstracts using Rayyan's Intelligent Systematic Review Platform. They also collected data and risk of bias assessed using the Cochrane Risk of Bias Tool for Randomised Trials, dividing articles into high risk of bias, few concerns and low risk of bias. A third researcher resolved conflict or doubt in case of divided opinions.
RESULTS
In total, 105 articles were identified, and 10 duplicates removed. 95 articles were reviewed by title and abstract and 75 of these did not meet the inclusion criteria. 20 articles were then read, excluding a further 15 due to comparing only partial removal or non-selective caries removal or absence of numerical data. This left 5 articles which met eligibility criteria. These were randomised controlled trials between 2010 and 2021. Follow up ranged from 1 month to 5 years. The inclusion and exclusion criteria in all studies had similar clinical parameters. 3 studies performed management only on permanent molars, whilst the rest also included management on permanent incisors/canines/premolars and molars. Management of caries was divided into non-selective caries removal vs partial caries removal (either selective or stepwise). All but 2 studies included specific information about the materials used. Liners were calcium hydroxide or Dycal, provisional restorations were glass ionomer cements or Ketax Molar and definitive restorations were Herculite Tetric N-Ceram resin, Ivolclar Vivadent or amalgam. Clinical success or failure was measured using pulp vitality, absence of periapical lesions, radiographic analysis and lack of symptoms. Clinical follow up was evaluated by external examiners, although 2 studies did not specify this clearly. There were a variety of tools used for statistical analysis in each study.
CONCLUSIONS
When comparing non-selective caries removal with either selective or stepwise, 3 studies proposed statistically significant differences in terms of longevity, marginal integrity and success rate of restorations. 1 study stated inexistence of statistically relevant divergences between procedures. Non-selective caries removal is not highly recommended for deep carious lesions and may be considered invasive and risks pulpal exposure. Both selective and stepwise removal are considered conservative approaches. Selective removal is considered the best management option in the short term (with 1.5 years follow up), predominantly related to a lower risk of pulpal exposure. At 5 years, however, the results of selective were similar to those of non-selective, accepting the null hypothesis. There were also no differences in success rates for materials used for definitive restorations.
Topics: Humans; Dental Caries Susceptibility; Dental Caries; Dentition, Permanent; Molar; Dental Amalgam
PubMed: 38253747
DOI: 10.1038/s41432-024-00973-0 -
Progress in Orthodontics Nov 2023To investigate the displacement of dentition and stress distribution on periodontal ligament (PDL) during retraction and intrusion of anterior teeth under different...
The displacement of teeth and stress distribution on periodontal ligament under different upper incisors proclination with clear aligner in cases of extraction: a finite element study.
OBJECTIVES
To investigate the displacement of dentition and stress distribution on periodontal ligament (PDL) during retraction and intrusion of anterior teeth under different proclination of incisors using clear aligner (CA) in cases involving extraction of the first premolars.
METHODS
Models were constructed, consisting of the maxilla, PDLs, CA and maxillary dentition without first premolars. These models were then imported to finite element analysis (FEA) software. The incisor proclination determined the division of the models into three groups: Small torque (ST) with U1-SN = 100°, Middle torque (MT) with U1-SN = 110°, and High torque (HT) with U1-SN = 120°. Following space closure, a 200 g intrusion force was applied at angles of 60°, 70°, 80°, and 90° to the occlusal plane, respectively.
RESULTS
CA therapy caused lingual tipping and extrusion of incisors, mesial tipping and intrusion of canines, and mesial tipping of posterior teeth in each group. As the proclination of incisors increased, the incisors presented more extrusion and minor retraction, and the teeth from the canine to the second molar displayed an increased tendency of intrusion. The peak Von Mises equivalent stress (VMES) value successively decreased from the central incisor to the canine and from the second premolar to the second molar, and the VMES of the second molar was the lowest among the three groups. When the angle between the intrusion force and occlusal plane got larger, the incisors exhibited greater intrusion but minor retraction.
CONCLUSIONS
The "roller coaster effect" usually occurred in cases involving premolar extraction with CA, especially in patients with protruded incisors. The force closer to the vertical direction were more effective in achieving incisor intrusion. The stress on PDLs mainly concentrated on the cervix and apex of incisors during the retraction process, indicating a possibility of root resorption.
Topics: Female; Humans; Periodontal Ligament; Incisor; Finite Element Analysis; Molar; Orthodontic Appliances, Removable
PubMed: 37981597
DOI: 10.1186/s40510-023-00491-2 -
Journal of Prosthodontics : Official... Jul 2019The oral rehabilitation of adolescent patients with amelogenesis imperfecta (AI) is complex due to the presence of mixed dentition with altered eruption sequence. In... (Review)
Review
The oral rehabilitation of adolescent patients with amelogenesis imperfecta (AI) is complex due to the presence of mixed dentition with altered eruption sequence. In this article, the interdisciplinary treatment approach for adolescent patients with AI is discussed. The types and timing of treatments at various stages of growth are described through a literature review on this topic. AI is an inherited condition that disturbs the development of the enamel structure. Because of the presence of mixed dentition, definitive treatment options often have to be delayed until eruption of permanent dentition is complete, requiring careful treatment coordination and proper sequencing between different dental disciplines starting at a young age. Adolescent patients require prosthodontic treatment design that can be adapted to the changes in arch shapes, sizes, interarch relationship, and esthetic needs. AI patients are often challenged with both excessive and limited restorative spaces within the same arch due to the abnormal growth patterns, enamel structure, tooth size, and tooth shape. Therefore, careful determination of the required restorative space is critical to ensure optimal prognosis. This clinical report discusses treatment recommendations, timing of various treatment modalities, and involvement of appropriate interdisciplinary teams for managing adolescent patients.
Topics: Adolescent; Amelogenesis Imperfecta; Dental Enamel; Esthetics, Dental; Humans; Tooth; Tooth Eruption
PubMed: 31054208
DOI: 10.1111/jopr.13069 -
Dental Traumatology : Official... Oct 2023The 2020 International Association of Dental Traumatology (IADT) Guidelines feature several important changes in the treatment recommendations for traumatic dental... (Review)
Review
The 2020 International Association of Dental Traumatology (IADT) Guidelines feature several important changes in the treatment recommendations for traumatic dental injuries (TDIs) from the previous 2012 iteration of these Guidelines. This evidence-based narrative review aims to provide a detailed appraisal of five specific changes incorporated in the 2020 IADT Guidelines, based on the available literature evidence that may have prompted these changes. The paper discusses three excellent additions/changes to the new Guidelines: (i) inclusion of a core outcome set for reporting TDIs; (ii) more conservative management of primary dentition TDIs including the changed recommendations for radiation exposure and managing primary dentition luxation injuries; and (iii) the changes in the treatment recommendations for permanent dentition avulsion injuries. The paper further debates whether two other changes made in the current IADT Guidelines for-(i) intrusion injuries in immature teeth; and (ii) complicated crown-root fractures in mature teeth-have sufficient evidence to support the changed recommendations.
Topics: Humans; Tooth Fractures; Tooth Avulsion; Traumatology; Fractures, Bone; Tooth Crown; Dentition, Permanent; Tooth Injuries
PubMed: 37408436
DOI: 10.1111/edt.12858