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Dental Traumatology : Official... Aug 2020Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations of these teeth are the most commonly... (Review)
Review
Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations of these teeth are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning, and follow up are important for achieving a favorable outcome. Guidelines should assist dentists and patients in decision making and in providing the best care possible, both effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. These Guidelines represent the best current evidence based on literature search and expert 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 cover the management of fractures and luxations of permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.
Topics: Child; Dentition, Permanent; Fractures, Bone; Humans; Tooth Avulsion; Tooth Fractures; Tooth Injuries; Traumatology; Young Adult
PubMed: 32475015
DOI: 10.1111/edt.12578 -
International Journal of Environmental... Sep 2021The need to rehabilitate severely compromised teeth is frequent in daily clinical practice. Tooth extraction and replacement with dental implant represents a common... (Review)
Review
The need to rehabilitate severely compromised teeth is frequent in daily clinical practice. Tooth extraction and replacement with dental implant represents a common treatment choice. However, the survival rate for implants is inferior to teeth, even if severely damaged but properly treated. In order to reestablish a physiological supracrestal tissue attachment of damaged teeth and to arrange an efficient ferrule effect, three options can be considered: crown lengthening, orthodontic extrusion and surgical extrusion. Crown lengthening is considered an invasive technique that causes the removal of part of the bony support, while both orthodontic and surgical extrusion can avoid this inconvenience and can be used successfully in the treatment of severely damaged teeth. The aim of the present narrative review is to compare advantages, disadvantages, time of therapy required, contraindications and complications of both techniques.
Topics: Crowns; Humans; Orthodontic Extrusion; Tooth; Tooth Fractures
PubMed: 34574454
DOI: 10.3390/ijerph18189530 -
Dental Traumatology : Official... Aug 2020Traumatic dental injuries (TDIs) occur most frequently in children and young adults. Older adults also suffer TDIs but at significantly lower rates than individuals in... (Review)
Review
Traumatic dental injuries (TDIs) occur most frequently in children and young adults. Older adults also suffer TDIs but at significantly lower rates than individuals in the younger cohorts. Luxation injuries are the most common TDIs in the primary dentition, whereas crown fractures are more commonly reported for the permanent teeth. Proper diagnosis, treatment planning and follow up are very important to assure a favorable outcome. These updates of the International Association of Dental Traumatology's (IADT) Guidelines include a comprehensive review of the current dental literature using EMBASE, MEDLINE, PUBMED, Scopus, and Cochrane Databases for Systematic Reviews searches from 1996 to 2019 and a search of the journal Dental Traumatology from 2000 to 2019. The goal of these guidelines is to provide information for the immediate or urgent care of TDIs. It is understood that some follow-up treatment may require secondary and tertiary interventions involving dental and medical specialists with experience in dental trauma. As with previous guidelines, the current working group included experienced investigators and clinicians from various dental specialties and general practice. The current revision represents the best evidence based on the available literature and expert opinions. In cases where the published data were not conclusive, recommendations were based on the consensus opinions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. It is understood that guidelines are to be applied using careful evaluation of the specific clinical circumstances, the clinician's judgment, and the patient's characteristics, including the probability of compliance, finances and a clear understanding of the immediate and long-term outcomes of the various treatment options vs non-treatment. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.
Topics: Aged; Child; Dentition, Permanent; Humans; Tooth Avulsion; Tooth Fractures; Tooth Injuries; Tooth, Deciduous; Traumatology; Young Adult
PubMed: 32472740
DOI: 10.1111/edt.12574 -
International Endodontic Journal May 2022Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical... (Review)
Review
Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is crucial in identifying teeth that may be susceptible. Thorough clinical examination with magnification and co-axial lighting is essential in identifying VRFs, and although CBCT is unable to reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, and therefore, increases the probability of correct diagnosis and management. The prevalence of VRFs in root filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre-existing fractures and biochemical effects of loss of vitality is highly relevant. Careful assessment of the occlusal scheme, presence of deflective contacts and identification of parafunctional habits are imperative in both preventing and managing VRFs. Furthermore, anatomical factors such as root canal morphology may predispose certain teeth to VRF. The influence of access cavity design and root canal instrumentation protocols should be considered although the impact of these on the fracture resistance of root filled teeth is not clearly validated. The post-endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed 'passively' and excessive 'post-space' preparation should be avoided. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. Currently, there are limited options other than extraction for the management of VRF, although root resection may be considered in multi-rooted teeth. Innovative techniques to 'repair' VRFs using both orthograde and surgical approaches require further research and validation. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, together with expedient and appropriate post-endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs.
Topics: Cone-Beam Computed Tomography; Humans; Root Canal Obturation; Root Canal Therapy; Tooth Fractures; Tooth Root; Tooth, Nonvital
PubMed: 35338655
DOI: 10.1111/iej.13737 -
Stomatologija 2014. The aim was to overview the etiology, prevalence and possible outcomes of dental trauma. (Review)
Review
OBJECTIVE
. The aim was to overview the etiology, prevalence and possible outcomes of dental trauma.
MATERIAL AND METHODS
An electronic search of Medline (PubMed), Cochrane, SSCI (Social Citation Index), SCI (Science Citation Index) databases from 1995 to the present, using the following search words: tooth injuries, tooth trauma, traumatized teeth, dental trauma, dentoalveolar trauma, oral trauma, epidemiology, etiology, prevalence, prevention, pulp necrosis, inflammatory resorption, ankylosis, cervical resorption, was performed.
RESULTS
During last decade traumatic dental injuries were recognized as public dental health problem worldwide. Prevalence of traumatic dental injuries varies between countries. According to the existing data they are more prevalent in permanent than in primary dentition. All treatment procedures in case of dental trauma are directed to minimize undesired consequences despite that treatment of traumatic dental injuries in the young patient is often complicated and can continue during the rest of his/her life. The changing lifestyle and requirements of modern society lead to an emergence of new patterns of dental trauma. A regular update of knowledge in dental traumatology is required.
Topics: Age Factors; Alveolar Process; Global Health; Humans; Risk Factors; Tooth Avulsion; Tooth Fractures; Tooth Injuries; Treatment Outcome
PubMed: 24824054
DOI: No ID Found -
Brazilian Oral Research Aug 2017Composites resins have become the first choice for direct anterior and posterior restorations. The great popularity is related to their esthetic appearance and reduced... (Review)
Review
Composites resins have become the first choice for direct anterior and posterior restorations. The great popularity is related to their esthetic appearance and reduced need of sound tissue removal as compared with former treatments. Several studies have demonstrated that composite restorations may last long in clinical service. In this review we discuss the factors playing a role on the long-term longevity. Composite restorations have demonstrated a good clinical performance with annual failure rates varying from 1% to 3% in posterior teeth and 1% to 5% in anterior teeth. Factors related to the patients such as caries risk and occlusal stress risk, in addition to socioeconomic factors, may affect the survival significantly. Characteristics of the clinical operators, particularly their decision making when it comes to observing or approaching an existing restoration, are decisive for longevity. Cavity features such as the number of restored walls, composite volume, and presence of endodontic treatment are of major importance and may dictate the service time of the restorative approach. The choice of restorative composite seems to have a minor effect on longevity provided that appropriate technical procedures are used. The main reasons for failure in posterior teeth are secondary caries and fracture (restoration or tooth/restoration), while in anterior teeth esthetic concerns are the main reasons leading to restoration failures. Composite resin restorations can be considered a reliable treatment as long as both the professional and the patient are aware of the factors involved in restoration failures.
Topics: Composite Resins; Dental Caries; Dental Restoration Failure; Dental Restoration, Permanent; Humans; Risk Factors; Time Factors; Tooth Fractures
PubMed: 28902236
DOI: 10.1590/1807-3107BOR-2017.vol31.0056 -
Indian Journal of Dental Research :... 2020Laboratory reports show that fiber-reinforced composites have improved fracture resistance over traditional composites. However, limitations in the biomechanics of tests...
BACKGROUND
Laboratory reports show that fiber-reinforced composites have improved fracture resistance over traditional composites. However, limitations in the biomechanics of tests to evaluate the fracture resistance of fiber-reinforced composites need to be considered for accurate clinical applications.
AIM
To assess the fracture resistance of particulate filler composites, glass fiber-reinforced composites, and polyethylene-fiber reinforced composites by analyzing the different fracture types and failure patterns.
MATERIALS AND METHODS
A standardized incisal (Group I) and mesioincisal fractures (Group II) were prepared on human maxillary central incisors. The test samples were further subdivided according to the restorative material used; particulate filler composites (Filtek Z 250), glass fiber-reinforced composites (fibre splint), and polyethylene-reinforced composites (Ribbond). The type of fractures was evaluated under the stereomicroscope and the failure patterns were analyzed using the graphical output from Universal Testing Machine.
STATISTICAL ANALYSIS
The Chi-square test of association was used to test the association between fiber-reinforced composites and fracture resistance of tooth restoration complex.
RESULTS
No statistical association was observed between fiber-reinforced composites to the type of fractures in both incisal (P = 0.29) and mesioincisal restoration (P = 0.27). A significant association was observed between the fiber-reinforced composites to the failure patterns in both the incisal (P = 0.005) and mesioincisal restoration (P = 0.007).
CONCLUSION
The glass and polyethylene fiber-reinforced composites showed improved fracture resistance properties than the traditional particulate filler composites in both incisal and mesioincisal restorations.
Topics: Composite Resins; Dental Materials; Dental Restoration Failure; Dental Restoration, Permanent; Dental Stress Analysis; Glass; Humans; Materials Testing; Stress, Mechanical; Tooth Fractures
PubMed: 32246697
DOI: 10.4103/ijdr.IJDR_465_18 -
Dental Traumatology : Official... Jun 2022An accurate, clear, and easy-to-use traumatic dental injury (TDI) classification and definition system is a prerequisite for proper diagnosis, study, and treatment....
An accurate, clear, and easy-to-use traumatic dental injury (TDI) classification and definition system is a prerequisite for proper diagnosis, study, and treatment. However, more than 50 classifications have been used in the past. The ideal solution would be that TDIs are adequately classified within the International Classification of Diseases (ICD), endorsed by the World Health Organization (WHO). TDI classification provided by the 11th Revision of the ICD (ICD-11), released in 2018, and previous Revisions, failed to classify TDIs satisfactorily. Therefore, in December 2018, a proposal was submitted by Dr's Stefano Petti, Jens Ove Andreasen, Ulf Glendor, and Lars Andersson, to the ICD-11, asking for a change of the existing TDI classification. Proposal #2130 highlighted the TDI paradox, the fifth most frequent disease/condition neglected by most public health agencies in the world, and the limits of ICD-11 classification. Namely, injuries of teeth and periodontal tissues were located in two separate blocks that did not mention dental/periodontal tissues; infraction, concussion, and subluxation were not coded; most TDIs lacked description; and tooth fractures were described through bone fracture descriptions (e.g., comminuted, compression, and fissured fractures). These limitations led to TDI mis-reporting, under-reporting, and non-specific reporting by untrained non-dental healthcare providers. In addition, no scientific articles on TDIs, present in PubMed, Scopus, and Web-of-Science, used the ICD classification. Proposal #2130 suggested to adopt the Andreasen classification, the most widely acknowledged classification used in dental traumatology. The Proposal was reviewed by two WHO teams, two scientific Committees, one WHO Collaborating Center, and the Department of Non-Communicable Disease Prevention at WHO headquarters, and it underwent two voting sessions. In March 2022, the Andreasen classification was accepted integrally. A new entity was generated, called NA0D, "Injury of teeth or supporting structures" (https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1413338122). Hopefully, this will contribute to increasing the public awareness, and the dental profession's management, of TDIs.
Topics: Humans; Prevalence; Tooth Fractures; Tooth Injuries; World Health Organization
PubMed: 35481941
DOI: 10.1111/edt.12753 -
Journal of Dentistry Nov 2023To summarize the available evidence of crack formation in teeth and to discuss the limitations of the current clinical diagnostic modalities for crack detection in teeth. (Review)
Review
OBJECTIVES
To summarize the available evidence of crack formation in teeth and to discuss the limitations of the current clinical diagnostic modalities for crack detection in teeth.
BACKGROUND
Cracks are a common clinical finding in teeth and yet clinicians still struggle to identify the full extent and orientation of cracks for their appropriate timely management. The biomechanics of crack development can be due to multiple factors and can differ from an unrestored tooth to a restored or endodontically treated tooth.
DATA & SOURCES
This narrative review has been designed following the guidelines published by Green et al. 2006 [1] Published literature in the English language that addresses the objectives of this review up to July 2022 was sourced from online databases and reference lists. The relevance of the papers was assessed and discussed by two reviewers. A total of 101 publications were included in this narrative review.
CONCLUSIONS
The initiation and development of cracks in teeth are likely linked to an interplay between the masticatory forces and fracture resistance of the remaining tooth structure. From the identified literature, the quality and quantity of remaining tooth structure in a restored or endodontically-treated tooth affects the biomechanics of crack development compared to an unrestored tooth. The extent, orientation, and size of the cracks do affect a clinician's ability to detect cracks in teeth. There is still a need to develop reliable diagnostic tools that will accurately identify cracks in teeth beneath restorations to enable effective monitoring of their propagation and provide appropriate interventions.
CLINICAL SIGNIFICANCE
The development and propagation of cracks in an unrestored tooth differ greatly from a restored and endodontically treated tooth; mainly linked to the quantity and quality of the remaining tooth structure and the forces acting on them. Identifying the extent of cracks in teeth remains challenging for early clinical intervention.
Topics: Humans; Cracked Tooth Syndrome; Tooth, Nonvital
PubMed: 37713950
DOI: 10.1016/j.jdent.2023.104683 -
Primary Dental Journal Mar 2021Examining the nature of stress distribution within the intact tooth can aid in understanding how natural tooth structures are able to resist mechanical forces during...
Examining the nature of stress distribution within the intact tooth can aid in understanding how natural tooth structures are able to resist mechanical forces during masticatory function. Identification of potential fractures in teeth on clinical examination is essential for correct diagnosis, particularly if there is pulpal involvement. This discussion will consider the different types of fracture, their identification and management. This paper will highlight management of tooth fractures, including identifying prognostic indicators, which are largely dependent on the extent of the fracture within the tooth structure.
Topics: Cracked Tooth Syndrome; Humans; Prognosis; Root Canal Therapy; Tooth Fractures
PubMed: 33722131
DOI: 10.1177/2050168420980987