Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 9/04/2009
Article title: Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries –a review article.
Author(s): Andreasen JO, Andreasen FM, Skeie A, et al.
Journal: Dental Traumatol. 2002
Volume (number): 18: 116-128
Major topic: Dental Trauma Treatment timing
Type of Article: Review of Literature
Main Purpose: The purpose of this article was to evaluate clinical and experimental studies when a treatment delay factor was analyzed. These treatment timing factors were divided into acute (<3>24 hrs). The studies were selected from a Medline search.
Materials and Methods: The studies were evaluated according to the following types of injuries: Enamel/Dentin fractures, Complicated crown fractures including pulp exposures, Crown root fractures, Alveolar fractures, Concussion and subluxation, Extrusion and lateral luxation, Intrusion, Avulsions, and Primary tooth trauma.
Findings: Enamel/Dentin fractures: There are few symptoms reported, and aside from the occurrence of luxation complications, there is very low risk of pulp complications. Pulp complications occur in 1-3% of cases on average regardless of timing of treatment. Complicated crown fractures which include pulp exposures: It is common to have stimulated pain such as during mastication and temperature changes. If pulp caps or partial pulpotomy is the treatment of choice than no time relationship was show between treatment and pulpal healing. However, if cervical pulpotomy is planned then a subacute approach has a better prognosis for pulp healing. Crown/root fracture: In these cases, the coronal fragment should be removed and the pulp should be extirpated in its entirety especially if the root development is mature. Treatment has no relation to timing. Root fractures: Pain is usually related to tooth displacement. Studies indicate no proof of treatment timing as it relates to prognosis. Alveolar fractures: Pain is present during coclusion on displaced tooth bone segment. The two studies evaluated indicate healing of bone is good, but the PDL and pulp often develop complications. A strong relationship exists between treatment time and risk of pulpal necrosis was reported, but the studies were biased. Acute treatment timing is indicated. Concussion and subluxation: Pain to occlusion and mastication but not spontaneous. Mobility may be related. No conclusions could be drawn between this injury type and timing of treatment. Extrusion and lateral luxation: Although no study yielded a significant relationship between treatment timine and periodontal ligament healing, it was suggested that to reduce clinical symptoms. An acute or subacute treatment time is indicated. Root development seems to have more relevance in time of healing of pulpal or PDL tissue. Intrusion: This type of injury has the most severe pulpal and periodontal injury prognosis regardless of treatment timing. Treatment considerations include immedicate extrusion or delated extrusion Avulsions: Prognosis is reated to storage medium and length of extra-alveolar timing. Acute timing for reimplantation is essential, but splinting may occur in a subacute time frame. Primary tooth trauma: most injuries are lateral locations and intrusions. The extent of the injury determines the prognosis of the permanent tooth more so than the timing of treatment. An acute treatment approach is more appropriate for injuries affecting occlusion. Otherwise subacute treatment is warranted.
Key points/Summary : Few acute treatment indications are supported by the literature as it relates to dental trauma. Repositioning and splinting of teeth has a questionable prognosis when treatment timing is considered. However the immediacy of antibiotics to prevent dental infection appear to be appropriate.
Assessment of article: Lots of data to support the conclusion that we do not as dentists need to rush to the office to treat dental truama
Showing posts with label 09/04/2009. Show all posts
Showing posts with label 09/04/2009. Show all posts
Saturday, September 5, 2009
Thursday, September 3, 2009
Dental Trauma in Children: A Survey
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 9/04/2009
Article title: Dental Trauma in Children: A Survey
Author(s): Perez R, Berkowitz R. Mcllveen L. et al
Journal: Endodontic Dental Traumatology
Volume (number): 1991 (7): 212-3
Major topic: Dental Trauma
Type of Article: Survey
Main Purpose: The purpose of this article was to determine the type and prevalence of injuries presenting to the pediatric dental service of the Children’s National Medical Center in Washington D.C..
Materials and Methods: This twelve month study consisted of 227 patients who reported to the Children’s Medical Center with a traumatic dental injury. A clinical evaluation was performed and the indicated dental radiographs were exposed. Demographic information consisting of patient age, sex, time and cause of injury, intraoral and extraoral soft tissue injury, fractured or displaced teeth, and lastly alveolar fracture. All crown fractures were classified using Ellis classification and root fractures were noted. Displacements were divided as follows: Group 1—sensitivity to percussion and mobile without displacement; Group 2—extrusion from socket; Group 3 –intrusion; and lastly Group 4—avulsion.
Findings: Of the 227 patients, 96 were less than 5 years of age, 85 were 5-12 years, 46 were greater than 13. The leading cause of injury was due to falls at 46%. 132 (58%) children sustained soft tissue injury, approximately 33% sustained at least one fractured tooth, 62% sustained a displacement injury, and approximately 6% presented with an alveolar fracture which was usually associated with an automobile accident.
Key points/Summary : Falls were the most common cause of dental injury, males have a greater prevalence of dental trauma than females, injuries occur more frequently during the late spring, summer and early fall than other seasons. Soft tissue injury occurs in approximately half of all dental trauma.
Assessment of article: Well presented article yielding trauma patterns consistent with private practice
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 9/04/2009
Article title: Dental Trauma in Children: A Survey
Author(s): Perez R, Berkowitz R. Mcllveen L. et al
Journal: Endodontic Dental Traumatology
Volume (number): 1991 (7): 212-3
Major topic: Dental Trauma
Type of Article: Survey
Main Purpose: The purpose of this article was to determine the type and prevalence of injuries presenting to the pediatric dental service of the Children’s National Medical Center in Washington D.C..
Materials and Methods: This twelve month study consisted of 227 patients who reported to the Children’s Medical Center with a traumatic dental injury. A clinical evaluation was performed and the indicated dental radiographs were exposed. Demographic information consisting of patient age, sex, time and cause of injury, intraoral and extraoral soft tissue injury, fractured or displaced teeth, and lastly alveolar fracture. All crown fractures were classified using Ellis classification and root fractures were noted. Displacements were divided as follows: Group 1—sensitivity to percussion and mobile without displacement; Group 2—extrusion from socket; Group 3 –intrusion; and lastly Group 4—avulsion.
Findings: Of the 227 patients, 96 were less than 5 years of age, 85 were 5-12 years, 46 were greater than 13. The leading cause of injury was due to falls at 46%. 132 (58%) children sustained soft tissue injury, approximately 33% sustained at least one fractured tooth, 62% sustained a displacement injury, and approximately 6% presented with an alveolar fracture which was usually associated with an automobile accident.
Key points/Summary : Falls were the most common cause of dental injury, males have a greater prevalence of dental trauma than females, injuries occur more frequently during the late spring, summer and early fall than other seasons. Soft tissue injury occurs in approximately half of all dental trauma.
Assessment of article: Well presented article yielding trauma patterns consistent with private practice
Wednesday, September 2, 2009
Diagnosis Dilemmas in Vital Pulp Therapy: Treatment for the Toothache is Changing, Especially in Young, Immature Teeth
Resident: Roberts
Date: 9/4/09
Article title: Diagnosis Dilemmas in Vital Pulp Therapy: Treatment for the Toothache is Changing, Especially in Young, Immature Teeth
Journal: Pediatric Dentistry
Volume #30 Pages 197-205
Year: June 2008
Findings:
Most of the diagnostic test used in conventional endodontic therapy are of very little use when involving primary teeth and permanent immature teeth. Thus it is important for a clinician to understand normal root formation and exfoliation of primary teeth. Root development begins when enamel and dentin formation reach the CEJ. Hertwigs Epithelial root sheath is formed by the epithelial dental organ, with one tube for each root. As formation proceeds apically, the apices are wide open diverging apically. Once root length is established, odontoblast that line the internal surface begin to lay dentin until root formation is complete and the apices are closed. In permanent teeth root formation is not complete until 1-4 years after eruption into the oral cavity, in primary teeth it is a shorter duration. During this formative period, treatments should be oriented toward keeping the tooth vital until root formation is complete.
Young immature teeth: Loss of vitality before completion of root length will lead to a poorer crown to root ratio and weak roots leading to periodontal breakdown and possible fracture. Therefore, all treatment for this group should be geared towards maintaining pulpal vitality. EPT and thermal testing are of limited value when testing for pulp vitality in immature permanant teeth. Most diagnoses to these type of teeth occur from radiographic and clinical interpretation. Recently different materials used to treat immature teeth have also began to surface. MTA has recently been the scrutiny of much research. It has been shown to be more successful in stimulating tertiary dentin and maintaining pulpal vitality in direct pulp caps when compared to calcium hydroxide. It has also been proven to be an effective barrier for the treatment of open apex pulpless teeth. It has also been shown to be a be a better cemento-conductive material than calcium hydroxide allowing for stronger root formation in a shorter period of time.
Summary: When assessing primary and permanant immature teeth a clinician should be fully aware of growth and development of the dentition. A clinician should take every opportunity to keep a tooth vital when possible. Primary teeth should not be kept at the risk of damaging permanant teeth. When dealing with immature permanant teeth, one should look for ways to strengthen root formation. MTA has been proven to be a successful agent when dealing with these difficult circumstances.
Assessment of article: The article was good but I would have liked to have seen more discussion involving different materials.
Date: 9/4/09
Article title: Diagnosis Dilemmas in Vital Pulp Therapy: Treatment for the Toothache is Changing, Especially in Young, Immature Teeth
Journal: Pediatric Dentistry
Volume #30 Pages 197-205
Year: June 2008
Findings:
Most of the diagnostic test used in conventional endodontic therapy are of very little use when involving primary teeth and permanent immature teeth. Thus it is important for a clinician to understand normal root formation and exfoliation of primary teeth. Root development begins when enamel and dentin formation reach the CEJ. Hertwigs Epithelial root sheath is formed by the epithelial dental organ, with one tube for each root. As formation proceeds apically, the apices are wide open diverging apically. Once root length is established, odontoblast that line the internal surface begin to lay dentin until root formation is complete and the apices are closed. In permanent teeth root formation is not complete until 1-4 years after eruption into the oral cavity, in primary teeth it is a shorter duration. During this formative period, treatments should be oriented toward keeping the tooth vital until root formation is complete.
Young immature teeth: Loss of vitality before completion of root length will lead to a poorer crown to root ratio and weak roots leading to periodontal breakdown and possible fracture. Therefore, all treatment for this group should be geared towards maintaining pulpal vitality. EPT and thermal testing are of limited value when testing for pulp vitality in immature permanant teeth. Most diagnoses to these type of teeth occur from radiographic and clinical interpretation. Recently different materials used to treat immature teeth have also began to surface. MTA has recently been the scrutiny of much research. It has been shown to be more successful in stimulating tertiary dentin and maintaining pulpal vitality in direct pulp caps when compared to calcium hydroxide. It has also been proven to be an effective barrier for the treatment of open apex pulpless teeth. It has also been shown to be a be a better cemento-conductive material than calcium hydroxide allowing for stronger root formation in a shorter period of time.
Summary: When assessing primary and permanant immature teeth a clinician should be fully aware of growth and development of the dentition. A clinician should take every opportunity to keep a tooth vital when possible. Primary teeth should not be kept at the risk of damaging permanant teeth. When dealing with immature permanant teeth, one should look for ways to strengthen root formation. MTA has been proven to be a successful agent when dealing with these difficult circumstances.
Assessment of article: The article was good but I would have liked to have seen more discussion involving different materials.
Sunday, August 30, 2009
Autotransplantation for a Missing Permanent Maxillary Incisor
Resident: Jason Hencler
Date: 09/04/2009
Article title: Case Report:
Autotransplantation for a Missing Permanent Maxillary Incisor
Author(s): Rao DDS, MS; Fields DDS, MS, MSD; Chacon DDS, MS
Journal: Pediatric Dentistry V30/NO 2 2008
Major topic: Autotransplantation as treatment option
Type of Article: Case Report
Main Purpose:
To describe the treatment of loss of a permanent incisor using transplantation of a maxillary first premolar to the incisor position.
Current Treatment Modalities: Dentists have multiple options to treat missing permanent maxillary anterior teeth that are lost during the mixed dentition due to trauma, decay, or developmental factors. These options include FPD, RPD, implants, ortho space closure, and autotransplanted permanent teeth.
Case Description:
9yo female presents with a chief complaint of unerupted tooth #9. Radiographs revealed an ectopically erupting (inverted) #9 with delayed root development. Tx options included EXT followed by either: prosthetics, asymmetric ortho space closure, surgical uncovering followed by ortho repositioning, or autotransplantation of the inverted tooth to a more acceptable position followed by ortho repositioning.
Treatment:
Autotransplantation with ortho traction to reposition inverted #9 was selected as initial tx. #9 was surgically exposed and revealed a significant dilacerations of the root. Due to future problems of moving such a tooth, decision was made to EXT. Revised tx plan was autotransplantation of maxillary 1st PM. After the site was surgically prepared, the PM was EXT and transplanted with its mesial surface facing buccal. The site was allowed to heal for 2 mos. Eval at 8 wks demonstrated grade II mobility. The labial and lingual surfaces were reduced incrementally to avoid pulp irritation. The implanted tooth was extruded while the adjacent teeth were intruded.
Key points in the article discussion:
Most traumatic injuries to permanent incisors occur in the mixed dentition, which is when PM roots are developing. Since partial root formation (2/3-3/4) is one of the requirements for god prognosis, PMs are likely donors for autotransplantation of incisor sites. At ½ root formation there is an 80% chance of optimal root length and over 90% chance of pulpal and perio healing. The presence of open apices seems to be crucial for good prognosis. Recipient site bone area should be 1-2mm wider and deeper than the dimension of the donor root. Some authors recommend porcelain laminate veneers over composite build up for best esthetics. If the transplant fails, which is rare, final treatment with an implant can still be accomplished if the alveolar bone support was maintained. No definitive data has been reported for ideal post op stabilization period for transplanted teeth. Initial perio healing around a transplanted tooth takes about 4 wks and complete perio healing can be observed radiographically around 8 wks. Because pulpal necrosis and inflammatory resorption are noticed usually w/in 2 mos post surgery, a waiting period of at least 12 wks is best before applying ortho forces. Generally antibiotics are not required but anti plaque rinses are often used during healin periods. Ortho tx can be initiated w/in 3-4 mos of the transplantation. This allows for adequate perio healing prior to complete pulpal obliteration, thus preventing late pulpal necrosis. Light, continuous ortho forces are best.
Summary of conclusions:
With its high success rate and by following reliable techniques, autotransplantation of a permanent maxillary central incisor with a maxillary PM is a favorable option that should be considered.
Assessment of article:
This article was very interesting. Although autotransplantation is not a very popular in the USA, it should be considered in situations similar to the case presented in this article. As a pediatric dentist, we would undoubtedly see such cases. A multi disciplinary approach, working with other specialists should definitely be taken when considering autotransplantation.
Date: 09/04/2009
Article title: Case Report:
Autotransplantation for a Missing Permanent Maxillary Incisor
Author(s): Rao DDS, MS; Fields DDS, MS, MSD; Chacon DDS, MS
Journal: Pediatric Dentistry V30/NO 2 2008
Major topic: Autotransplantation as treatment option
Type of Article: Case Report
Main Purpose:
To describe the treatment of loss of a permanent incisor using transplantation of a maxillary first premolar to the incisor position.
Current Treatment Modalities: Dentists have multiple options to treat missing permanent maxillary anterior teeth that are lost during the mixed dentition due to trauma, decay, or developmental factors. These options include FPD, RPD, implants, ortho space closure, and autotransplanted permanent teeth.
Case Description:
9yo female presents with a chief complaint of unerupted tooth #9. Radiographs revealed an ectopically erupting (inverted) #9 with delayed root development. Tx options included EXT followed by either: prosthetics, asymmetric ortho space closure, surgical uncovering followed by ortho repositioning, or autotransplantation of the inverted tooth to a more acceptable position followed by ortho repositioning.
Treatment:
Autotransplantation with ortho traction to reposition inverted #9 was selected as initial tx. #9 was surgically exposed and revealed a significant dilacerations of the root. Due to future problems of moving such a tooth, decision was made to EXT. Revised tx plan was autotransplantation of maxillary 1st PM. After the site was surgically prepared, the PM was EXT and transplanted with its mesial surface facing buccal. The site was allowed to heal for 2 mos. Eval at 8 wks demonstrated grade II mobility. The labial and lingual surfaces were reduced incrementally to avoid pulp irritation. The implanted tooth was extruded while the adjacent teeth were intruded.
Key points in the article discussion:
Most traumatic injuries to permanent incisors occur in the mixed dentition, which is when PM roots are developing. Since partial root formation (2/3-3/4) is one of the requirements for god prognosis, PMs are likely donors for autotransplantation of incisor sites. At ½ root formation there is an 80% chance of optimal root length and over 90% chance of pulpal and perio healing. The presence of open apices seems to be crucial for good prognosis. Recipient site bone area should be 1-2mm wider and deeper than the dimension of the donor root. Some authors recommend porcelain laminate veneers over composite build up for best esthetics. If the transplant fails, which is rare, final treatment with an implant can still be accomplished if the alveolar bone support was maintained. No definitive data has been reported for ideal post op stabilization period for transplanted teeth. Initial perio healing around a transplanted tooth takes about 4 wks and complete perio healing can be observed radiographically around 8 wks. Because pulpal necrosis and inflammatory resorption are noticed usually w/in 2 mos post surgery, a waiting period of at least 12 wks is best before applying ortho forces. Generally antibiotics are not required but anti plaque rinses are often used during healin periods. Ortho tx can be initiated w/in 3-4 mos of the transplantation. This allows for adequate perio healing prior to complete pulpal obliteration, thus preventing late pulpal necrosis. Light, continuous ortho forces are best.
Summary of conclusions:
With its high success rate and by following reliable techniques, autotransplantation of a permanent maxillary central incisor with a maxillary PM is a favorable option that should be considered.
Assessment of article:
This article was very interesting. Although autotransplantation is not a very popular in the USA, it should be considered in situations similar to the case presented in this article. As a pediatric dentist, we would undoubtedly see such cases. A multi disciplinary approach, working with other specialists should definitely be taken when considering autotransplantation.
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