Abstract –  Fracture of the alveolar process is a common injury; the majority of alveolar fractures may be managed by closed reduction. However, some cases with severe segmental alveolar fracture cannot be reduced by close reduction, usually resulting in occlusion disturbance. This article describes open reduction by vestibular approach in the treatment of severe segmental alveolar fractures, with the aim of evaluating the prognosis. Fifteen patients with severe segmental alveolar fractures that could not be reduced by closed method were included in our case series. Open reduction by vestibular approach was performed on these patients, and the fractures were stabilized with dental arch bars or dental wires. Postoperatively, all patients achieved uneventful healing; consolidation of the fracture was confirmed clinically after 4 weeks. The technique presented is an effective treatment approach proposed for cases of severe segmental alveolar fracture that cannot be managed by closed reduction.

Abstract –  Objectives:  Rugby players are at a high risk of sustaining dental injury because of the high number of tackles implicit to the game. This study aimed to determine the frequency of injuries sustained by players in the Swiss rugby league.

Abstract – Background: Mineral trioxide aggregate (MTA) is a multi-purpose dental material with various uses in dentistry. Iodine potassium iodide (IKI) is the most commonly used iodine compound in endodontics. We aimed to assess the antimicrobial activity of tooth-colored ProRoot MTA combined with IKI. Materials and methods: The antimicrobial activity of IKI was assessed at three concentrations (1%, 2%, and 4%) as the mixing agents combined with MTA against Enterococcus faecalis, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. For each microorganism, three plates were inoculated with 100 μl of a microbial suspension (McFarland 0.5). Four wells were prepared in each plate. MTA (70 mg) was mixed with any of the three concentrations of IKI (25 μl) or sterile distilled water (25 μl) and placed in each well. The plates were incubated for 24 h at 37°C. Zones of inhibition (ZOI) were measured in millimeters by a blinded observer. Data were analyzed using analysis of variance and the Dunnett t-test. Results: All MTA mixtures with water or IKI solutions showed inhibitory zones. The mean ZOI of each MTA/IKI mixture was not significantly different from MTA/water mixture (P > 0.05). MTA/1% IKI had smaller ZOI than MTA/water against E. coli, E. faecalis, and C. albicans. MTA/2% IKI showed larger ZOI only against P. aeruginosa. MTA/4% IKI showed larger ZOI against P. aeruginosa and E. coli (P < 0.05). Conclusions: Substitution of IKI solutions (1%, 2%, and 4%) for water did not significantly increase the antimicrobial activity of MTA.

Abstract –  Penetrating injuries in the oral cavity are common in children. However, penetrating injuries with retained foreign bodies are rare. We report a case of a toothbrush impalement injury of the floor of the mouth in a child with autism. A 5-year-old boy with autism presented with an accidentally impaled toothbrush in the oral cavity. He was taken to the operation room and examined under general anesthesia. The handle of the toothbrush was cut off using rib scissors for mask ventilation, and intra-oral intubation was performed. The toothbrush was located approximately 2.5 cm into the floor of the mouth. The toothbrush was removed uneventfully. Intravenous antibiotic therapy was instituted during hospitalization, and discharge from the hospital occurred 4 days after the operation.

Abstract – Background: Knowledge of the impact of traumatic dental injuries (TDI) on children’s quality of life is sparse. Aim: To determine the association between TDI and oral health–related quality of life (OHRQoL) among schoolchildren aged 11–14 years. Material and methods: A cross-sectional study was carried out involving a representative sample of 409 schoolchildren from 13 municipalities in the Midwest Region of the Brazilian Southern State of Santa Catarina. Clinical examination included the presence and type of TDI and the treatment provided (or needed) according to criteria used in the UK Children’s Dental Health Survey. Dental caries in anterior teeth and malocclusion status were also collected according to WHO criteria. OHRQoL was assessed using the short form of the Child Perceptions Questionnaire (CPQ11–14), and the outcome was the prevalence of one or more adverse impacts on quality of life occurring often/very often. Results: The prevalence of TDI was 16.6% (95% CI 13.0–20.2). The prevalence of one or more adverse impacts occurring often/very often was 46.6% (95% CI 41.7–51.5). Logistic regression modeling for the outcome indicated an independent and significant association between the prevalence of one or more adverse impacts occurring often/very often and the presence of TDI even after adjustment for gender, presence of dental caries in anterior teeth and malocclusion. A prevalence ratio of 1.79 (95% CI 1.16–2.76) of one or more adverse impacts occurring often/very often in schoolchildren with TDI was found, compared to those without TDI. Conclusions: Traumatic dental injuries appear to affect schoolchildren’s OHRQoL.

Abstract – Background:  Prevention of traumatic dental injuries relies on the identification of etiologic factors and the use of protective devices during contact sports. Mouthguards are considered to be an effective and cost-efficient device aimed at buffering the impacts or blows that might otherwise cause moderate to severe dental and maxillofacial injuries. Interestingly, besides their role in preventing injury, some authors claim that mouthguards can enhance athletic performance. Thus, the purpose of this controlled randomized trial was to evaluate and compare the effect of two different types of mouthguards on the athletic performance and strength of collegiate athletes.

Abstract –  Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment.

Abstract –  The release and diffusion of hydroxyl ions (OH⁻) of calcium hydroxide (Ca(OH)₂)-based intracanal medications may be affected by the association with other substances. The aim of this study was to evaluate the diffusion of OH− ions through root dentin by the medications: G1, Ca(OH)₂/saline; G2, Calen; G3, Calen/camphorated p-monochlorophenol (CMCP); and G4, Calen/0.4% chlorhexidine (CHX). Root canals from bovine teeth were prepared in a standardized manner. A cavity until dentin was prepared in the middle third of the root surface of each specimen. The external surface of the root was made impermeable using a layer of adhesive, except the prepared cavity. The root canals were filled with different medications, and teeth were individually stored in flasks containing 10 ml distilled water at 37°C. The water pH was measured at 1, 3, 7, 14, 21, 30, and 60 days. Data obtained were subjected to anova and Tukey’s tests. Increase in pH was observed at 3 days for Calen/CHX and from 7 to 14 days for the other mixtures. Calen paste promoted pH increase up to 21 days. Calen/CMCP had the highest pH up to 21 days, and all groups had similar results at 30 days. At 60 days, the greatest pH values were observed for Calen/CMCP and Calen alone. All different formulations of Ca(OH)₂-based medications tested release hydroxyl ion that can diffuse through the dentin.

Abstract –  The purpose of this study was to analyze tooth mobility changes in root-fractured permanent teeth and relate this to type of interfragment healing (hard tissue healing (HT), interfragment healing with periodontal ligament (PDL) and nonhealing with interposition of granulation tissue (GT) because of pulp necrosis in the coronal fragment. Furthermore, the effect of age, location of the fracture on the root, and observation period on mobility values was analyzed. Mobility values were measured for 44 of 95 previous reported root-fractured permanent incisors. Mobility changes were measured with a Mühlemanns periodontometer and noninjured incisors served as controls. The mobility values represented the labial-lingual excursion of the root measured in μm when the tooth received a frontal and a palatal impact of 100 g force. In 18 cases of hard tissue healing (HT), a slightly increased mobility was seen after 3 months and 1 year, and a normalization of mobility value was usually found after 5 and 10 years. In 17 cases of PDL healing, generally a higher mobility was found in comparison with root fractures healing with hard tissue, and a consistent decrease in mobility value was found in the course of the 10 year observation period. A tendency for reduced mobility over time was found, a relation that could possibly be explained by the known general decrease in tooth mobility with increasing age. Finally, nine cases of nonhealing with initial interposition of granulation tissue (GT) because of pulp necrosis in the coronal fragment resulted in increasing mobility values possibly related to a lateral breakdown of the PDL in relation to the fracture line. In control teeth, a lowering of mobility was found over the course of a 10-year observation period. In conclusion, mobility changes appeared to reflect the radiographic healing stages and known age effects upon tooth mobility.

Abstract –  Intrusive luxation is a kind of traumatic injury characterized by an axial displacement of the tooth toward the alveolar bone. Its main causes are bicycle accidents, sports/recreational activities, and falls or collisions. Treatment strategies include waiting for the tooth to return to its position, immediate surgical repositioning, and repositioning through dental traction by orthodontic devices. In order to decide which treatment to follow, the degree of root formation, the patient’s age, and intrusion severity should be taken into consideration. This study aimed to report a 10-year follow-up of two patients that suffered permanent incisor (PI) traumatic injury who had a similar root development (incomplete rooting) but different results. In the first case, the treatment of choice was follow-up. The patient showed gingival alteration and root resorption of tooth 21. Calcium hydroxide therapy and root canal filling were performed twice because of not attending callback. After finishing the endodontic treatment, follow-up visits showed no abnormalities. In the second case, the treatment of choice was watch and wait to the teeth 11 and 21. After 7 months spontaneous eruption of both teeth was detected. Radiographic examination showed atypical root formation and almost completely pulp canal obliteration, 8 years later. In the follow-up, visit after 10 years was observed complete crow and pulp canal obliteration. It was concluded that PI intrusion treatments are good intervention alternatives, as they proved to be successful after a 10-year follow-up period.

Abstract –  Aim:  To evaluate the influence of calcium hydroxide (CH) paste used as intracanal medication on the bond strength of AH Plus (AH) and Epiphany (EP) sealers to root dentin.

Abstract –  Background aim:  The aim of this study was to evaluate, by radiographic and histomorphometric analyses, the effects of high-power diode laser irradiation on the root surfaces of delayed replanted rat teeth.

Abstract – Background: Owing to a lack of symptoms and difficult visualization in routine intraoral radiographs, diagnosis of external root resorptions can be challenging. Aim: The goal of this study was to compare two image acquisition methods, intraoral radiographs and cone beam computed tomography (CBCT), in the diagnosis of external resorption. Material and Methods: Thirty-four maxillary and mandibular bicuspids were divided into three groups. Perforations measuring 0.3 and 0.6 mm in diameter and 0.15 and 0.3 mm in depth, respectively, were made on the lingual root surfaces in thirty teeth, and four were used as controls. Next, teeth were mounted on an apparatus and radiographed at mesial, distal, and orthoradial angulations. CBCT images were also taken. The analysis of the intraoral radiographic and tomographic images was carried out by two experts using standardized scores. Data were then compared statistically. Results: A strong agreement between the examiners was observed in both diagnosis methods, the intraoral radiographic (r = 0.93) and the tomographic analysis (r = 1.0). Tomography had higher statistically significant detection values than intraoral radiography (P < 0.05). In intraoral radiographs, the detection was significantly greater (P < 0.05) in the mandibular bicuspids, compared with their maxillary counterparts. The ability to detect 0.6-mm perforations by intraoral radiography was significantly higher than that of 0.3-mm perforations (P < 0.05). Conclusion: Cone beam computed tomography showed better diagnostic ability compared with intraoral radiography, regardless of the tooth or the dimensions of the resorption evaluated.

Abstract –  An 11-year-old male who injured his maxilla and right maxillary central incisor and lip during a fall was presented to our hospital. His lower lip and upper gingiva were lacerated with swelling and epistaxis, and he had a maxillary alveolar bone fracture and severe intrusion of the right maxillary central incisor, which had penetrated the floor of the nasal cavity with avulsion. Under local anesthesia, we repositioned the incisor and bone segment and fixed them with a titanium micromesh plate and self-tapping screws and splints. The incisor was also treated by root canal 3 days after the operation and was restored with a crown. We performed root canal filling 1 month later. Five months later, the plate and screws were removed. In prognosis of our case, no symptoms of inflammatory root resorption or ankylosis have observed for more than 1 year and 6 months of follow up based on both clinical and radiographic findings.

Abstract –  Aim: The aim of this study was to compare calcium hydroxide plus points (CHPPs) with the conventional calcium hydroxide paste (CHP) clinically and radiographically as materials used in apexification treatment. Material and methods: Sixteen children, each with at least one necrotic permanent central incisor requiring apexification treatment, were selected for this study. Twenty-two selected teeth were divided into two test groups (10 CHP and 12 CHPP). The children were recalled for clinical evaluations every 3 weeks, and their radiographical evaluations were carried out every 3 months. Mann–Whitney U and Fisher’s exact tests were used to evaluate the differences between the groups. Results: The follow-up evaluations revealed that the success rate was 100% for CHP and 92% for CHPP. No statistically significant difference between the groups was observed (P > 0.05). Conclusions: CHPP-treated central incisors requiring apexification demonstrated good success. CHPP can be used for cases in which traditional Ca(OH)₂ apexification is indicated as it has a similar outcome with CHP.

Abstract –  Aim: To analyze the influence of a crown fracture without pulp exposure on the risk of pulp necrosis (PN) in teeth with extrusion or lateral luxation. Material and methods: The study included 82 permanent incisors with extrusion from 78 patients (57 male, 21 female) and 179 permanent incisors with lateral luxation from 149 patients (87 male, 62 female). A total of 25 teeth with extrusion and 33 teeth with lateral luxation had suffered a concomitant crown fracture (infraction, enamel fracture or enamel-dentin-fracture). All the teeth were examined and treated according to a standardized protocol. Statistics: The risk of PN was analyzed separately for teeth with immature and mature root development by the Kaplan–Meier method, the log-rank test and Cox regression (lateral luxation only). The level of significance was set at 5%. Risk factors included in the analysis were gender, age, crown fracture, and response to electric pulp test at the initial examination. Results: A concomitant crown fracture significantly increased the risk of PN in teeth with lateral luxation. For teeth with immature root development (hazard ratio: 10 [95% confidence interval (CI): 1.1–100] P = 0.04), the overall risk increased from 4.7% (95% CI: 0–10.8) to 40% (95% CI: 2.8–77.2). For teeth with mature root development [hazard ratio: 2.4 (95% CI: 1.4–4.2) P < 0.001], the overall risk increased from 65.1% (95% CI: 55.2–75.1) to 93% (95% CI: 85.5–100). In teeth with extrusion and mature root development, the overall risk of PN increased from 56.5% (95% CI: 37.7–75.4) to 76.5% (95% CI: 58.9–94) in case of a concomitant crown fracture, but the difference was not statistically significant (P > 0.05). Conclusion: A concomitant crown fracture without pulp exposure significantly increased the risk of PN in teeth with lateral luxation. This risk factor may be used to identify teeth at increased risk of PN following lateral luxation injury.

Abstract –  Background:  The reported risk of pulp necrosis (PN) is low in teeth with concussion injuries. A concomitant crown fracture may affect the risk of PN.

Abstract –  Background:  The reported risk of pulp necrosis (PN) is generally low in teeth with subluxation injuries. A concomitant crown fracture may increase the risk of PN in such teeth.

Abstract –  The objective with this study was to search for and to analyze the presence of scientific papers, guidelines, and recommendations in dental literature regarding which radiographs should be prescribed after a dento-alveolar trauma. We know from earlier that guidelines and recommendations are available in general in dental traumatology. The International Association of Dental Traumatology (IADT) has earlier developed guidelines for the management of dental trauma cases in general. There are also recommendations about useful intraoral radiographic methods when caries and periodontal disease are studied. An additional objective was to provide some guidelines for general practitioners about the most accurate radiographic examination immediately after a dento-alveolar trauma using intraoral radiographs or a common extraoral imaging method. Because radiographs are an important diagnostic tool for establishing a correct differential diagnosis after a trauma, radiographic guidelines and recommendations are of importance to be able to start the correct treatment. PubMed Central, Cochrane and World Wide Web were searched and the identified existing guidelines for different intraoral radiographic methods in dentistry were analyzed and found to be very few. Those that were identified were in general not so detailed and specific. In conclusion, we found an explicit need for more detailed guidelines regarding which intraoral and other dental radiographs should be prescribed initially in dental traumatology.

Abstract –  The aim of this study was to evaluate the rat subcutaneous tissue reaction to implanted polyethylene tubes filled with mineral trioxide aggregate (MTA) FILLAPEX^® compared to the reaction to tubes filled with Sealapex^® or Angelus MTA^®. These materials were placed in polyethylene tubes and implanted into the dorsal connective tissue of Wistar rats for 7, 15, 30, 60, and 90 days. The specimens were stained with hematoxylin and eosin or Von Kossa or left unstained for examination under polarized light. Qualitative and quantitative evaluations of the reaction were performed. All materials caused moderate reactions after 7 days, which decreased with time. The reactions were moderate and similar to that evoked by the control and Sealapex^® on the 15th day. MTA FILLAPEX^® and Angelus MTA caused mild reactions beginning after 15 days. Mineralization and granulation birefringent to polarized light were observed with all materials. It was concluded that MTA FILLAPEX^® was biocompatible and stimulated mineralization.

Abstract –  The aim of this study was to investigate differences in the thickness of the mouthguard sheet according to the holding conditions during heating. The material used in this study was Sports Mouthguard (3.8 mm thickness), and two holding conditions of the sheet were undertaken: one was the condition that the sheet was held all around the periphery and the other was that the sheet was held at only four points. The sheets were formed using a vacuum former when the sheets were heated until they hung 2.0 cm from the baseline. We measured the thickness of each part of the mouthguard and calculated the ratio of changes in the thickness. The difference in the thickness by the holding conditions at the area of the sheet that fitted over the anterior teeth, palate, and posterior teeth was analyzed by the paired t-test. The results showed that the thickness of the sheet differed statistically and significantly at the regions of the sheet that fitted over the anterior teeth and posterior teeth (P < 0.01) and the palate (P < 0.05) according to the holding conditions of the sheet. The thickness of the condition that the sheet was held all around the periphery was thinner than that of the condition that the sheet was held at only four points. These results suggested that the thickness of the sheet was maintained by holding the sheet only at four points, and this new method could be an effective way to maintain the thickness of the mouthguard in clinical use.

Abstract –  Background:  The purpose of this study was to compare the fracture resistances of immature teeth treated with MTA along with root canal obturation methods using AH Plus, MetaSEAL, MTA Fillapex sealers + lateral compaction technique, and Unicore quartz fiber posts.

Abstract –  Objective:  (i) To assess the prevalence of traumatic dental injuries (TDI) in individuals with cerebral palsy and its possible relationship with type of palsy at Udaipur city, Rajasthan, India. (ii) To assess the prevalence of temporomandibular joint symptoms in cerebral palsy individuals.

Abstract –  Clinical experience has shown that most avulsed teeth are replanted after a long extra-alveolar time and dry or inadequate wet storage, causing necrosis of periodontal ligament cells. This condition invariably leads to development of external root resorption, leaving the filling material in contact with the periapical connective tissues. In this study, the periapical tissue reactions to calcium hydroxide (CH) and mineral trioxide aggregate (MTA) were evaluated after occurrence of external root resorption as an expected sequela of delayed tooth replantation. Twenty male Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. Then, the dental papilla, enamel organ, pulp tissue, and periodontal ligament were removed, and the teeth were immersed in a 2% acidulated phosphate sodium fluoride solution, pH 5.5, for 10 min. The teeth were randomly assigned into two groups (n = 10), in which the canals were filled with either a CH and saline paste (CH group) or MTA (MTA group). The sockets were irrigated with saline, and the teeth were replanted. After 80 days, it was possible to observe large areas of replacement root resorption and some areas of inflammatory root resorption in both groups. More severe inflammatory tissue reaction was observed in contact with calcium hydroxide compared with the mineral trioxide aggregate. New bone formation was more intense at the bottom of the socket in the MTA group. In conclusion, as far as periapical tissue compatibility is concerned, intracanal MTA can be considered as a viable option for root canal filling in delayed tooth replantation, in which external root resorption is an expected sequela.

Abstract –  This study aimed to assess the responsiveness of the Brazilian version of the Parental–Caregiver Perception Questionnaire (B-P-CPQ) to describe changes in quality of life (QoL) after treatment for traumatic dental injury (TDI). After eligibility criteria were applied, 42 of 255 patients who went to a dental trauma center for TDI treatment were included. QoL was evaluated in two different appointments: A1 (after TDI) and A2 (after TDI treatment). The B-P-CPQ scores were calculated using the additive method. Psychometric properties like internal consistency (Cronbach’s Alpha), test–retest reliability, intraclass correlation coefficient (ICC), and construct validity (Spearman’s correlations) were assessed, and, mainly, the responsiveness was analyzed by standardized response means (SRM). Mean B-P-CPQ scores were 30.05 (1.74 SD) and 2.67 (4.05 SD), while the median scores were 17.39 and 2.00 (P < 0.01), respectively in A1 and A2. Cronbach’s Alpha was 0.87 in A1 and 0.66 in A2. ICC was 0.90. B-P-CPQ scores were correlated with overall well-being (P < 0.01; rho: 0.71). The B-P-CPQ responsiveness scores declined 27.38 points, and a perfect SRM of 1.76 was achieved. The B-P-CPQ scores indicated changes in QoL following TDI. The change was observed as an impact decrease after TDI treatment, demonstrating positive reduction and improvement on QoL. The responsiveness of the P-CPQ (Brazilian version) in detecting change on QoL after TDI treatment was confirmed by SRM assessment. The findings represent an evidence of the importance of professional care and treatment of TDI.

Abstract –  Traumatic injuries to the chin are not uncommon in children. Nevertheless, crown fractures, which are common sequelae to this type of injury, might be overlooked, especially if dental care is not sought immediately after a visit to a non-dental facility. The present case report reviews the delayed diagnosis and treatment outcome of a bilateral posterior complicated crown fracture affecting mandibular second primary molars in a young child. Pharmacologic and orthodontic considerations are also discussed in the paper.

Abstract –  The aim of this paper was to report the diagnosis and evaluation of periradicular bone repair by using computed tomography and digital subtraction radiography in an endodontic surgery case treated with mineral trioxide aggregate (MTA). The patient had local swelling and fistula 7 years after trauma in the upper jaw. Periapical lesion on tooth #12 and root resorption of tooth #11 were detected radiographically. Endodontic therapy and placement of intracanal medication were carried out. After 3 months, with no improvement in the clinical signs and symptoms, computed tomography was performed, showing extensive apical bone resorption on tooth #12 and dental resorption promoting communication of the root canal with the periodontium of tooth #11. The patient was referred to endodontic surgery. After surgery and postoperative periods of 15, 30, 60, 90, and 120 days, standardized radiographs were taken, digitized, and subjected to digital subtraction of the images using Adobe Photoshop CS software. Four years later, a cone-beam computed tomography was performed, showing bone repair and absence of root resorption at tooth #11. In this clinical case, digital subtraction radiography was effective for early detection of new bone formation and evolution of repair.

Abstract –  Although current guidelines for the treatment of traumatic injuries recommend the use of ‘flexible’ splints, the precise definition of what is considered flexible versus rigid has not been rigorously defined, leaving the clinician with a wide range of options for this critical factor. The purpose of this study was to quantify and compare the effect of eight different splints on tooth mobility after extraction and replantation using a human cadaveric model. Following strict selection criteria including complete root maturation, lack of periodontal disease, normal bone levels, and crown integrity, a maxillary central incisor was atraumatically extracted and splinted with eight different splints. The experimental splints included a 30-pound test monofilament nylon-composite splint and six wire-composite splints made of wires of 0.012′ (0.3 mm), 0.016′ (0.4 mm), or 0.020′ (0.5 mm) diameter stainless steel (SS) or nickel titanium (NT). A direct composite splint represented the most rigid type of splint. These eight splints were applied five times each, and tooth mobility was measured before and after each splint was applied. The average splint effect, defined as the difference between the presplint and the postsplint measurements quantified using the Periotest, was calculated for each splint and compared. No significant differences were found between the nylon-composite and the wire-composite splints. There was significantly less tooth mobility with the direct composite splint compared to all other splints. In conclusion, the results of this study suggest that nylon and SS or NT wires up to 0.016′ diameter are significantly more flexible than direct composite splints and thus may be better suited for the splinting and management of traumatized teeth.

Abstract –  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.

Abstract –  Water polo is a sporting activity which has a medium risk of causing dental trauma. Owing to the high speed, close body contact, and the combination of throwing and swimming that is inherent to the sport, the general injury potential is high. Using a standardized questionnaire for a total of 415 water polo players from Switzerland, this study examines the frequency of dental and facial injuries in water polo, athletes’ habits regarding the wearing of mouthguards, and the general level of knowledge about emergency procedures following dental trauma. The participating players came from 6 divisions: Swiss national leagues A and B, first and second leagues, as well as the women’s, and junior’s league. The data were evaluated according to division and gender. Of the 415 interviewees, 185 (44.6%) had witnessed a dental injury in water polo. Eighty-seven (21.0%) players reported having suffered a tooth injury when playing water polo. Tooth fracture was the most stated dental injury [86 (16.4%)]. A similar number of tooth injuries were experienced by both male [355 (21.1%)] and female [60 (20.0%)] players. The interviewees over the age of 50 showed a higher incidence of tooth injuries than younger players (>50 years = 41.7%). Slightly more than half of the interviewed players [228 (54.9%)] were aware of the possibility of replanting avulsed teeth. As few as 43 (10.4%) players were familiar with tooth rescue boxes. Only 32 (7.7%) water polo players wore a mouthguard; the most common reason for not wearing a mouthguard was that it was seen to be unnecessary [169 (40.7%)]. This survey highlights the potential for improvement in the level of knowledge about dental injury prevention in water polo. In addition to information and guidelines from the relevant sports’ associations, and coaches, dentists could also play a role in the provision of this education.

Abstract –  Aim:  The purpose of this study was to evaluate the knowledge of first aid in tooth avulsion among nurses working at schools in Bialystok, Poland. A part of this population attended a lecture on the management of dental trauma 2 years before.

Abstract –  Objective:  Dentofacial emergencies are a common presentation to the emergency department (ED) but there is little recent data on physicians’ knowledge, confidence and attitudes in handling these cases.

Abstract –  Management of pediatric maxillofacial injuries is mainly governed by their psychological, physiological, developmental, and anatomical characteristics. Pediatric mandibular fractures can have variable etiologies but have similar manifestations as those in adult patients. There are various treatment modalities to treat mandibular parasymphysis/symphysis fractures in children, which have their own limitations and complications. We currently describe our experience with open cap splint as a treatment modality which involves fewer risks in treating 10 pediatric parasymphysis/symphysis mandibular fractures.

Abstract –  Dog bites represent lesions commonly found in Hospital Emergency Clinic. This type of lesion may cause severe harm to patients, but it rarely affects the underlying bone structure causes facial fracture. This study aims to illustrate a rare clinical case in which a pediatric patient presented a comminuted fracture in the mandible which evolved into a unilateral avulsion of the mandibular condyle, body fractures as well as a mandibular ramus and hemiface that had been deformed, with multiple lacerations and loss of soft-tissue mass. Intermaxillary fixation was performed using the Ivy method, followed by internal rigid fixation using miniplates and screws in attempt to reconstruct the child’s mandible. After 2 years of follow-up, a satisfactory esthetics and functional results could be observed.

Abstract – Objectives: To compare the fracture resistance of bovine teeth after intracoronal bleaching with sodium percarbonate (SPC) or sodium perborate (SP) mixed with water or 20% hydrogen peroxide (HP). Materials and methods: Fifty extracted bovine teeth were divided into four experimental groups (G1–G4) and one control (n = 10) after endodontic treatment. Following root canal obturation, a glass ionomer barrier was placed at the cemento–enamel junction. After that, the pulp chambers were filled with: G1 – SP with water; G2 – SP with 20% HP; G3 – SPC with water; and G4 – SPC with 20% HP. No bleaching agent was used in the control group. Coronal access cavities were sealed with glass ionomer and specimens were immersed in artificial saliva. The bleaching agents were replaced after 7 days, and teeth were kept in artificial saliva for an additional 7 days, after which the pastes were removed and the coronal access cavities were restored with glass ionomer. Crowns were subjected to compressive load at a cross head speed of 0.5 mm min⁻¹ applied at 135° to the long axis of the root by an EMIC DL2000 testing machine, until coronal fracture. Data were statistically analysed by anova and Tukey test. Results: No differences in fracture resistance were observed between the experimental groups (P > 0.05). However, all experimental groups presented lower fracture resistance than the control group (P < 0.05). Conclusion: SPC and SP led to equal reduction on fracture resistance of dental crowns, regardless of being mixed with water or 20% HP.

Abstract –  Aim:  To assess the influence of cervical preparation on fracture susceptibility of roots.

Abstract –  Aim:  The purpose of this study was to evaluate Iranian teachers’ knowledge and attitude with regard to emergency management of dental trauma.

Abstract –  Aim:  To evaluate the ability of parents to recall past injuries to their children’s maxillary primary incisors.

Abstract – Aim:  The objectives of this clinical study were as follows: (i) to determine the effect of frequency of calcium hydroxide [Ca(OH)₂] dressing change on the apical barrier formation in immature permanent incisors with necrotic pulps and (ii) to investigate the effect of various clinical factors before and during treatment that may be associated with the frequency of Ca(OH)₂ dressing changes.

Abstract –  The purpose of the present study was to evaluate the efficacy of (−)-epigallocatechin-3-gallate (EGCG) in maintaining the vitality of human periodontal ligament (PDL) cells when used as a storage medium for avulsed teeth prior to replantation. Thirty freshly extracted single-rooted human teeth with closed apices were randomly assigned to three experimental groups with 10 samples per group and immersed in one of the storage media: EGCG, Hank’s balanced salt solution (HBSS), or milk for 2 h. The PDL cells were dissociated by an enzyme treatment with collagenase and trypsin. The cells were then labeled with 0.4% Trypan blue for the determination of viability. The result showed that EGCG group had the highest percentage of cell viability, followed by HBSS and milk group, in descending order.

Abstract –  Milk has been studied extensively and has gained wide acceptance as a suitable storage medium capable of maintenance of avulsed teeth that cannot be replanted immediately. The objective of this study was to evaluate whether the renewal of milk as a storage medium every 24 h for up to 120 h is able to increase its ability to maintain human periodontal ligament fibroblasts (PDLF) viability in vitro. Plates with confluent PDLF were soaked in minimum essential medium (MEM) at 37°C (positive control) and in skimmed milk (22 wells) and water (negative control) for 24, 48, 72, 96, and 120 h at 5 and 20°C. The skimmed milk was renewed every 24 h in 11 of the wells of each plate. After these periods, cell viability was determined by the tetrazolium salt-based colorimetric (MTT) assay. Data were statistically analyzed by Kruskal–Wallis and Scheffé tests (α = 5%). At 24 h, milk and MEM performed similarly. However, from 48 h onwards, MEM was significantly better than renewed and not renewed milk at both temperatures. Regardless of temperature (5 or 20°C), renewal of milk with fresh milk did not affect its ability to maintain PDLF viability.

Abstract –  The ability of a periapical radiograph to exhibit the fracture depends on many factors including, but not limited to, the resolution of the image. The quality can be reduced by the image compression. The purpose of this study is to evaluate the effect of Joint Photographic Experts Group (JPEG) compressions on the diagnostic capability of periapical images in the detection of root fractures. Ten dry human mandibles containing 151 teeth were used in this study. Mandibles were radiographed with direct digital imaging sensor using the paralleling technique. Four observers detected root fracture on the images saved in one uncompressed and two compressed formats. Receiver operating characteristic (ROC) and anova analyses were performed to compare the performance of the three different systems and evaluate the effect of the compression on the accuracy of root fracture detection. Results did not show any statistically significant difference between the original, large images presented in tagged image file format (TIFF) and the two compressed images (JPEG medium file and JPEG small file images) in the detection of root fractures. The intra-rater comparison showed a significant consistency in the detection of the fracture. The compression reduced the file size considerably (from 1.77 MB to 453 and 95 Kb), but it did not affect the accuracy of root fracture detection. The file size reduction, on the other hand, is very beneficial for image electronic storage and mainly in teleradiology.

Abstract –  The management of complicated crown-root fractures is a challenge. Intentional replantation with 180° rotation may be a useful procedure to overcome this problem. In Case 1, a 23-year-old woman with complicated crown-root fractured teeth #11, #21, and #22 was referred for treatment. All fractured teeth were extracted, rotated 180°, and replanted in a slightly extruded position. After 3 months, root canal treatment was completed and the final restorations fabricated. At the 18-month follow up, the patient was asymptomatic, the tooth was functional, and no root resorption was observed radiographically. At the 90-month follow up, slight cervical root resorption of tooth #11 was noted. In Case 2, a 27-year-old woman with a crown-root fractured tooth #21 was referred for treatment. Despite immediate repositioning of the coronal fragment and a 2-week stabilization with a wire splint, the coronal fragment remained separated from the apical tooth segment. The apical segment was extracted, rotated 180°, and replanted in a slightly extruded position. After 1 and 4 weeks, the root canal treatment was completed and the final restoration fabricated, respectively. At the 24-month follow up, the patient was asymptomatic and apical healing was completed.

Abstract – Background: Root fractures are a relatively rare type of injury with frequencies of 0.5–7% of traumatized permanent teeth. It is well known that teeth with intra-alveolar root fractures have a good prognosis. The pulp remains vital in about 80% of these teeth. If pulp necrosis develops, this normally only occurs in the coronal fragment. Although several studies on intra-alveolar root fractures have been published during the last decades, none have mentioned that transient discoloration can occur. The aim of our study was to study the frequency and prognosis for intra-alveolar root fractures with discoloration. Material and methods: The material consisted of 42 permanent incisors from 21 boys and 18 girls aged 7–19 years (mean = 12.7, median 12.0). In two girls and one boy, two incisors exhibited concurrent intra-alveolar root fractured. The follow-up period ranged from 1 to 9 years. The colour changes were determined at each control by transillumination of the clinical crown from the facial and palatal surfaces. Electrometric sensibility was evaluated and compared to the values of adjacent teeth using an electric pulp tester. At the final clinical and radiographic control, the type of healing was registered. Results: Discoloration was found in nine teeth. The root development was completed in all these teeth. The discoloration disappeared within 4 weeks to 6 months in eight teeth. The sensibility, which was lost at the injury, followed the changes in discoloration, and all teeth had regained normal sensibility when the discoloration had disappeared. Only one tooth, which showed a greyish hue, developed pulp necrosis. Conclusion: Transient discoloration in intra-alveolar fractures is relatively common and is indicative of a good prognosis for healing.

Abstract –  Vertical root fractures (VRFs) in teeth without endodontic treatment are relatively uncommon. The diagnosis is based on clinical and radiographic presentations. It might be difficult to detect VRFs in non-endodontically treated molars by conventional radiographs in certain situations because of the limitations of 2D images and many others factors such as the VRFs being in their early stages. Root morphology variation and the orientation of VRFs can influence conventional radiographic detection and the interpretation of a radiolucent fracture line. The four case reports presented here describe and discuss the use of cone-beam computed tomography (CBCT) in successfully diagnosing VRFs based on direct visualization of radiolucent lines, especially those suspected from routine conventional radiographs, as well as their symptoms and clinical findings. CBCT also provides more information on the presence of VRFs.

Abstract – Aim: The objective of this study was to compare in vitro the antibacterial activity of Tetraclean (mixture of doxycycline, citric acid and polypropylene glycol), Niclor 5 (5.25% sodium hypochlorite solution), Cloreximid (0.2% chlorhexidine and 0.2% cetrimide solution) and hydrogen peroxide 12 volumes on three endodontic pathogens associated with primary endodontic infections. Enterococcus faecalis, Streptococcus mutans and Staphylococcus aureus strains were selected to evaluate the antibacterial activity of endodontic irrigants by the agar disc-diffusion test. Material and methods: Paper discs were saturated with each one of the test solutions (at room temperature and preheating at 50°C) and placed onto culture agar-plates preadsorbed with bacterial cells and further incubated for 24 h at 37°C. The growth inhibition zones around each irrigant were recorded and compared for each bacterial strain. Kruskal–Wallis and Mann–Whitney tests were applied to compare the various groups. Results: At room temperature, Tetraclean showed significantly higher inhibition of bacteria growth than all other irrigants tested. Preheating at 50°C significantly increased growth inhibition for all the groups tested. At 50°C, hydrogen peroxide 12 volumes and Tetraclean showed significantly higher efficacy than all other irrigants tested. Conclusions: 50°C-preheated hydrogen peroxide 12 volumes and Tetraclean showed highest inhibition of the bacterial growth.

Abstract –  Endodontic treatment is an important step of tooth replantation protocols, but the ideal moment for definitive obturation of replanted teeth has not yet been established. In this study, a histomorphometric analysis was undertaken to evaluate the repair process on immediate replantation of monkey’s teeth after calcium hydroxide (CH) therapy for 1 and 6 months followed by root canal filling with a CH-based sealer (Sealapex^®). The maxillary and mandibular lateral incisors of five female Cebus apella monkeys were extracted, kept in sterile saline for 15 min, replanted and splinted with stainless steel orthodontic wire and composite resin for 10 days. In Group I (control), definitive root canal filling was performed before tooth extraction. In Groups II and III, CH therapy started after removal of splint, and definitive root canal filling was performed 1 and 6 months later, respectively. The animals were euthanized 9 months after replantation, and specimens were processed for histomorphometric analysis. In all groups, epithelial attachment occurred at the cementoenamel junction or very close to this region; the areas of resorption on root surface had small extension and depth and were repaired by newly formed cementum; and the periodontal ligament was organized. Statistical analysis of the scores obtained for the histomorphometric parameters did not show any statistically significant difference (P = 0.1221) among the groups. The results suggests that when endodontic treatment is initiated 10 days after immediate replantation and an antibiotic regimen is associated, definitive root canal filling can be performed after a short-term CH therapy.

Abstract –  The prognosis for a reimplanted tooth depends largely on the condition of the root. Platelet-derived growth factor (PDGF)-BB has been shown to regenerate periodontal tissue in animal and human clinical studies. However, information regarding the effect of PDGF-BB on tooth reimplantation is limited. The objective of this study was to investigate the effect of PDGF-BB on root resorption after reimplantation of a partially denuded tooth in dog. A total of 15 healthy female beagle dogs were used. Mandibular third and fourth premolars were endodontically treated and then extracted as atraumatically as possible. The coronal portion of each root was carefully scaled and planed. The roots on the right side of the mandible were treated with PDGF-BB and reimplanted, while the roots on the left side served as controls. After 2, 4, or 8 weeks, specimens were collected and processed for histopathological examination. By the 4th week after reimplantation, new periodontal ligament (PDL)-like tissue had formed around the PDGF-BB-treated root surfaces and new bone. By the 8th week, healing of the PDGF-BB-treated roots was characterized by newly formed PDL with inserting attachment formation. In contrast, control roots showed multiple areas of replacement resorption. Immunohistochemical staining of proliferating cell nuclear antigen (PCNA) performed at 2 weeks after reimplantation showed that the number of PCNA-positive cells in the connective tissue area was statistically significantly greater in the PDGF-BB-treated group than in the control group (P < 0.001). The application of PDGF-BB resulted in a significantly lower occurrence and extent of root resorption and ankylosis. These results suggest that the use of PDGF-BB reduces occurrence of ankylosis and root resorption in tooth reimplantation.

Abstract– Introduction: The aim of this study was to compare the effect of subcutaneously implanted white mineral trioxide aggregate (WMTA) on inflammatory reactions before and after expiry date. Methods: Fifty Wistar rats were used in this study. Polyethylene tubes were filled with WMTA with expiry dates of 2008, 2009, and 2011, and empty ones serving as the controls were implanted into the subcutaneous tissue. The rats were sacrificed at 7-, 14-, 28-, and 60-day intervals. 5-μm sections were stained with hematoxylin and eosin and observed under a light microscope. Inflammatory reactions were categorized as 0, none (without inflammatory cells); 1, mild (inflammatory cells < 25); 2, moderate (25–125 inflammatory cells); and 3, severe (more than 125 inflammatory cells). Statistical analysis was performed with Kruskal–Wallis test. Results: All the experimental materials provoked moderate to severe inflammatory reactions after 7 days, which significantly differed from the control group (P < 0.05). At 14-day interval, WMTA with expiry date of 2008 and the control group elicited mild to moderate infiltration of inflammatory cells. However, WMTA with expiry dates of 2009 and 2011 provoked moderate to severe inflammatory reactions, which were significantly different from WMTA with expiry date of 2008 and the control group (P < 0.05). At 28- and 60-day intervals, the overall inflammation subsided in all the groups to mild to moderate infiltration of inflammatory cells without any significant differences (P < 0.05). Conclusion: It seems that the expiry date has less negative effects on the response of inflammatory cells. WMTA keeps its biocompatibility even after expiry date.

Abstract – Background/Aim: The objective of this study was to investigate the occurrence of injuries, especially dental trauma, in scooter-related accidents. In addition, children’s habits of wearing protective gear were assessed. Material and Methods: The study was conducted in primary schools in three neighboring towns near Basel, Switzerland, using anonymous multiple-choice questionnaires completed by parents of schoolchildren. Results: A total of 953 scooter riders were included in the study. The average age was 9.1 years (range 6–12 years). Of riders, 58.3% wore no protective gear, 39.6% wore a helmet, and 2% wore other protective equipment. Twenty-nine percentage of the children have sustained an accident while riding the scooter, of those injuries, 41.4% affected the lower extremities, 37.0% the upper extremities, 21.6% the head, and 11.2% dental injuries; 20.3% of accidents required medical treatment. Conclusions: Parents, teachers, and doctors should be aware of the dangers involved in scooter riding. Educational measures, especially concerning use of protective gear, should be implemented to reduce the number and severity of injuries caused by this popular recreational activity.

Abstract – Background: Study was designed to evaluate shear bond strengths of different restorative techniques of uncomplicated enamel-dentin fractures in permanent incisors. Material and Methods: Forty human mandibular incisors were divided into four groups. One-third of their anatomical crowns from the incisal edges were cut off in three groups, representing an uncomplicated enamel-dentin fracture. Intact teeth in group 1 were used as control. In group 2, edge fragments were reattached by flowable composite (Filltek Flowable Supreme XT). In group 3, teeth were restored with universal resin composite (Filtek Z 250). In group 4, pre-impregnated glass fiber sheet (everStickNet) was positioned onto fractured surface, and then restorations were completed with resin composite. Three-step etch-and-rinse adhesive system (Adper Scotchbond Multi Purpose) was used in all test groups. Shear bond strengths of all samples were determined in universal testing machine, and data were analyzed with Kruskal–Wallis followed by Mann–Whitney U tests. Failure types were observed by light microscope. Results: Shear bond strength of sound teeth was significantly higher than those of restored teeth (P < 0.05). Mean shear bond strengths of the reattached teeth were lower than the other two restoration types; however, differences were not statistically significant (P > 0.05). Conclusions: Load-bearing capacity of restored teeth was not as high as sound teeth in the uncomplicated crown fracture. However, shear bond strength of different types of restorations seems close to each other.

Abstract –  Mouth opening limitation after the neurosurgical procedures is a common complication and usually resolves within 3 months. If limited mouth opening remains unresolved on the long term, an intra-articular ankylosis of temporomandibular joint may develop eventually. The possible mechanisms base on the myositis and atrophy of the masticatory muscles for these craniotomies are often involved in the temporalis. This article reports two unusual cases with the intra-articular ankylosis of temporomandibular joint after the traumatic brain injury, who received a modified surgical treatment for joint ankylosis. Therefore, the early diagnosis and intervention are important to minimize these complications.

Abstract –  Background: The aim of the present study was to investigate the prevalence of dental trauma, etiological factors, predisposing factors, and associations with socioeconomic status and the risk of alcohol and illicit drug use among adolescents in the city of Belo Horizonte, Brazil. Methods: A cross-sectional study was carried out that included clinical examinations and self-administered questionnaires. The sample population was composed of 891 adolescents from public and private schools. The Social Vulnerability Index (SVI) was used for socioeconomic classification. Information on alcohol and illicit drug use was obtained using two questionnaires: the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Results: The prevalence of traumatic dental injury (TDI) was 24.7%. Falls (17.7%) was the most frequently cited etiological factor in dental injury. Among the participants with TDI, 32.8% were students in the private school system (P = 0.006). A total of 56.8% of individuals with accentuated overjet had some type of TDI (P = 0.000). There was a high prevalence of adolescents who consumed alcoholic beverages (50.3%) and used illicit substances (15.2%). However, no statistically significant associations were found between these variables and the presence of TDI. The results of the analysis demonstrate that individuals in a private school system [prevalence ratio (PR) = 1.11; 95% confidence interval (CI): 1.03–1.20] and those with accentuated overjet (>3 mm) (PR = 1.17; 95% CI: 1.10–1.25) had a 1.11- and 1.17-fold greater chance of belonging to the group of individuals diagnosed with some type of TDI. Conclusions: The prevalence of dental trauma in the study population was high. The same was true regarding alcohol and illicit drug use among the adolescents examined, although no statistically significant associations were found between these variables and a history of TDI. Private school system and accentuated overjet were significantly associated with dental trauma.

Abstract – Background: The prevention of dental injuries during full-contact sports such as rugby is extremely important. Wearing a mouthguard can significantly reduce the frequency and severity of orofacial injuries, but it is not always used as athletes find it difficult to tolerate. The purpose of the present study was to determine the awareness and the extent of mouthguard use in a sample of young rugby athletes in the North West of Italy. Material and Methods: The athletes of four amateurs rugby teams based in the Province of Turin, Italy completed a questionnaire about playing history, current use and type of mouthguards, disturbs associated with mouthguard use, and general attitudes towards mouthguards. Results: Only 53.85% of the subjects reported wearing their mouthguard all the time both during training and games. The most commonly reported problem associated with using a mouthguard was the discomfort on speech, followed by difficulty in closing lips, adversely affected breathing, adversely affected swallowing and slipping sensation. A statistically significant association between patients <22 years and non-use of mouthguards was observed. Conclusion: Limited knowledge about oral injury prevention and limited use of mouthguards were observed. The present study suggests that educational courses for rugby players and coaches to promote the use of mouthguards would be extremely important to reduce common complaints about these devices and increase their usage.

Abstract –  The treatment plan represents the final step in every diagnostic procedure and is the result of a series of assessments based on information gathered from a detailed clinical history. This clinical case reports the replacement of two central incisors that were lost because of a trauma. The advantages and disadvantages of the two treatment options (i.e. implantology or prosthetic restoration) were carefully evaluated in relation to the case in hand. Patient compliance and aesthetic requirements had been also considered. In this case, a conventional prosthetic restoration was performed using a metal-ceramic bridge, utilising full crowns between the right and left maxillary lateral incisors associated with minimal canine preparation. By this strategy, the treatment plan allows for a future implant restoration, should this become necessary.

Abstract –  Fracture of the anterior teeth by trauma is the most frequent type of injury affecting the permanent dentition, especially the maxillary central incisors. When the fragment is not available or its use is not recommended, donated extracted teeth (homogenous bonding) can be used. The aim of this paper is to report the successful 18-year follow up of a maxillary central incisor fracture in which homogenous bonding was performed.

Abstract –  The fracture of anterior teeth in children and adolescents is a common injury. When most tooth structure is compromised and the broken fragment is not recovered, its restoration can become rather complex to both dentist and dental technician. Restoration of single anterior elements is one of the most demanding challenges in fixed prosthodontics. This article describes a clinical case of a 13-year-old patient with an extensive fractured central incisor and contra lateral incisor. Endodontic treatment was performed on both teeth, and a temporary removable appliance was made for esthetics. One month later, an indirect esthetic post and core was made for each tooth, and provisionals were placed. After a 6-month period of soft tissue stabilization, two pressed all-ceramic crowns were fabricated and bonded to the preparations. The authors believe this to be a stable long-term option relative to the reminiscent tooth structure, esthetic demand, and occlusal features of the case.

Abstract –  The purpose of this study was to evaluate the ability of soymilk, powdered milk, and Hank’s balanced salt solution (HBSS) to maintain human periodontal ligament (PDL) cell viability in vitro. PDL cells were obtained from extracted healthy third molars and cultured in Dulbecco’s modified Eagles medium (DMEM). The cultures were exposed for 1, 2, 4, and 8 h to experimental solutions (tap water served as negative control and DMEM as positive control) at 37°C. The viable cells were then counted using the trypan blue exclusion technique. Data were analyzed by using one-way anova, post hoc Scheffe and two-way anova test. Statistical analysis showed that HBSS, powdered baby formula, and soymilk maintain cell viability equally well in different periods of times. Tap water cannot keep cells viable as well as other solutions. Soymilk and powdered baby formula can be recommended as suitable storage media for avulsed teeth for up to 8 h.

Abstract – Aims: The aim of this study was to retrospectively evaluate iatrogenic dental root damage, caused by two different techniques that utilized bone anchor screws, for intermaxillary fixation (IMF) in orofacial trauma. Materials and methods: The techniques used included either predrilled or drill-free bone anchor screws. A total of 123 patients who required IMF were evaluated (97 men and 26 women). Sixty-four patients were treated in the predrilled group, and 59 patients were treated in the drill-free group. The data were collected over an 8-year period and were analyzed using crosstabs and Fisher’s exact test. Results: Injuries to dental roots were found only in the predrilled group. Twenty-nine patients (45.3%) were injured at the time of surgery. One year after surgery, 10 patients (15.6%) had permanently injured dental roots. There was a significant difference in injury rates between the predrilled and drill-free groups 1 year after surgery (P < 0.001). Conclusion: There is an increased potential risk of iatrogenic injury and permanent damage to the dental roots when a technique that involves predrilled holes for bone anchor screws is used.

Abstract –  The teeth most commonly affected by trauma are the maxillary central incisors. The most frequent types of traumatic dental injuries to permanent teeth are enamel fractures, enamel and dentine fractures, and enamel and dentine fractures with pulp involvement. This article describes three clinical cases with different levels of traumatized maxillary incisors and several cosmetic approaches for recovery of the esthetics and the masticatory function, as well as the social/psychological aspects of treatment. All cases involved young adult men. The three clinical cases involve dentin and enamel fractures, dentin and enamel fractures with pulp exposure, and dentin and enamel fractures with pulp exposure associated with root fracture. The cosmetic treatments used to resolve fractures were direct composite resin by layering technique, indirect all-ceramic restorations (laminate veneer and ceramic crowns over the teeth), and immediate implant after extraction followed by immediate loading (ceramic abutments with ceramic crown over implant). In all three cases, excellent functional and esthetic results were achieved by use of these treatment modalities. The patients were very satisfied with the results.

Abstract –  Intrusion injuries are considered among the most severe forms of dental trauma, potentially leading to ankylosis as a late consequence. In 1991, a 7-year-old boy suffered a traumatic intrusion leading to an infraposition of tooth 21 along with its immobility. Based on the clinical findings, including bright-sounding percussion testing, disappearance of the periodontal space and a failed attempt at orthodontic movement, a diagnosis of ankylosis was made. Following prosthetic restoration of the infrapositioned tooth, spontaneous re-eruption occurred 15 years later. With the help of a partial multibracket appliance, the tooth could be adjusted to occlusal level and was then restored to the patient’s satisfaction. Radiographically, it was demonstrated that extrusion of the tooth had been accompanied by a significant gain in local alveolar bone volume. While a wait-and-see strategy cannot be recommended as a treatment option following ankylosis, considering that spontaneous re-eruption after several years is an extremely rare finding, elucidating the mechanisms at work in spontaneous re-eruption at a cellular level might create an opportunity for iatrogenic triggering of re-eruption, thus paving the way to new forms of therapy.

Abstract –  The clinical management of orthodontic patients with dental trauma before or during the treatment is mainly founded on clinical experience, expert opinions, and individual case reports. It is proposed in the literature that teeth sustaining mild trauma with minor damage to the periodontium (e.g. subluxation) should be followed for a period of time before being subjected to orthodontic forces. A minimum period of 3 months has been proposed. In this study, we used an animal model to investigate whether shorter observation periods could be established in case of mild trauma. The periradicular region of rat molars was examined microscopically to determine the biological events of tooth movement started 15 and 30 days after intentional subluxation using an experimental method to induce dentoalveolar trauma. Thirty adult male Wistar rats were assigned to 6 groups (n = 5): Group 1 (control – no trauma/orthodontic movement); Group 2: the animals received an orthodontic device and were sacrificed after 7 days; Groups 3 and 4: dentoalveolar trauma (subluxation) was experimentally induced by the application of an axial force of 900 cN on the occlusal surface of the maxillary right first molar, and the animals were sacrificed after 22 and 37 days, respectively; and Groups 5 and 6: 15 and 30 days, respectively, after force application, an orthodontic device was installed and the rats were sacrificed 7 days later. In G5 and G6, the periodontal ligament and pulp tissue were rich in cellular elements and blood vessels, the alveolar bone was preserved, and the root surface presented only very small areas of surface resorption (cementum), maintaining the characteristics of normality. In conclusion, the microscopic alterations in the gingival and periodontal tissues in response to an experimentally induced mild dentoalveolar trauma simulating subluxation were not sufficient to contraindicate starting the orthodontic movement 15 and 30 days after trauma.

Abstract –  There has been a significant increase in the number of facial fractures stemming from sport activities in recent years, with the nasal bone one of the most affected structures. Researchers recommend the use of a nose protector, but there is no standardization regarding the material employed. Clinical experience has demonstrated that a combination of a flexible and rigid layer of ethylene vinyl acetate (EVA) offers both comfort and safety to practitioners of sports. The aim of the present study was the investigation into the stresses generated by the impact of a rigid body on the nasal bone on models with and without an EVA protector. For such, finite element analysis was employed. A craniofacial model was constructed from images obtained through computed tomography. The nose protector was modeled with two layers of EVA (1 mm of rigid EVA over 2 mm of flexible EVA), following the geometry of the soft tissue. Finite element analysis was performed using the LS Dyna program. The bone and rigid EVA were represented as elastic linear material, whereas the soft tissues and flexible EVA were represented as hyperelastic material. The impact from a rigid sphere on the frontal region of the face was simulated with a constant velocity of 20 m s⁻¹ for 9.1 μs. The model without the protector served as the control. The distribution of maximal stress of the facial bones was recorded. The maximal stress on the nasal bone surpassed the breaking limit of 0.13–0.34 MPa on the model without a protector, while remaining below this limit on the model with the protector. Thus, the nose protector made from both flexible and rigid EVA proved effective at protecting the nasal bones under high-impact conditions.

Abstract – Aim: The aim of this study was to evaluate via a questionnaire the knowledge level of primary school teachers in Ankara, Turkey, regarding dental trauma; to inform them on the subject through a leaflet; and to evaluate the effectiveness of the leaflet by reapplying the questionnaire. Materials and methods: A questionnaire was distributed to 500 teachers in seven randomly selected primary schools. The questionnaire consisted of four different scenarios presented with photographs and a total of eight questions on crown fracture, lateral luxation, root fracture, and avulsion. After responding to the questionnaire, teachers were given a leaflet containing information about traumatic dental injuries and their emergency management. After 1 month, the same questionnaire was distributed, and the responses collected. Results: A total of 450 of 500 teachers responded to the questionnaire. Initial responses indicated the knowledge level of teachers to be quite low. Following the distribution of the information leaflet, the rate of correct answers increased for each of the individual questions, and the total scores for the questionnaire increased significantly (P = 0.0001). Conclusion: There is a clear need to inform teachers about traumatic dental injuries. The use of educational leaflets can be a successful and appropriate means of providing teachers with information.

Abstract –  This study was designed to compare the thickness of dentin formed associated with autogenous tooth transplantation in dogs, using either one- or two-stage surgical techniques. The study consisted of three Beagles, older than 5 months, in which six incisors and six premolars were transplanted to mechanically prepared recipient sockets. One group was transplanted using a one-stage method to recipient beds prepared immediately before transplantation. The second groups of teeth were transplanted using a two-stage method in which the recipient beds were prepared and left to heal for 7 days before transplantation. Dogs were injected with xylenol orange, calcein and oxytetracycline at 2 days before, 3 and 9 weeks after transplantation, respectively, for vital staining. Clinical examinations were carried out every week, and the animals were euthanized 9 weeks later. The jaws were resected, fixed in formaldehyde and embedded in resin. Undemineralized sections were cut and examined by fluorescent microscopy. The thickness of dentin formed in the third week after transplantation and 9 weeks was evaluated by undertaking histomorphometric analysis and analysed using the Mann–Whitney U test (P = 0.05). All the transplanted teeth in both groups survived, and the dentin was formed. No statistically significant difference was found in the thickness of dentin formed in the third week and formed in the third to ninth week between the treatment groups (P = 0.999 and P = 0.998, respectively). This study demonstrated that there was no difference between the two surgical techniques in terms of the thickness of dentin formed in transplanted teeth.

Abstract –  Delayed replantation of an avulsed tooth may result in rapid root resorption or, more frequently, dental ankylosis with subsequent bone substitution. If this process develop slowly, it is possible to observe that tooth loss is characterized by a well conserved alveolus with regard to bone preservation, particularly in vertical dimension. This clinical case reports a dental trauma of a central incisor in a young boy characterized by tooth avulsion and its delayed replantation. After 10 years, dental ankylosis of the incisor was recorded and the patient underwent a prosthetic-orthodontic rehabilitation using CAD-CAM technology and no-prep veneers.

Abstract –  The aim of this pilot study was to evaluate the clinical efficacy of mineral trioxide aggregate (MTA) as an apexification material when used in non-vital immature permanent incisors in children. Fifteen children with a mean age of 11.7 years and 17 non-vital permanent incisors were ajudged suitable for inclusion. Standard endodontic procedures were followed and an apical plug of 3–4 mm was created by using MTA after a calcium hydroxide intracanal dressing had been applied for at least 1 week. Final obturation was completed by using thermoplastisized Gutta–Percha (Obtura II) at least 1 week following MTA placement. Subjects were reviewed clinically and radiographically at 3-month intervals. Mean follow-up time for MTA was 12.53 months (±2.94 SD). Of the total of 17 teeth treated, MTA placement was considered to be adequate in 13 teeth. The procedure showed clinical success in 94.1% of the cases, radiographic success was found to be 76.5% and in further three cases (17.6%) the outcome was considered to be uncertain. This is one of the very few studies that have reported the out coming of MTA as an apexification material in children with non-vital teeth and incomplete root development. However, larger clinical studies are required to evaluate the long-term success of this procedure.

Abstract –  The ability of storage media to preserve periodontal ligament (PDL) cell vitality has been previously evaluated. However, the mechanisms by which different storage conditions alter the functional status of PDL cells have not been determined. The purpose of the present study was to investigate, in vitro, the level of programed cell death or apoptosis in a population of PDL cells following storage under different conditions. Primary human PDL cells were plated into 24-well-culture plates and allowed to attach for 24 h. Cells were then exposed for 1 h to milk, Hank's balanced salt solution (HBSS), Soft Wear contact lens solution or Gatorade at room temperature or on ice. Culture medium was used as a negative control. Apoptosis was evaluated at 24, 48, and 72 h after treatment on quadruplicate samples by using the ST 160 ApopTag Fluorescein Direct In Situ Detection Kit. The total number of cells and the total number of apoptotic cells were counted. The results indicated that at 24 and 72 h, PDL treated with Gatorade and the contact lens solution displayed the highest percentages of apoptotic cells when compared with the other treatment groups at room temperature. Overall, cells treated on ice showed significantly lower levels of apoptosis when compared with treatments at room temperature. In conclusion, the results indicated that apoptosis plays a major role in cell death in cells treated with Gatorade and contact lens solutions in comparison to other storage solutions and that storage on ice can inhibit programed cell death.

Abstract –  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 followup 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.

Abstract –  Regeneration (revitalization) of infected necrotic pulp tissue has been an important issue in endodontics for more than a decade. Based on a series of case reports, there appears to be evidence that new soft tissue can enter the root canal with a potential for subsequent hard tissue deposition resulting in a narrowing of the root canal. Very little is presently known about the exact nature of this tissue growing into the canal and how it may behave in the long term. In the case of regeneration of necrotic non-infected pulp tissue, a series of clinical and histological studies have shown that such events may take place in four variants: (i) Revascularization of the pulp with accelerated dentin formation leading to pulp canal obliteration. This event has a good long-term prognosis. (ii) Ingrowth of cementum and periodontal ligament (PDL). The long-term prognosis for this event is not known. (iii) Ingrowth of cementum, PDL, and bone. The long-term prognosis is only partly known, but cases developing an internal ankylosis have been described. (iv) Ingrowth of bone and bone marrow is a rare phenomenon and the long-term prognosis does not appear to be good. Based on current knowledge, expectations with respect to pulp regeneration (revitalization) of infected necrotic dental pulps are difficult to predict; more information than now available is needed before procedures for pulpal regeneration can be routinely recommended with a predictable long-term prognosis.

Abstract –  Healing subsequent to dental trauma is known to be very complex, a result explained by the variability of the types of dental trauma (six luxations, nine fracture types, and their combinations). On top of that, at least 16 different cellular systems get involved in more severe trauma types each of them with a different potential for healing with repair, i.e. (re-establishment of tissue continuity without functional restitution) and regeneration (where the injured or lost tissue is replaced with new tissue with identical tissue anatomy and function) and finally metaplasia (where a new type of tissue replaces the injured). In this study, a review is given of the impact of trauma to various dental tissues such as alveolar bone, periodontal ligament, cementum, Hertvigs epithelial root sheath, and the pulp.

Abstract –  Mineral trioxide aggregate (MTA) has over the last two decades begun to take the place of calcium hydroxide (CH) in the treatment of a variety of pulpal and periodontal healing complications following dental trauma. These conditions include teeth with: (i) exposed pulps, (ii) immature roots and pulp necrosis, (iii) root fractures and pulp necrosis located in the coronal part of the pulps, and (iv) external infection-related (inflammatory) root resorption. The main reasons for replacing CH with MTA in these situations have generally been the delayed effect when using CH to induce hard tissues, the quality of such induced hard tissues, and finally the dentin weakening effect of CH, which in some instances lead to cervical root fractures in immature teeth. MTA appears, from a relatively few clinical studies, to overcome these shortcomings of CH. The lack of long-term clinical studies, however, may warrant a certain reservation in an unrestricted replacement of CH with MTA. A definite need for randomized clinical studies comparing CH and MTA in trauma healing situations is urgently needed.

Abstract –  The regeneration of immature permanent teeth following trauma could be beneficial to reduce the risk of fracture and loss of millions of teeth each year. Regenerative endodontic procedures include revascularization, partial pulpotomy, and apexogenesis. Several case reports give these procedures a good prognosis as an alternative to apexification. Care is needed to deliver regenerative endodontic procedures that maintain or restore the vitality of teeth, but which also disinfect and remove necrotic tissues. Regeneration can be accomplished through the activity of the cells from the pulp, periodontium, vascular, and immune system. Most therapies use the host’s own pulp or vascular cells for regeneration, but other types of dental stem cell therapies are under development. There are no standardized treatment protocols for endodontic regeneration. The purpose of this article is to review the recent literature and suggest guidelines for using regenerative endodontic procedures for the treatment of permanent immature traumatized teeth. Recommendations for the selection of regenerative and conventional procedures based on the type of tooth injury, fracture type, presence of necrosis or infection, periodontal status, presence of periapical lesions, stage of tooth development, vitality status, patient age, and patient health status will be reviewed. Because of the lack of long-term evidence to support the use of regenerative endodontic procedures in traumatized teeth with open apices, revascularization regeneration procedures should only be attempted if the tooth is not suitable for root canal obturation, and after apexogenesis, apexification, or partial pulpotomy treatments have already been attempted and have a poor prognosis.

Abstract –  The prognosis of tooth replantation is usually related to the need of endodontic treatment, which has a direct relationship with the occurrence of root resorptions. Several studies have been undertaken in an attempt to prevent, delay, or treat these complications, which are the main causes of loss of replanted teeth. This literature review examines research evidence on intracanal dressings and root canal filling materials used in cases of tooth replantation. A comprehensive search was performed in the Medline/Pubmed, Bireme and Scielo full-text electronic journal databases to retrieve English-language articles referring to these topics that had been published between 1964 and 2010. Calcium hydroxide (CH) remains the usually recommended choice as an intracanal medicament in replanted teeth; however, there is evidence to support the initial use of a corticosteroid-antibiotic combination such as Ledermix paste to control potential early resorption, prior to the introduction of CH where the beneficial effect in the treatment of progressive root resorption has been well proven. Regarding root filling materials, CH-containing sealers are a good option because of their biological properties. Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth.

Abstract –  Dental trauma is, unfortunately, not uncommon and may be even more prevalent in high-risk populations. It should be emphasized and acknowledged that many cases of dental trauma are preventable. Appropriate management includes primary prevention, i.e. avoidance of pathology development, and secondary prevention, i.e. early diagnosing and treatment of the pathology before significant morbidity occurs. The aim of this article is to provide a review of the current dental trauma literature with regard to education and knowledge and with relevance to primary and secondary prevention. As the duty of providing the public with measures for the maintenance of proper oral health is of the dental profession, the responsibility of providing primary and secondary prevention of dental trauma is of dentists, dental hygienists, and dental nurses. They may, and should, educate other medical, paramedical, and non-medical professionals, taking into account that those non-dental professionals could not maintain a high level of knowledge and service regarding dental trauma without a continuous backing by the dental professionals. It should be remembered that as the prevalence of dental decay has reduced in the Western world during recent decades, dental trauma plays a significant part in causing dental morbidity and mortality (tooth loss). It seems that now is the time to act for the benefit of our community and move from ‘treating’ toward ‘managing’ risk factors and prevention.

Abstract –  Background: Non-setting calcium hydroxide (Ultracal XS^®) is recommended by the International Association of Dental Traumatology as the initial medicament following avulsion and replantation for mature teeth. There is experimental evidence to suggest Ledermix^®, placed as an alternative inter-visit dressing may improve periodontal healing. Aim: This study investigated, using a multi-centre randomized controlled trial, the effect of two root canal medicaments, Ledermix^® and Ultracal XS^®, on periodontal healing of avulsed and replanted teeth. Material and methods: Children were recruited if they fulfilled all inclusion criteria. Treatment followed a standardized protocol. Assessment of periodontal healing or ankylosis was made clinically and radiographically by an experienced, ‘blinded’, clinician at 12 months. Results: Over 200 patients were assessed for eligibility at five centres. Twenty-nine patients were eligible for inclusion. Final analysis involved 22 patients with 27 teeth. Ankylosis was detected in four of the 12 teeth in the Ledermix^® group and nine of 15 in the Ultracal XS^® group. No significant difference between medicaments was found in the proportion of teeth or patients showing periodontal healing. Discussion: There was no significant difference in periodontal healing between the two medicaments at either a tooth or patient level. The numbers recruited fell short of an estimated power calculation. For patients meeting the inclusion criteria and completing the trial, periodontal healing was seen in 52% of teeth at the 12-month assessment between both groups. The only factor found to significantly influence the periodontal outcome was dry time.

Abstract – Aim: To evaluate the influence of reinforcement material on in vitro dental splint rigidity. Materials and Methods: A custom-made artificial model was used. The central incisors simulated ‘injured’ teeth with increased mobility, and the lateral incisors served as ‘uninjured’ teeth with physiologic mobility. The Periotest and Zwick methods were used to assess horizontal and vertical tooth mobility before and after splinting, and relative splint effect (SpErel) was calculated. Teeth 12–22 were splinted using two wire-composite splints (WCS), WCS1 (Dentaflex 0.45 mm), and WCS2 (Strengtheners 0.8 × 1.8 mm) as well as four quartz-fiber splints, QS1 (Quartz Splint UD 1.5 mm), QS2 (Quartz Splint Rope 1.5 mm), QS3 (Quartz Splint Woven 2.5 mm), and QS4 (dry fibers 667 tex). The influence of the splint type was evaluated using anova, Tukey range, and the Dunnett-T3 test (α = 0.05). To test the influence of initial tooth mobility, the t-test was applied (α = 0.05). Results: Reinforcement materials significantly influenced splint rigidity (P < 0.05). The horizontal and vertical SpErel of WCS1 compared with WCS2 and QFSs1–4 was statistically significant (P < 0.05). Significant differences were found when comparing the horizontal SpErel of WCS2 with WCS1 and QSs1–4 (P < 0.05). SpErels of the ‘injured’ and ‘uninjured’ teeth showed significant differences (P < 0.05). Conclusion: WCS1 is flexible compared with the more rigid WCS2 and QSs1–4. Initial tooth mobility influences SpErel. The flexible WCS1 can be recommended for splinting dislocation injuries whereas the semi-rigid/rigid WCS2 and QS1–4 can be used for horizontal root fractures and alveolar process fractures. The QS1–4 provide good esthetic outcome.

Abstract –  The aim of the present study was to investigate whether there is a direct correlation between the amount of residual tooth structure in a fractured maxillary incisor and the fracture resistance of composite resin restorations or porcelain veneers after cyclic loading. Sixty human-extracted maxillary central and lateral incisors were mounted in an acrylic block with the coronal aspect of the tooth protruding from the block surface. The teeth were assigned to two groups: 2-mm incisal fracture and 4-mm incisal fracture. Then, the teeth were further divided into two different restoration subgroups, porcelain laminate veneer and composite resin restoration, therefore obtaining four groups for the study (n = 15). The specimens were subjected to 1000 cycles of thermocycling and were mechanically tested with a custom-designed cyclic loading apparatus for 2 × 106 cycles or until they failed. The specimens that survived the cyclic loading were loaded on the incisal edge along the long axis of the tooth with a flat stainless steel applicator until they fractured using a universal testing machine to measure the failure load. Two-way anova was used to assess the significance of restoration, amount of fracture, and interaction effect (α = 0.05). During the cyclic loading, for the composite resin group, two specimens with 2-mm fracture and three specimens with 4-mm fracture failed. For the porcelain veneer group, two specimens with 2-mm fracture and one specimen with 4-mm fracture failed. The 2-way anova did not show statistical significance for restoration (P = 0.584), amount of fracture (P = 0.357), or interaction effect (P = 0.212). A composite resin restoration and a porcelain veneer could perform similarly for replacing a fractured incisor edge up to 4 mm. Other factors such as esthetic and/or cost would be considerations to indicate one treatment over the other.

Abstract – Aims:  This study sought to establish the prevalence of traumatic dental injuries in the primary dentition of Irish children and to investigate the relationship between dental trauma and non-nutritive sucking habits.