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Background/aims: Dental traumatic injuries are common in children during the mixed dentition stage. These injuries usually require splinting for stabilization, which is complicated by the various stages of the permanent tooth development and primary tooth exfoliation. The aim of this study was to evaluate the effect on mobility of splint materials and extensions for an avulsed central incisor, stabilized with and without the adjacent incisor under intrusive and extrusive loading with different periodontal ligament (PDL) conditions., Materials and Methods: Seventeen 3D model variations were created from a CBCT scan of a 7-year-old patient without erupted permanent upper lateral incisors. A 1000 N palatal load on the right central incisor simulated the avulsion injury and created an increased alveolus and bone deformation, resulting in an increased PDL thickness of 0.45 mm. Wire-resin composite splints with 0.9 mm cross-section (WCS) or 1.0 mm diameter nylon-resin composite splints (NCS) were created. The models simulated conditions with and without the adjacent upper central incisor. Two PDL conditions were investigated, simulating detached PDL or PDL with polyether impression material-like properties. Mobility was calculated under simulated biting loads in horizontal and vertical (intrusive and extrusive) directions., Results: The NCS allowed greater tooth mobility of the avulsed incisor than the WCS, irrespective of splint extension, PDL condition, or load application. During horizontal loading, polyether-like properties for the PDL allowed around 0.2 mm mobility of the avulsed tooth with the WCS, similar to the intact tooth, whereas a simulated detached PDL allowed 25% more mobility with a WCS than with a NCS., Conclusions: Based on the FEA analysis, a 1.0 mm NCS may be suitable for splinting avulsion injuries during the mixed dentition stage compared to the considerably more rigid WCS. The NCS models provided flexibility for PDL healing while maintaining stability, even when missing adjacent teeth increased span widths. Extensions beyond directly adjacent teeth did not alter the mobility with the NCS but should still be considered an extra protection in case of bond failure or exfoliation., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Backgrounds/aims: Traumatic dental injuries with bone fractures require rigid splinting. The degree of rigidity of the wire-composite splints can be challenging. The aim of this study was to evaluate the effect of the rigidity of different wire-composite splints on alveolar process displacement., Material and Methods: A model was created using polystyrene resin to simulate the anterior maxilla, bovine incisors to simulate maxillary incisors, and polyether impression material to simulate the periodontal ligament. An alveolar process fracture was created, while maintaining the labial bone connection with the PDL. Four wire-composite splints (0.3, 0.6, 0.9, and 1.2 mm in diameter) were compared with models without splints and with no fracture (n = 5). The alveolar process displacement was measured (3 times per model/per splint type) at the fractured and adjacent central incisor regions using a deflectometer (Instron) under functional cycling and static loading (100 N). Data (μm) were analyzed using RM ANOVA, followed by Tukey's HSD test (α = 0.05)., Results: The displacement at the region of the adjacent incisor was not influenced by the splint during static and cycling load (P > .05). The Tukey test demonstrated that the model without splints had significantly higher alveolar process displacement at the traumatized teeth than that of all other splint models (P < .001). Increasing the wire diameter from 0.3 mm to 0.9 mm significantly reduced the alveolar process displacement (P < .001). No difference was observed between the 0.9 mm (P = .123) and 1.2 mm (P = .219) wire-composite splints irrespective of the measured tooth regions., Conclusions: The rigidity of the wire-composite splint significantly influenced the mobility of the fractured alveolar process. The use of at least 0.9 mm wire was effective in reducing the fractured alveolar process displacement to a level that was similar to the adjacent teeth., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background/aims: Traumatic dental injuries are highly prevalent and are considered an important health problem. The aim of this study was to evaluate the in vitro stress distribution around simulated traumatized teeth subjected to different types of splints by photoelastic analysis., Materials and Methods: For each group, five models of maxillary and mandibular arches were made in photoelastic resin using prefabricated teeth models, which were fixed and adjusted in a semi-adjustable articulator. All splints were bonded with composite resin on the labial surfaces of the maxillary central incisors, the lateral incisors and the canine teeth, simulating trauma to the 11. The groups were divided according to the type of splint: control-without splint; rigid-brackets and 0.021 × 0.025 inch stainless steel wire; semi-rigid-brackets and 0.016 × 0.016 inch cobalt-chromium wire; fiber-fiberglass ribbon; and flexible-nylon thread. The groups were submitted to an occlusal force in a special device attached to a universal test machine in balanced, protrusive, and lateral occlusions. Then, the incisal edge of the 11 was ground to simulate infra-occlusion, and the tests were performed again. Five points were analyzed around tooth 11 with a polariscope, and the data were submitted to ANOVA and Tukey tests at a 5% level of significance., Results: When centric occlusion was analyzed by comparing normal occlusion to infra-occlusion, all groups showed high stress values in infra-occlusion with statistical differences-except for the control group. When lateral occlusion was analyzed, the nylon splint showed lower statistical differences compared with the control, fiberglass, and rigid splint groups, which did not differ between each other. The semi-rigid splint did not differ from any group., Conclusions: Fiberglass and semi-rigid splints showed better stress distribution around the traumatized tooth under occlusal loads. The nylon splint showed characteristics of non-stress distribution., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background/aim: The influence of abutment tooth position and adhesive point dimension on rigidity of wire-composite splints, used in dental trauma, was evaluated in vitro., Materials and Methods: A commercial artificial resin model was used. The central incisors served as injured teeth with increased mobility (degrees of loosening II tooth 21 and III tooth 11), whereas teeth 12/22 or teeth 13/23 served as non-injured teeth with physiological mobility. Horizontal and vertical tooth mobility before and after splinting was assessed, using a universal testing machine. Teeth were splinted with a wire-composite splint (0.8 mm). Four groups were assigned with respective abutment tooth position and adhesive point dimension: group 1 (13-11-21-23, 2 × 2 mm(2) ), group 2 (12-11-21-22, 2 × 2 mm(2) ), group 3 (12-11-21-22, 3 × 3 mm(2) ), group 4 (12-11-21-22, 4 × 4 mm(2) )., Results: For each group, tooth mobility after splinting was significantly higher than the physiological tooth mobility (P < 0.05). For teeth 11 and 12, no significant differences between Group 1 and 2 (P > 0.05) were found in tooth mobility after splinting. Significant differences were found in horizontal tooth mobility after splinting of tooth 11 between Group 2 and 3, Group 2 and 4 and Group 3 and 4, respectively (P < 0.05), whereas significant difference was found in vertical dimension for tooth 11 only between Group 2 and 4 (P < 0.05). Significant differences were found in horizontal mobility of tooth 21 between Group 2 and 3, and Group 2 and 4 (P < 0.05)., Conclusion: Splinting the injured teeth 11 and 21 and the bilateral uninjured abutment teeth (teeth 12/22 or teeth 13/23) with the stainless steel wire-composite splint (0.8 mm), can be considered flexible splinting. While mobility was still higher than in unaffected teeth, increase in size of the adhesive splinting point decreased horizontal but not vertical mobility in most cases., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To evaluate the influence of adhesive point dimension and splint type on the rigidity of wire-composite splints in vitro., Materials and Methods: A custom-made artificial model was used. The two central incisors served as injured teeth (degrees of loosening III and II) and the two lateral incisors as non-injured teeth (physiological mobility). Horizontal and vertical tooth mobilities were investigated before and after splinting with the Periotest(®) method; the percent change was taken as the relative splint effect. Teeth were splinted with three types of wire-composite splints: Dentaflex (0.45 mm), Strengtheners (0.8 × 1.8 mm), and Dentaflex completely covered with composite. Four adhesive point dimensions (2, 3, 4, and 5 mm) were evaluated. Normal distribution was tested with the Kolmogorov-Smirnov test. Differences were evaluated with the anova and post hoc tests for pair-wise comparisons. Significance level was set at 0.05., Results: The adhesive point dimension did not influence splint rigidity, in general ( P  = 0.288). Significant effects were found in non-injured teeth with the Dentaflex ( P  < 0.001) and in injured teeth with the Strengtheners ( P  < 0.001). The Strengtheners splint rigidity increased significantly with increasing adhesive point dimensions. The three splints showed significantly different effects at 5-mm adhesive point dimension ( P  < 0.001)., Conclusion: Splint rigidity for injured teeth was influenced by adhesive point dimension only when splinting with Strengtheners. We recommend adapting splint rigidity by selecting different wires and reducing the adhesive point dimension to a minimum. Dentaflex can be used for flexible splinting, Strengtheners, and composite covered Dentaflex for rigid splinting., (© 2012 John Wiley & Sons A/S.)

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 20-pound test (9.072-kilogram test) [corrected] 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., (© 2011 John Wiley & Sons A/S.)

Avulsion of permanent teeth is one of the most serious dental injuries, and a prompt and correct emergency management is very important for the prognosis. 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 task group. The guidelines represent the current best evidence and practice based on literature research and professionals' opinion. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of avulsed permanent teeth., (© 2012 John Wiley & Sons A/S.)

Aim: We developed two versions of an artificial model and assessed their suitability for splint rigidity evaluation. These models allowed the simulation of traumatically loosened teeth and the use of the acid-etch technique for splint application., Materials and Methods: A straight and half-round arch bar model with bovine tooth facets were manufactured. Using the Periotest method, tooth mobility was evaluated before (PTVpre) and after (PTVpost) splinting. Two types of previously investigated wire-composite splints, WCS1 (Dentaflex 0.45 mm; Dentaurum) and WCS2 (Strengthens 0.8 × 1.8 mm; Dentaurum), were applied (n = 10) to each model. The relative splint effect (SpErel = ΔPTV/PTVpre) was calculated, and the working times for the models and splints were evaluated. Student's t-test and the Mann-Whitney U-test were employed with Bonferroni correction for multiple hypotheses., Results: When comparing the relative splint effect of the 'injured' central incisors between the models within one splint type, differences were only found for tooth 21 (WCS2; P < 0.008); for comparisons of splints within one model type, differences were detected for both incisors and model types (P < 0.008). With the straight model, significantly less working time was necessary (P < 0.05)., Conclusion: Using these models for in vitro splint rigidity evaluation, the splints can be applied with the acid-etch technique and tooth mobility can be individually adjusted. WCS1 is considered flexible compared to the more rigid WCS2. The results from the straight and the round model were predominantly closely related to each other. In terms of working time, the straight model is superior to the round model., (© 2011 John Wiley & Sons A/S.)

Unlabelled: Prevention of dental injury is considered to be more important than its treatment. A study was established to reduce the prevalence and the complications of tooth avulsion., Aim: The aim of this study was to investigate the characteristics of tooth avulsion of permanent teeth among patients that visited the Emergency Department of Beijing Stomatological Hospital in China., Materials and Methods: A retrospective analysis was performed of the dental records of 88 patients with 120 avulsed permanent teeth between 7 and 75 years old who had attended the Emergency Department of Beijing Stomatological Hospital in China during the period 1 July 2008 until 30 June 2009., Results: In 88 examined patients, the number of avulsed permanent teeth was 120. In 63 (71.6%) patients, in total 85 avulsed teeth were treated with replantation. In 18 (28.6%) patients, the avulsed teeth were stored in dry media. In only eight cases (12.7%), the avulsed teeth were replanted within 30 min. In approximately half of the cases (49.2%), the replanted teeth were fixed with stainless steel splint and a composite resin., Conclusions: It was evident from this study that there were delayed tooth replantations in many tooth avulsion cases. Thus, educational programs should be conducted to create awareness about the importance of immediate replantation, which will entail better prognosis of traumatic avulsed permanent tooth., (© 2011 John Wiley & Sons A/S.)

This paper presents clinical protocols for the emergency, early and post treatment complications of the avulsed tooth. The biological basis for these protocols is presented so that the reader understands the clinical decisions that have been made. Most of the protocols described in this article, but not all, have been adopted in the official guidelines of the International Association of Dental Traumatology. Some experimental results are promising and they have therefore been included in the review to stimulate colleagues to further research., (© 2011 John Wiley & Sons A/S.)

An immature permanent mandibular central incisor with periapical involvement in a 7-year-old boy was treated to promote revascularization. The tooth suffered from acute apical periodontitis after periodontal treatment by a general practitioner. An access cavity was prepared in the tooth and the cavity was left open until the next visit to achieve drainage through the canal. The root canal was not mechanically cleaned during the treatment period, but was irrigated with hydrogen peroxide and sodium hypochlorite. Calcium hydroxide compound was used for disinfection. At the fifth visit vital tissue appeared in the canal near the apical region, and calcium hydroxide compound was placed in contact with the soft tissue in the root canal. The access cavity was sealed with glass-ionomer cement followed by an adhesive composite resin filling. Radiographic examination 30 months after the initial treatment confirmed closure of the apex and thickening of the root wall. The case was observed for up to 13 years and root development was confirmed., (© 2011 John Wiley & Sons A/S.)

Alveolar process fractures are particularly complicated by the developing jaws, the presence of tooth germs and the eruption of permanent teeth. The present report describes the management and 24-month follow up of a segmental mandibular alveolar process fracture involving laterally luxated primary incisors. A 5-year-old boy was admitted to the clinic 3 h after a fall accident, which resulted in the fracture of the mandibular alveolar process with substantial dislodgement of the buccal cortical bone and right primary incisors. Emergency treatment consisted of fracture reduction in the dislodged bone and repositioning of the primary incisors, followed by placement of a semi-rigid splint between mandibular canines and suturing of soft-tissue lacerations. The splints were removed at the end of week 3, and the affected primary incisors remained asymptomatic until natural exfoliation. At 24 months, Eruption of the permanent successors was almost complete in the absence of any sequel from prior trauma., (© 2010 John Wiley & Sons A/S.)

Intrusive luxation is one of the most severe types of dental traumatic injuries. The risk of occurrence of pulpal necrosis and inflammatory or replacement resorption is high. In an attempt to prevent or delay the appearance of such lesions, endodontic intervention is required soon after the occurrence of trauma. A 17-year-old boy reported to the Department of Conservative dentistry and Endodontics, KLE VK Institute of Dental Sciences, Belgaum, 2 days after a fall from a bicycle. Clinical and radiographic examination revealed an intrusive luxation of the left maxillary central incisor and lateral incisor. There were complicated crown fracture with the right maxillary central incisor and uncomplicated crown fracture with the left maxillary central incisor. Also, all the incisors showed the presence of Oelhers type II Dens-in-dente. The management was hence challenging. Immediate surgical repositioning was performed and the teeth were stabilized with a composite resin splint. Endodontic therapy was initiated with the right maxillary central incisor, and the canal was sealed with calcium hydroxide dressing. After 3 weeks, pulp sensitivity was repeated with the maxillary left central and lateral incisors. The result was negative. Considering the incidence of pulp necrosis and root resorption in intruded teeth with complete root formation, they also were dealt in a similar manner as the maxillary right central incisor. The splint was removed after 1 month. After 6 months of calcium hydroxide therapy, there was a satisfactory apical and periodontal healing. At this stage, the teeth were obturated and the fractures were restored with composite resin. A 1-year follow up revealed a satisfactory clinical and radiographic outcome., (© 2010 The Authors. Dental Traumatology © 2010 John Wiley & Sons A/S.)

This paper describes the resolution of an extensive complicated crown-root fracture of an endodontically treated maxillary central incisor. Initially, the fractured crown was splinted to the adjacent teeth with orthodontic wire and composite resin. Subsequently, the crown fragment was reattached by means of a fiber post using a hybrid composite resin. Early stage success was achieved with the observance of normality in function, esthetics, and health of the tooth and surrounding periodontal structures. An athletic mouthguard was fabricated to prevent further trauma. Advantages, disadvantages, and prognosis of the treatment presented are discussed.

Background/aim: The Periotest method is a technique for the objective assessment of tooth mobility. The aims of this study were to determine normal Periotest values in the vertical and horizontal dimensions of periodontally healthy teeth in individuals aged 20-35 years and investigate the reliability of Periotest in terms of intra-series and inter-series reproducibility before and after applying a dental trauma splint in vivo., Materials and Methods: Periotest values were measured in periodontally healthy dental students (n = 33; mean age 24.7 years) at reproducible measuring points in the vertical and horizontal dimensions, before and after splint insertion. Three readings were taken per series to observe the intra-series reproducibility; three series were measured to test inter-series reproducibility (Friedman-test; P

Conservative solutions for the restoration of a single edentulous space in the anterior maxilla present an esthetic challenge to the clinician. A 45-year-old male patient whose right upper central tooth was planned to be extracted was referred to our clinic for a conservative, rapid, and economic treatment. After radiographic and clinical examinations, it was decided that the tooth which was to be extracted should be used for the restoration of its own extracted area. The extracted tooth was splinted to adjacent teeth with the aid of the grooves and fiber-reinforced composite (everStick, StickTech Ltd., Turku, Finland). Following an early and unexpected failure of the restoration, the fiber layer was thickened twice with a flowable composite resin (Stick Flow, Stick Tech Ltd.) which fit better to the grooves. The restoration satisfied the patient with a good mechanical behavior, esthetics, and long-term durability after 12 months while. Restoring the missing tooth area with the patient's own tooth is advantageous when combined with modern adhesive techniques. The clinician must pay attention to the mechanical adaptation of the restoration and the technique sensitivity of the applied adhesive system.

Almost all treatment procedures used for dental traumas are still today not evidence-based, a fact, which makes it difficult to analyse the long-term outcome of healing and its relationship to treatment. Crown fractures with extensive dentin exposure represent a dominant injury in the permanent dentition. Accepted treatment philosophy is dentin coverage (dental liner and/or dentin bonded restoration) to prevent bacteria penetration into the pulp. Today there is, apart from deep proximal fractures, no evidence that this treatment is necessary to protect the pulp. In case of luxation injuries, the accepted treatment principles appear to be anatomically correct repositioning, stabilization with a splint and sometimes antibiotic coverage. In clinical studies, these principles could not be proven to optimize either periodontal or pulpal healing, the explanation possibly being that both reposition and application of splints in certain cases add extra damage to the pulp and periodontal ligament. In case of root fractures with dislocation, fast and optimal repositioning and rigid long-term splinting (i.e. 3 months) have been considered the principle of treatment. However, a recent clinical study has shown that short-term splinting with a semi-rigid splint appears to optimize fracture healing. In tooth avulsion with subsequent replantation, cleansing of the root surface for contamination and systemic antibiotics has been considered essential for pulp and periodontal healing. These treatment concepts have been derived from experimental studies in animals. However, their importance could not be verified in large clinical studies. Ideally, randomized clinical studies are needed in the future for selected trauma types. The influences of repositioning, splinting and the role of infection and antibiotics should be further investigated. However, for ethical reasons, it will be difficult to perform randomized studies on trauma victims and we will be forced in the future to rely on experimental animal studies supported by clinical observational studies.

Aim: The aim of the study was to evaluate the flexibility of five different splint systems [polyethylene fibre-reinforced splint (Ribbond THM, Ribbond Inc., Seattle, WA, USA), resin splint (RS), wire-composite splint (WCS), button-bracket splint (BS) and titanium trauma splint (TTS)] commonly used in clinical practice for the treatment of dental traumatic injuries involving the periodontal supporting tissues., Materials and Methods: For the experimental study, a resin cast of the upper arch was manufactured, where teeth 11, 12 and 21 (used for the stress analysis) were inserted in a non-rigid fashion so as to allow for replacement, whereas the other teeth were permanently fixed to the corresponding sockets. Two different test sessions were performed for each splint: (i) stress analysis with increasing intensity ranging between 0 and 50 N directed along the tooth's longitudinal axis; (ii) stress analysis with 45 degrees of oblique force of increasing intensity ranging between 0 and 30 N. For each loading direction, five recordings were conducted without a splint, followed by five with the splint applied. The energy required to modify the position of the teeth was calculated for both the splinted and un-splinted teeth and the difference between the two values was determined. Energy variation was assessed for the testing of both axial (DeltaE(a)) and oblique force (DeltaE(o)). DeltaE represents the rigidity index of the analysed contention devices: high DeltaE values correspond to high rigidity materials., Results: The RS showed the highest DeltaE value for the axial stress analysis, whereas the highest DeltaE value at a 45 degrees was recorded for the WCS and RS. For both tests, the lowest DeltaE values were recorded for the TTS and Ribbond THM splints., Conclusions: The data show that the contention devices with the highest flexibility are the TTS and the Ribbond THM as they exhibit a lower energy variation needed for splint deformation compared with the other materials that were examined.

A high prevalence of dental trauma exists and its effects on function and esthetics deserve the attention of general dentists. The aim of this study was to assess the level of general dental practitioners' (GDPs) knowledge about guidelines for dental avulsion and its prevention using a questionnaire. The 21-item questionnaire was distributed among 264 GDPs and the survey was realized between August-November 2006. The data obtained were statistically analyzed using descriptive analysis and Pearson's Chi-square test to determine associations between knowledge regarding emergency treatment and dentists from public or private dental schools and years of experience. The results showed that the participants exhibited appropriate knowledge concerning procedures in cases of tooth avulsion and its prevention. The number of correct answers was low in relation to recommended treatment at the site of injury. Storage medium, preparation of the alveolus and splint time for receiving the avulsed tooth received a high number of correct answers. One statistically significant association between years of experience and recommended treatment at the site of the injury in the case an avulsed tooth (chi(2) = 9.384, P = 0.009). In conclusion, this survey showed appropriate knowledge of dental avulsion management and its prevention among the surveyed dentists. The findings also showed that communication between dentists and the population is deficient, especially concerning practitioners of high risk and contact sports.

Background/aims: The stability of immobilization devices varies from flexible to rigid, depending on the trauma. We evaluated the rigidity of various commonly used splints in vitro, Material and Methods: An acrylic resin model was used. The central incisors simulated injured teeth, with increased vertical and horizontal mobility. The lateral incisors and canines stimulated uninjured teeth. Tooth mobility was measured with the Periotest device. Vertical and horizontal measurements were made before and after splinting, and the difference between values was defined as the splint effect. We evaluated 4 composite splints, 3 wire-composite splints, a titanium trauma splint, a titanium ring splint, a bracket splint, and 2 Schuchardt splints, Results: For all injured teeth and all splints, there was a significant splint effect for the vertical and horizontal dimensions (P < 0.05). For injured teeth, the composite splints produced the largest changes in vertical tooth mobility; wire-composite splints 1 and 2, using orthodontic wires, produced the smallest vertical splint effects. For uninjured teeth, the Schuchardt 1 splint and the bracket splint produced the largest splint effects; wire-composite splints 1 and 2 produced only a slight change in tooth mobility. Composite splints 2 and 3 produced the largest horizontal splint effects for injured teeth, and the 4 composite splints produced the largest horizontal splint effects for uninjured teeth. The most horizontally flexible splints were the titanium trauma splint and wire-composite splints 1 and 2., Conclusions: According to the current guidelines and within the limits of an in vitro study, it can be stated that flexible or semirigid splints such as the titanium trauma splint and wire-composite splints 1 and 2 are appropriate for splinting teeth with dislocation injuries and root fractures, whereas rigid splints such as wire-composite splint 3 and the titanium ring splint can be used to treat alveolar process fractures.

The presence of mesiodens often results in complications including retention of primary teeth and delayed eruption of permanent teeth, closure of eruption path, rotations, retention, root resorption, pulp necrosis, and diastema as well as nasal eruption and formation of dentigerous and primordial cysts. Less common complications involving the permanent incisors include dilaceration of the developing roots and loss of tooth vitality. Therefore, early diagnosis of mesiodens has particular importance in terms of preventing such complications. However, with respect to surgical removal of mesiodens, ideal timing of intervention - immediate or delayed intervention - remains to be a highly controversial issue. While predisposing factors of dental trauma such as open bite, increasing overjet with protrusion of upper incisors, and insufficient lip closure have been well documented in the literature, there is limited evidence indicating mesiodens as a risk factor in trauma. In this report of two cases, it is aimed to emphasize mesiodens as a risk factor in the treatment of dental trauma besides its effect on prognosis.

Unlabelled: The anterior maxilla is the most traumatized region during childhood and tooth loss is frequently involved. Space closure with implants is contraindicated in growing patients and maintenance of space is necessary over a long period. Transplantation of premolars from the mandible with two-third to three-quarter root formation wide open foramen provides the best prognosis for permanent survival., Case Report: This report describes the management of a 10 year old girl with autotransplantation to replace an upper incisor by a lower premolar under consideration of special care for the periodontal ligament during surgical procedure. A 3-D imaging with digital volume tomography (DVT) was used 20 months after transplantation to evaluate the periodontal morphology., Discussion: Autotransplantation of premolars with incomplete root formation to replace maxillary incisor is a treatment alternative after traumatic loss of teeth. There were no signs of pathosis like resorption or ankylosis and a normal periodontal space demonstrated with DVT. There is no need for endodontic treatment before transplantation. In this case of autotransplantation of a premolar, the DVT after 20 months gives evidence of a successful regeneration of the periodontal ligament.

Clinical guidelines are now available for the management of avulsed teeth. The principles of evidence-based dentistry can be used to assess whether these guidelines are based on currently-available evidence. A qualitative systematic review was conducted of relevant clinical literature to examine the evidence on splinting duration and periodontal healing outcomes. The review was constrained markedly by small sample sizes, retrospective nature of clinical audits, dissimilarities of selected studies in their design, methodology and observation periods, and lack of uniformity in terminology for outcomes. A total of 138 replanted avulsed permanent teeth pooled from four papers each reporting both short-term splinting (14 days or less) and long-term splinting (over 14 days) in accord with current clinical guidelines, were studied. The evidence for an association between short-term splinting and an increased likelihood of functional periodontal healing, acceptable healing, or decreased development of replacement resorption, appears inconclusive. The study found no evidence to contraindicate the current guidelines and suggests that the likelihood of successful periodontal healing after replantation is unaffected by splinting duration. Pending future research to the contrary, it is recommended that dentists continue to use the currently-recommended splinting periods when replanting avulsed permanent teeth.

The aim of this study was to evaluate the tensile strength of orthodontic wires bonded onto the enamel with cyanoacrylate ester. To obtain the specimens, 120 human premolars (extracted for orthodontic or periodontal reasons) were included in acrylic blocks of rapid polymerization with three teeth each. Four groups were formed with ten specimens each. In the specimens, a dental splint model was made with cyanoacrylate ester and round stainless steel wire. In groups I, II and III, cyanoacrylate ester was used with round steel wires, with variation in diameter: 0.014 inches; 0.016 inches and 0.018 inches, respectively. In group IV, round steel wire 0.018 inches was used with photo polymerizing resin composite with previous acid etching. The adhesive force of the materials was measured in two points under the action of the tensiometer (ETM-USA). The number of loose wires was counted along with those that remained fixed according to the different levels of force applied because of the direction of the tensile force (vertical or horizontal) and the diameter of the wire used. The data obtained were first submitted to a descriptive analysis and then submitted to a statistical analysis (Friedman's Test and Dunn's Test of Multiple Comparison - Epi-info 3.2). Within the limitations of the experimental conditions presented, the cyanoacrylate ester or 'Super Bonder' maintained bonded to enamel and steel wires (0.016 and 0.018 inches) during the tensile strength tests under different levels of applied forces.

The root fractures occur relatively rarely and account for 0.5-2.5% of all dental injuries. The fracture type, severity of dislocation, mobility of fragments and diastasis have negative influence on the healing process. The aim of this study was to describe the treatment and the 42-month follow-up period of three trauma histories in a 12-year-old patient in 1 year and to emphasize the negative effects of recurrent traumas on the healing pattern and prognosis of root fractures.

Dental avulsion is a common and complex injury which affects multiple oral tissues. In this case report, a 9-year-old girl patient with two traumatically avulsed maxillary central incisors with loss of periodontal tissue was presented. Treatment guidelines for avulsed permanent teeth with open apex were carried out. Bilateral laterally sliding flap procedure was performed, to repair loss of gingival soft tissue. Conventional immobilization was carried out for 6 weeks. Five months follow-up of the patient in whom replantation was performed resulted in positive sensitivity test, no symptoms of infection, pain or any discomfort and good periodontal wound healing. In conclusion, this report presents successful replantation and periodontal treatment of a patient with complex dentoalveolar injury.

The etiology of internal root resorption is not fully understandable, trauma and chronic pulpitis are considered the main risk factors. Usually the process is asymptomatic and diagnosed upon routine radiographic examination. This case report presents a rapid progression of internal resorption related directly to traumatic injury. A 16-year-old female arrived at the emergency room after a mild extrusion of the mandibular incisors. The initial treatment included repositioning and splinting of the teeth. Radiographs performed at repositioning and splinting demonstrated normal configuration of the incisor's roots. Ten months later progressive internal resorption of the left mandibular first incisor was diagnosed. While treating this tooth similar process was detected in the right mandibular second incisor and in the mandibular left second incisor. The lower right first incisor reacted inconsistently to vitality test. As a result of the severe and rapidly progressive nature of the process, root canal treatments were performed in all lower incisors. The follow-up radiographs demonstrate arrest of the internal resorption process.

The objectives of this study were to (i) characterize epidemiologic trends in anterior permanent tooth trauma in a sample of children and adolescents (ii) examine the relationship of crown fractures (CF) and concomitant root fractures (RF) to determine if CFs are protective against RFs and (iii) examine the radiographic evidence of RFs to determine the value of obtaining three vertical periapical radiographic projections. This was an 8-year cross-sectional study of patients aged 6-18 with anterior permanent tooth trauma. We examined cases involving maxillary central/lateral incisors for which three clearly diagnostic periapical radiographs were obtained during the initial emergency visit. Two trained and calibrated dentists served as expert examiners for the radiographic assessments. Kappa statistics were used to determine reliability. Tests for association of concomitant crown and root fractures were performed using Likelihood Ratio Chi-Square tests. The final sample included 185 teeth in 114 children. Our demographic and epidemiologic findings were comparable to those of previous studies. Experts reached this consensus: 22 RFs were detected, 9.6% (eight out of 83) teeth exhibited root fractures when no CFs was documented, and 13.7% (14 out of 102) teeth had both CFs and RFs as separate entities. Good examiner reliability was reached confirming the presence of RFs (Kappa = 0.81). The association of concomitant RFs and CFs was odds ratio = 1.97 (P = 0.052). CFs were not protective against RFs; indeed, teeth with CFs were twice as likely to have an RF as those without CFs. As the number of radiographic projections increased, RFs were identified more often; however, our data suggest that there is no reason to suspect a complete RF in preteen children unless the root exhibits clinical signs such as luxation or severe mobility. This study provides solid evidence to support obtaining multiple radiographic projections at different vertical angulations to rule out RFs in children and adolescents when RFs are suspected.

Primary canines were transplanted to replace lost or ankylosed permanent upper incisors. Healing, healing complications and loss and survival were evaluated in a prospective case series study. In total, 27 primary canines were transplanted. Extraorally posts made of titanium were inserted into the root canal from a retrograde direction as an immediate endodontic treatment and as an elongation of the short autologous roots. In some cases antiresorptive-regenerative therapy was used. Inclusion criteria for the evaluation were a minimal observation period of 12 months or the observation of complications. The median observation period of the analyzed 17 transplants was 26.6 months (min: 6.7 months, max: 54.6 months). Sixteen out of seventeen transplants exhibited functional healing until the end of the observation or the occurrence of an external influence (another trauma, resorption by neighbored tooth). In no case ankylosis or arrest of alveolar growth was recorded. In some transplants resorptions not related to infection or ankylosis were observed. One transplant exhibited an early infection-related complication and was removed. One transplant was resorbed by the developing permanent canine and lost. Following another trauma five transplants were lost. External influence and new trauma were significantly related to the loss of transplants (Fisher's exact test; P = 0.0006 and 0.0034). The estimated survival according to a Kaplan-Meier analysis was 40.7 months for all transplants. It was significantly shorter for teeth which were lost in relation to an external influence (survival 28.4 months vs 44.7 months; log rank test: P = 0.0093). The transplantation of primary canines maintains bone and soft tissues of the alveolar process. The healing rate is high. However, there is a high incidence of repeated trauma episodes, causing a high loss rate. The observation period is still limited.

Dental trauma with children and adolescents is a serious dental public health problem. Traumatic injuries on permanent teeth are common, and dramatic episodes can occur during childhood. Cases of dental avulsions and reimplantations, dentoalveolar fractures, several forms (lateral, extrusive and intrusive) of luxations, concussion, subluxation, gingival lacerations and hard, pulpal dental tissue lesions have been extensively reported. This case report presents the therapy for severe trauma caused by multiple traumatic injuries to the dentoalveolar complex of a patient.

This case report presents use of a custom trauma splint that was fabricated to prevent excessive thumb-sucking trauma to a previously-subluxated permanent incisor. A 10-year-old boy was referred to the clinic 10 days after falling in the schoolyard that resulted in a trauma to his maxillary left central incisor. The extent of clinical mobility stipulated fabrication of a custom trauma splint that would prevent further trauma to the incisor caused by excessive pressure of the thumb. A light-cured resin composite splint, covering the incisal edges of the central incisors and labial surfaces of the lateral incisors was made, and approximately 1-mm composite within the impressions of central incisors were trimmed off. The splint was bonded to the neighboring lateral incisors with flowable resin composite and root canal therapy was initiated on the subluxated incisor. After one week, the patient stopped his sucking habit completely. The treatment not only allowed for complete healing of the subluxated incisor without being exposed to further trauma, but also for spontaneous eruption of the tooth and closure of the existing open-bite.

Horizontal root fractures frequently occur at the maxillary anterior region and sometimes may be healed without endodontic treatment. Diagnosis of horizontal root fractures is mainly reached by the information obtained in clinical and radiographic examinations. The report of three cases presents horizontal root-fractured teeth, at different thirds, which were healed satisfactory with and without endodontic treatment, rigid splint and carefully monitored.

Laser Doppler flowmetry (LDF) is a non-invasive method to assess pulpal blood flow (PBF). Dental fracture injuries have been associated with significant PBF reduction The purpose of this study was: (i) to evaluate whether the severity of outcomes of dental fracture injuries may be related to LDF measurements of PBF, and (ii) to investigate whether outcomes of dental fracture injuries may predict PBF levels. The relationship between outcomes and PBF measurements was analyzed in 72 permanent maxillary incisors of 52 consecutive dental trauma patients. The diagnostic outcome group comprised 72 incisors with a type I (absence of sensitivity, periapical radiolucency, and grey discoloration of crown) (n = 42), type II (loss of sensitivity) (n = 16), or type III (loss of sensitivity, periapical radiolucency, and/or grey discoloration of crown) diagnosis. At each session, when an injured permanent maxillary incisor was recorded, a contralateral homologous tooth was used as a control. An ordinal stepwise regression was completed to assess the degree of association between PBF measurements and diagnostic outcomes. A logistic regression analysis was used to compute the odds ratios for the outcome features for incisor non-injury controls vs two outcome groups: type II (n = 16) and type III (n = 14). PBF measurements that were significantly associated with more severe outcome were PBF levels of

Clinical practice has shown that most avulsed teeth are replanted after an extra-alveolar time that compromises the prognosis of replantation. In cases of delayed replantation, the use of adequate media for storage and transportation of the avulsed teeth may improve this prognosis considerably. Difficulties inherent to accidental dental avulsion include the lack of immediate access to ideal storage media, which accentuates the importance of saliva as a viable and readily available option. The authors report the case of an accidentally avulsed permanent maxillary central incisor that was kept into the patient's oral cavity from the moment of trauma until its replantation, 90 min later. Three years of follow-up revealed absence of root resorption, ankylosis or abnormal mobility, which demonstrates the feasibility of keeping avulsed teeth in saliva, at least when more indicated storage media are not available immediately.

An essential procedure for the incorporation of the tooth into the alveolus following injury is fixation of an avulsed or luxated tooth. Multiple traumatic injuries, e.g., from road accidents, often accompany dental injury. As dental trauma is not life-threatening, treatment is usually delayed and not given as much attention as general medical treatment. Simple and immediate tooth fixation with suturing in the emergency or operating room could improve long-term prognosis of the injured tooth. This easy-to-perform procedure can prevent later complications and morbidity.

Because there is no standard protocol for the removal of resin-based materials that retain semi-rigid trauma splints on teeth, iatrogenic enamel damage caused by various splint removal techniques has remained unknown. The purpose of this study was to evaluate the effect of five different resin removal techniques (H6/H7 scaler, ultrafine diamond bur, ultrasonic scaler, 16-blade tungsten carbide bur, and Sof-Lex disks) on the surface roughness of human enamel. Three-dimensional white-light interferometry, a non-contact profilometry technique, was used to obtain qualitative and quantitative measurements of surface roughness both at baseline and after finishing procedures. Statistical analysis using Friedman test and Wilcoxon signed ranks test showed that the roughest enamel surface was obtained after splint removal with the hand scaler (P < 0.05). Overall, the smoothest enamel surface was obtained after removal of resin with Sof-Lex disks and the 16-blade tungsten carbide bur (P < 0.05).

Crown fractures and luxations occur most frequently of all dental injuries. An appropriate treatment plan after an injury is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. 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 current best evidence, based on literature research and professional opinion. In this first article of three, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Injuries to the dentoalveolar complex are fairly common and can be caused by a number of reasons. There are many techniques for repositioning and stabilizing traumatically luxated or avulsed teeth. Many of the splinting techniques previously advocated were time-consuming. Not only were the splints difficult to fabricate and difficult to remove, they also contributed to injury of the soft and hard supporting tissues. Ribbond (Ribbond Inc., Seattle, Wash) is basically a reinforced ribbon which is made from ultrahigh molecular weight polyethylene fiber having an ultrahigh modulus. It is used in dentistry for various purposes. The use of Ribbond appears to be an adequate and easy method for stabilization and fixation. It can be used in the treatment of dental injuries. In this article the use of Ribbond for the treatment of dentoalveolar injuries is described.

This case report describes the treatment of an upper right central incisor with an intra-alveolar horizontal root fracture at the level of the middle third and an upper left central incisor with the horizontal root fracture in the cervical third. The root fractures were reduced and rigidly splinted for 4 months. The endodontic therapy was instituted in the upper left central incisor because there was no possibility of fracture repair due to the proximity of the fracture and the gingival sulcus. As soon as the diagnosis of pulp necrosis was established in the upper left lateral incisor, the endodontic treatment was performed. After 3 years and 9 months check-up appointments showed healing in the middle root third of the upper right central incisor and it responded within normal limits to pulp testing. Thus, there is no need for endodontic therapy on this tooth.

This 7-year-old girl experienced pain in her upper central incisors following a fall to the ground. Radiographic examination revealed immature upper central incisors with mid-root oblique and horizontal root fractures. Splinting was performed. When at 3 months, an electric pulp test was positive for both injured teeth, and after 5 months, the fracture lines had disappeared on the radiographs, the splint removed. After 2 years, clinical examination showed normal tooth color and position, with a positive response to the pulp test. Radiographs demonstrated continuous root development, although root canal narrowing was noted at the healed fracture sites.

This report describes the case of a 10-year-old boy that was referred to the pediatric dentistry clinic 15 days after sustaining a severe traumatism that led to complete intrusion of the maxillary left mature permanent central incisor. The intruded tooth was repositioned by using surgical extrusion. Endodontic therapy was performed with calcium hydroxide-based paste as root canal dressing and root canal filling was performed with a calcium hydroxide-based root sealer and gutta-percha points. The postoperative course was uncomplicated, with both clinical and radiographic success up to 10 years of follow up. In this case surgical repositioning combined with endodontic therapy constituted a viable alternative treatment for intrusive luxations in mature permanent teeth.

This study was undertaken to assess the effect of splint type on stresses occurring around traumatized tooth by photoelastic stress analysis. Three semi-rigid splint types--a wire-composite splint, fiberglass splint and titanium trauma splint--were utilized for comparisons. Extracted left upper central and lateral incisors and the canine tooth of an otherwise healthy patient were embedded equidistantly in photoelastic resin. For all cases studied, a static axial and 20 degrees oblique force of 100 N was applied on the lateral incisor in separate sessions. The experiments were undertaken without any splint application (unsplinted, control) after which the splints, adhesively bonded to the labial aspects of teeth, were consecutively tested. During each loading sequence, generation of isochromatic fringes was observed in the field of a polariscope, and photographed by a digital camera. Quantification of fringes was performed on magnified images, transferred to a PC. Under vertical loading, the highest stresses in the apical regions were observed for the unsplinted and ribbond-splint groups, whereas the lowest fringes occurred with the use of orthodontic wire as a splinting medium. Titanium trauma splint had absolutely no effect on reduction of stresses, as the fringe orders were slightly higher than the unsplinted lateral tooth. The use of orthodontic wire resulted in lowest fringe orders around the traumatized tooth.

The present case report describes the reimplantation of avulsed teeth with the treatment of Emdogain. Case was avulsed right maxillary permanent central and lateral incisor in a 9-year-old girl suffering from a traumatic injury. After pretreatment of avulsed teeth, Emdogain was applied to the root surface and into the extraction socket with subsequent replantation of the tooth. Evaluation parameters included horizontal and vertical percussion sound and periapical radiographs. At 1-2-6-12-month follow-up period, the clinical and radiographic appearance of the teeth showed resolution of mobility and no signs of replacement resorbption.

This is the second part of a retrospective study of 400 root-fractured permanent incisors. In this article, the effect of various treatment procedures is analyzed. Treatment delay, i.e. treatment later than 24 h after injury, did not change the root fracture healing pattern, healing with hard tissue between fragments (HH1), interposition of bone and/or periodontal ligament (PDL) or pulp necrosis (NEC). When initial displacement did not exceed 1 mm, optimal repositioning appeared to significantly enhance both the likelihood of pulpal healing and hard tissue repair (HH1). Significant differences in healing were found among the different splinting techniques. The lowest frequency of healing was found with cap splints and the highest with fiberglass or Kevlar splints. The latter splinting procedure showed almost the same healing result as non-splinting. Comparison between non-splinting and splinting for non-displaced teeth was found to reveal no benefit from splinting. With respect to root fractures with displacement, too few cases were available for analysis. No beneficial effect of splinting periods greater than 4 weeks could be demonstrated. The administration of antibiotics had the paradoxical effect of promoting both HH1 and NEC. No explanation could be found. It was concluded that, optimal repositioning seems to favor healing. Furthermore, the chosen splinting method appears to be related to healing of root fractures, with a preference to pulp healing and healing fusion of fragments to a certain flexibility of the splint and possibly also non-traumatogenic splint application. Splinting for more than 4 weeks was not found to influence the healing pattern. A certain treatment delay (a few days) appears not to result in inferior healing. The role of antibiotics upon fracture healing is questionable., (Copyright Blackwell Munksgaard, 2004.)

This report presents a case of replantation of a traumatically avulsed central incisor in a 32-year-old woman. The tooth was replanted after a 30-min extra-alveolar period. Emergency unconventional immobilization was performed, using 2-0 chromic gut, and a restorative composite made Gunning-type splint. The tooth is still in place 27 years after replantation (1976 to date) without marked resorption., (Copyright Blackwell Munksgaard, 2004.)

A longitudinal outcome study was designed to identify variables that influenced tooth survival as well as pulpal and periodontal outcomes of laterally luxated permanent maxillary incisors of children and adolescents. All cases were treated between June 1988 and June 1998 in a teaching hospital clinic. Clinical and radiographic data were collected for 42 patients (26 males, 16 females) that represented 58 permanent maxillary incisors. Mean age at the time of injury was 11.4 years (range: 6.3-17.8 years). Mean follow-up time was 1460 days (range: 183-3905 days). In the entire sample (n = 58), no incisors required extraction. Survival analysis and logistic regression were used to identify variables significantly related to the survival and healing outcomes of these incisors. Pulp necrosis (PN) (40%) and pulp canal obliteration (PCO) (40%) were common healing complications. Proportional hazards (Cox) regression showed that PN develops within the first year. Logistic regression demonstrated that root development (P = 0.3, PN; P = 0.8, PCO) and extent of lateral luxation (P = 0.5, PN; P = 0.9, PCO) were not significantly related to PN and PCO. This study provides the first report of incisor survival in children and adolescents following lateral luxation injuries.

- The aim of this retrospective study was to determine the type of healing which occurred in root-fractured permanent incisor teeth in children. The objectives were to determine whether gender, age, stage of root development or location of the fracture affected the healing type. The method involved careful scrutiny of clinical records and radiographs of children who attended a unit of paediatric dentistry in a dental hospital. Relevant information was entered onto a data collection sheet. The results were tabulated and analysed by the chi2-tests using the SPSS statistical package. The results are based on 34 root-fractured teeth in 33 children aged 8-15 years. Root development was incomplete in 27 of the root-fractured teeth and complete in seven teeth. A good healing outcome was seen in 27 (79.4%) of the teeth and poor healing in 7 (20.6%). The only factor which was found to be statistically significantly related to healing was the stage of root development. It can be concluded that root-fractured teeth with immature roots have a better chance of showing good healing than teeth with mature roots.

The aim of this study was to evaluate, through histologic examination, the effect of surgical repositioning of intruded dog teeth upon the pulpal and surrounding tissues. Thirty teeth in 10 adult dogs, aged 2-3 years, were used. Fifteen teeth were intruded, surgically repositioned and fixed using orthodontics wire, composite resin, and enamel acid conditioning. All these teeth served as the experimental group. The remaining intruded teeth were not treated (control group). The animals were sacrificed to allow observations at 7, 15, and 30 post-operative days. The maxillary and mandibular arches were removed and processed for histologic exam. Based on the methodology and observed results, we concluded that: pulpal necrosis, external root resorption and ankylosis were common sequelae to severe traumatic intrusion; a careful immediate surgical repositioning of severed intruded permanent tooth with complete root formation has many advantages with few disadvantages.

Different data were published documenting the influence of fixation methods and periods on the outcome of autotransplantations of teeth. Besides studies reporting increased ankylosis and disturbances of pulpal revascularization following rigid or extended fixation, there are studies revealing no connection in this matter. The clinical and radiological results of 76 transplanted germs of third molars were to be assessed after a rigid fixation for 4 weeks or after a suture splinting for 7 days and compared with each other. The choice of fixation method depended on the initial stability of the transplant. After a mean observation period of 3.4 years (range 1.0-6.1 years), 92.9% of the teeth stabilized with a suture, but only 73.5% fixed with an acid-etch composite and wire splint could be classified as successful (P = 0.029). The significant increases in ankylosis (P = 0.036) and pulp necrosis (P = 0.041) were the factors for the less favorable results of the rigidly fixed teeth. Our data support the results of other experimental and clinical studies with regard to the negative influences of an extended and rigid fixation on the success of tooth transplantation. However, apart from a correlation with the method and period of fixation, we also suspect the influence of an incongruity between the transplant and recipient site.