Search

Aim: To describe radiographic features, clinical signs and symptoms, and chronological patterns of post-traumatic transient apical breakdown (TAB) in luxated permanent teeth. Methodology: Records from 56 patients treated at the Dental Trauma Clinic of the School of Dentistry of the Federal University of Minas Gerais from 1993 to 2024 were accessed to collect demographic, clinical, and imaging features of 89 teeth that presented with radiographic signs of TAB after traumatic dental injury (TDI). Kaplan–Meier curves were built to illustrate the time elapsed between trauma until TAB onset and resolution for the whole sample and for each one of the TAB patterns. A Cox regression was used to explore the effect of clinical covariates in both events. Results: Patients’ mean age at the time of trauma was 17.7 ± 6.6 years (range 9.1 to 39.7 years), with most being male (59.6%). All included teeth were mature at the time of trauma (Moorrees stage 6). Upper central incisors (66.3%) were predominant and mostly suffered extrusions (40.4%) or lateral luxations (32.6%). TAB was observed as an expansion of the periodontal ligament associated with a “V-shaped” widening of the apical foramen together with apical root resorption in 45 teeth (50.6%). Expansion of the periodontal ligament associated with “V-shaped widening of the apical foramen only was observed in 32 teeth (36%), and 12 teeth (13.5%) showed expansion of the periodontal ligament associated with apical root resorption only. The overall median time for TAB onset was 3.2 months (range, 26 days to 8 months), being significantly lower for pattern 2 (1.8 months) when compared to TAB pattern 1 and 3 (3.4, and 3.9 months) respectively (Logrank test p values < 0.001 for both comparisons). The overall median time for TAB regression was 9.1 months (range, 4.8 to 34.8 months) after trauma. Again, TAB pattern 2 presented lower periods when compared to TAB pattern 1 and 3 (Logrank test p values < 0.001 and 0.013, respectively). Color changes were not frequent neither at the time of TAB onset nor at the time of TAB resolution. However, while most teeth (53.3%) did not respond to pulp sensibility tests at the time of TAB onset, this proportion decreased to 17.6% by the time of TAB resolution. Conclusion: TAB was mainly diagnosed within four months after luxation of mature teeth, most of them being resolved within the 1-year of follow-up. The most frequent TAB pattern was an expansion of the PDL associated with a “V-shaped” widening of the apical foramen together with external apical root resorption. Clinical relevance: These findings represent an important contribution for treatment decision-making during the follow-up of luxated permanent teeth. [ABSTRACT FROM AUTHOR]

Background/Aims: Tooth auto‐transplantation is a treatment option, which is often not considered to replace anterior maxillary incisors in children and adolescents. There are multiple prognostic factors that may influence the outcomes of premolar auto‐transplantation, but there is limited evidence from human studies. The aim of this study was to report the outcomes of auto‐transplanted premolars in the anterior maxilla following traumatic dental injuries (TDIs) and to identify their prognostic factors. Materials and Methods: The clinical records of patients who had premolars transplanted in the anterior maxilla following TDI, with appropriate radiographs and a minimal of 1‐year follow‐up, were reviewed retrospectively. A specific data extraction form was developed, tested and used to collect information for the prognostic factors and outcomes. Results: The cohort included 120 patients with 144 auto‐transplanted premolars. The mean age was 12.2 years (±2.0), and the mean observation period was 3.7 years (±1.8). The success rate was 80%, and the survival rate was 93%. Unfavourable outcomes included external replacement resorption in 12.5%, uncontrolled external inflammatory resorption in 2.7%, and both resorption types in 4.9% of teeth. Periodontal healing was significantly associated with donor tooth root maturity, graft handling at the time of surgery including ease of donor tooth extraction and placement at the recipient sites, recipient site alveolar bone status, and post‐operative transplant mobility. Seventy‐four teeth (53.4%) were immature at the time of transplantation where pulp revascularisation was anticipated, and 52 (70%) of those had radiographic and clinical signs of pulp healing. Pulp healing was significantly related to donor tooth eruption stage, ease of extraction of donor tooth, and ease of placement in the recipient site. Conclusions: Good outcomes were observed for premolar teeth auto‐transplanted in the anterior maxilla. The main prognostic factors were ease of extraction of donor tooth and ease of placement in the recipient sites and donor tooth root maturity. [ABSTRACT FROM AUTHOR]

Tooth transplantation is one of the treatment options for extracted teeth that can be considered before dental implantation. Although the success rate of tooth transplantation is lower than that of implantation, tooth replantation and transplantation have the great advantage of using natural teeth. Tooth replantation might be considered a promising option in some cases. In present study, the expression patterns of revascularization and pulpal healing, which are the most important for the pulp viability, were analyzed after tooth replantation and allograft in mice. The inflammatory response and root dentin resorption were observed and not different between replantation and allograft in initiation of healing process. However, bonelike tissue formation, pulp revascularization and pulp healing were faster in replantation. The difference of healing patterns between tooth replantation and allograft found in present study will be helpful to select the treatment option and to understand healing mechanism.

Objective: Given the tremendous progress in biophotonics applications in biology and engineering, we sought to examine the evidence for the use of low-dose biophotonics treatments, termed photobiomodulation (PBM) therapy, in pediatric dentistry. Background: PBM therapy has been noted to alleviate pain and inflammation while promoting tissue healing and regeneration. These basic processes contribute to the fundamental etiopathogenesis of various oral diseases, and hence, there is now a growing list of potential clinical applications with PBM therapy in children. Materials and methods: An exhaustive literature search was conducted for PBM studies in pediatric dentistry that includes patients up to 21 years of age. An analysis of the quality of the included studies was also performed to evaluate the rigor of the evidence. Specific emphasis was placed on the treatment efficacy on the relevant specified outcomes for individual applications. Results: From a total of over 420 initial hits, 19 studies were deemed suitable for inclusion in this review. Among them, PBM therapy has been used in pediatric dentistry for prevention and treatment of oral mucositis associated with oncotherapy (chemotherapy, radiation, and transplants), for postsurgical oral pain and for pulpotomies. Overall, all studies reported therapeutic benefits, and no adverse effects were reported. Conclusions: This review noted that PBM therapy is a safe and effective treatment modality for various clinical applications in pediatric dentistry. Despite potential positive publication bias, there appears to be clear evidence of clinical benefit with this treatment, and we recommend well-designed randomized, placebo-controlled human clinical trial be pursued. [ABSTRACT FROM AUTHOR]

Background/aim: The extra-alveolar period and storage medium are important for the survival of replanted teeth. The aim of this study was to evaluate factors affecting the survival of replanted teeth in children.Material and Methods: Complete dental records of avulsed teeth including age, gender, extra-alveolar time, storage type and period, stage of root development, crown fracture, gingival laceration, alveolar fracture, antibiotics, and splint type and period were obtained. Kaplan-Meier, Cox regression and chi-square tests were used to analyse the risk factors affecting survival (P < 0.05).Results: The study included 196 replanted teeth with a mean follow-up period of 4.0 years. Forty-two (21.4%), 45 (23.0%), and 109 teeth (55.6%) showed functional healing, inflammatory resorption and replacement resorption. The root resorption incidence of teeth with extra-alveolar time longer than 30 minutes was higher vs teeth with a time of less than 30 minutes (P = 0.010). Physiologically stored replanted teeth showed lower incidence of root resorption (19/31, 61.3%) than those stored in non-physiologic media (94/114, 82.5%) (P = 0.025). Root resorption incidence of teeth stored non-physiologically within 30 minutes and then transferred to physiologic media (25/33, 75.8%) was similar to that of teeth stored physiologically (P = 0.127). Teeth stored non-physiologically for longer than 30 minutes had a significantly higher root resorption incidence (99/113, 87.6%) than teeth stored non-physiologically within 30 minutes (55/83, 66.3%) (odds ratio = 1.726, P = 0.001). Pulp canal obliteration occurred in five of the 56 immature teeth (8.9%) but two of them were later extracted because of replacement resorption. The survival of mature teeth (111/140, 79.3%) was significantly higher than that of immature teeth (39/56, 69.6%) (P = 0.007).Conclusions: This study suggested that non-physiologic storage within 30 minutes was critical for the periodontal healing of replanted teeth. Replanted immature teeth had lower survival rates than mature teeth. [ABSTRACT FROM AUTHOR]

Abstract Introduction On stimulation by lipoteichoic acid or by a physical injury, fibroblasts have been shown to play a major role in the initiation of the pulp inflammatory reaction and healing through secretion of complement proteins and growth factors. The application of direct pulp-capping materials on these cells may interfere with the inflammatory and the healing processes within the pulp's inextensible environment. This work was designed to study in vitro the effects of silicate-based materials on pulp fibroblast modulation of the initial steps of pulp inflammation and healing. Methods The effects of Biodentine, TheraCal, and Xeno III eluates were studied on lipoteichoic acid–stimulated and physically injured fibroblasts. Cytokine secretion (interleukin 6, vascular endothelial growth factor, fibroblast growth factor-2, and transforming growth factor-β1) was quantified by enzyme-linked immunosorbent assay. Inflammatory THP-1 adhesion to endothelial cells and their migration and activation were studied in vitro. Human pulp fibroblast proliferation was investigated with the MTT test, and their migration to the injury site was studied with the scratch healing assay. Results Interleukin 6 and vascular endothelial growth factor secretion increased with all materials but to a lesser extent with Biodentine. Fibroblast growth factor-2 and transforming growth factor-β1 secretion was significantly higher with Biodentine than with all other materials. THP-1 cell adhesion to endothelial cells and their activation were reduced by Biodentine and TheraCal. However, their migration decreased only with Biodentine. Fibroblast proliferation significantly increased with Biodentine but significantly decreased with Xeno III after day 6. Finally, only Biodentine induced fibroblast migration to the injury site in the scratch assay. Conclusions These results confirm that pulp-capping materials affect the early steps of pulp inflammation and healing. They show that Biodentine had the highest pulp healing and anti-inflammatory potential when compared with the resin-containing materials. This highlights the interest of the material choice for direct pulp-capping. Highlights • Direct pulp-capping materials modulate the initial steps of pulp inflammation and healing. • Biodentine inhibits pulp inflammation and induces pulp healing. • Adding resins to silicates alters their bioactivity. • Direct pulp-capping material choice is crucial for the clinical outcome. [ABSTRACT FROM AUTHOR]

Background/aim: Tooth autotransplantation has been advocated for replacement of missing teeth or teeth that are unsuitable for restoration. The aim of this study was to investigate the outcomes and prognostic factors that influenced the success of tooth transplantation in a paediatric population.Materials and Methods: Data were extracted from the records of 75 patients (89 teeth). Demographic and prognostic factors were recorded and analysed for the clinical and radiographic outcomes for periodontal ligament (PDL) and pulp healing of transplanted teeth.Results: The mean age at transplant was 13.2 years, and the mean follow-up observation period was 2.6±1.8 years with a range of 12.0 months to 9.9 years. The main reason for transplantation was to replace upper central incisors lost or missing due to dental trauma, hypodontia and dilaceration. Of the 45 teeth that were monitored for pulp revascularization, 75.6% showed clinical and radiographic signs of pulp healing and 24.4% showed signs of pulp necrosis and infection. Pulp healing was significantly related to the stage of root development of the transplant. Favourable PDL healing was observed in 87.6% of the transplants, while 13.5% showed signs of replacement resorption. PDL healing was significantly related to the stage of root formation of the transplanted tooth at the time of the surgery, the ease of handling and placement of the tooth, and the status of the alveolar bone at the recipient site at the time of the surgery. Overall success of tooth transplantation was 87.6%, and the survival rate was 94.4%.Conclusions: Tooth transplantation carried out in children and adolescents demonstrated high success and survival, with the stage of root development influencing both the pulp and PDL healing of the transplanted teeth. [ABSTRACT FROM AUTHOR]

Objectives Biocompatibility of dental materials has gained increasing interest during recent decades. Meanwhile, legal regulations and standard test procedures are available to evaluate biocompatibility. Herein, these developments will be exemplarily outlined and some considerations for the development of novel materials will be provided. Methods Different aspects including test selection, release of substances, barriers, tissue healing, antibacterial substances, nanoparticles and environmental aspects will be covered. The provided information is mainly based on a review of the relevant literature in international peer reviewed journals, on regulatory documents and on ISO standards. Results Today, a structured and systematic approach for demonstrating biocompatibility from both a scientific and regulatory point of view is based on a clinical risk assessment in an early stage of material development. This includes the analysis of eluted substances and relevant barriers like dentin or epithelium. ISO standards 14971, 10993, and 7405 specify the modes for clinical risk assessment, test selection and test performance. In contact with breached tissues, materials must not impair the healing process. Antibacterial effects should be based on timely controllable substances or on repellant surfaces. Nanoparticles are produced by intraoral grinding irrespective of the content of nanoparticles in the material, but apparently at low concentrations. Concerns regarding environmental aspects of mercury from amalgam can be met by amalgam separating devices. The status for other materials (e.g. bisphenol-A in resin composites) needs to be evaluated. Finally, the public interest for biocompatibility issues calls for a suitable strategy of risk communication. Significance A wise use of the new tools, especially the clinical risk assessment should aim at preventing the patients, professionals and the environment from harm but should not block the development of novel materials. However, biocompatibility must always be weighed against the beneficial effects of materials in curing/preventing oral diseases. [ABSTRACT FROM AUTHOR]

Trauma to the permanent teeth involves not only the teeth but also the pulp, the periodontal ligament, alveolar bone, gingiva and other associated structures. There are many variations in the types of injuries with varying severity and often a tooth may sustain more than one injury at the same time. In more severe trauma cases, there are many different cellular systems of mineralized hard and unmineralized soft tissues involved, each with varying potential for healing. Furthermore, the responses of the different tissues may be interrelated and dependent on each other. Hence, healing subsequent to dental trauma has long been known to be very complex. Because of this complexity, tissue responses and the consequences following dental trauma have been confusing and puzzling for many clinicians. In this review, the tissue responses are described under the tissue compartments typically involved following dental trauma: the pulp, periradicular and associated soft tissues. The factors involved in the mechanisms of trauma are analysed for their effects on the tissue responses. A thorough understanding of the possible tissue responses is imperative for clinicians to overcome the confusion and manage dental trauma adequately and conservatively in order to minimize the consequences following trauma. [ABSTRACT FROM AUTHOR]

Autotransplantation of premolars to the anterior region subsequent to tooth loss represent a unique treatment method that has a number of advantages in comparison with other tooth substitution methods. A tooth transplant has a bone inducing capacity implying that lost labial bone is regenerated. Secondly the tooth precipitates growth of the alveolar process and allows treatment to be performed at an early age (10-12 years) where the trauma incidence is at its maximum. Finally transplanted teeth can be moved orthodontically. These characteristics make implant solutions appealing in a number of situations. The procedure consist in selecting a premolar in a optimal root development stage which is approximately three fourths root formation where optimal pulp and periodontal ligament healing can be achieved in more than 90 percent of the cases. The tooth is later after slight crown remodeling restored with composite or a porcelain laminate. Four recent long-term studies have shown survival rates between 90-98 percent and a single long term study (33 years) showed a survival rate of 90 percent, a survival rate not surpassed by any other type of tooth replacement (fixed or removable prosthetics, implants). In conclusion premolar transplantation should be considered in cases of early loss of a permanent teeth. [ABSTRACT FROM AUTHOR]

Aim To investigate the hypothesis that different haemostatic agents could impair the histological response of human pulps capped with calcium hydroxide. Methodology Forty-five third molars scheduled for extraction were selected. Class I cavities with pulp exposures were prepared. Three agents were used to control bleeding: 0.9% saline solution (control, n = 14), 5.25% sodium hypochlorite ( n = 16) and 2% chlorhexidine digluconate ( n = 15). The pulps were dressed with hard-setting calcium hydroxide cement. After 7, 30 or 90 days, teeth were extracted, formalin-fixed and prepared for histochemical techniques. The biological response was categorized using the following criteria: inflammatory response, soft tissue organization, reactionary dentine and reparative dentine. Data were submitted to statistical analysis, using nonparametric Kruskal–Wallis one-way analysis of variance on ranks. Differences amongst groups were detected using Dunn's method. Results The statistical analysis disclosed that whilst inflammatory response decreased over time, reactionary dentine deposition and reparative dentine formation increased in the latter periods of evaluation ( P < 0.05). The three agents had similar performances for all criteria evaluated. The conventional pulp response to calcium hydroxide was observed over time, and complete pulp healing was observed in 88% of the specimens after 90 days. Conclusion The three haemostatic agents did not impair the healing process following pulp exposure and capping with calcium hydroxide at different time intervals investigated. [ABSTRACT FROM AUTHOR]

A prospective study of 140 intruded permanent teeth was done to evaluate the following healing complications: pulp necrosis (PN), root resorption (surface, inflammatory and replacement resorption) (RR) and defects in marginal periodontal healing (MA). These complications were related to various preinjury and injury factors. Age appeared to be related to all three healing complications in that patients younger than 12 years had the lowest complication rate. Stage of root formation at the time of the injury was very strongly related to PN and MA, with immature root formation (i.e. incomplete root formation or completed root formation with wide open apex) having better prognosis than more mature root development. Lateral incisors showed significantly more defects in MA, a finding possibly explained by the observation that lateral incisors were more often involved in multiple intrusions compared to other teeth and noting that multiple intrusions had a significantly higher frequency of MA. An associated crown fracture with exposed dentin resulted in more frequent PN, a finding possibly related to bacterial invasion through dentinal tubules into an ischemic pulp. The presence of a gingival laceration added to both PN and MA. The extent of intrusion (in mm) showed some relation to both RR with intrusion 1–3 mm having the lowest frequency of RR, whereas PN and MA showed no significant relation to the extent of intrusion. Finally, multiple adjacent intruded teeth were more frequently involved in a significantly greater loss of interproximal marginal bone (MA) than single intrusions. In conclusion, the relationship between healing complications and preinjury and injury factors could generally be explained by better healing possibilities in teeth with immature root formation. A possible explanation for that could be the softer bone surrounding the tooth, whereby trauma to the periodontium might be diminished. [ABSTRACT FROM AUTHOR]

A prospective study of 140 intruded permanent teeth was examined for the following healing complications: pulp necrosis (PN), root resorption (RR; surface, inflammatory and replacement resorption), and defects in marginal periodontal bone healing (MA). The occurrence of these healing complications was related to various treatment factors such as treatment delay, method of repositioning (i.e. expecting re-eruption, orthodontic reposition and surgical reposition), type of splint (rigid, semirigid and flexible), length of splinting (days) and the use of antibiotics. Treatment delay, i.e. before and after 24 h, had no effect upon healing. Active repositioning in individuals with incomplete root formation (surgical or orthodontic) had a negative effect upon the three healing parameters compared with spontaneous eruption. In teeth with complete root formation and an age of 12–17 no repositioning was still the best treatment in regard to MA. In individuals older than 17 years of age, cases were not anticipated to spontaneously erupt and in these cases, the general choice of treatment was either active orthodontic or surgical repositioning. The former procedure appeared in this treatment scenario to slightly reduce the risk of MA complications. However, this treatment procedure was also found to be more time demanding (an average of 22 consultations for orthodontic repositioning compared with 17 consultations for surgical repositioning). If a surgical repositioning was performed, the type of splint (i.e. flexible, semirigid or rigid) appeared to have no significant effect on the type of healing. The same applied to the length of splinting time (shorter or longer than 6 weeks). No effect of dentin covering procedures for associated crown fractures (enamel–dentin fractures) could be demonstrated. Likewise, antibiotics had no apparent effect upon healing. In conclusion, in patients with intruded teeth with incomplete root formation, spontaneous eruption should be expected. In patients with completed root formation and with an age of 12–17 spontaneous eruption can still occur, but must be monitored very carefully. In older patients (i.e. >17 years) with completed root formation, either surgical or orthodontic extrusion should be attempted. The latter procedure appeared to lead to a slight reduction (not significant) in the risk of MA complications. The extent and direction of the intrusion may however favour surgical repositioning. [ABSTRACT FROM AUTHOR]

Andreasen JO, Andreasen FM, Mejàre I, Cvek M. Healing of 400 intra-alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics. Dent Traumatol 2004; 20: 203–211. © Blackwell Munksgaard, 2004. 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. [ABSTRACT FROM AUTHOR]

Andreasen JO, Andreasen FM, Mejàre I, Cvek M. Healing of 400 intra-alveolar root fractures. 1. Effect of pre-injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation. Dent Traumatol 2004; 20: 192–202. © Blackwell Munksgaard, 2004. This retrospective study consisted of 400 root-fractured, splinted or non-splinted incisors in young individuals aged 7–17 years (mean = 11.5 ± 2.7 SD) who were treated in the period 1959–1995 at the Department of Pediatric Dentistry, Eastman Dental Institute, Stockholm. Four hundred of these root fractures were diagnosed at the time of injury; and 344 teeth were splinted with either cap-splints, orthodontic appliances, bonded metal wires, proximal bonding with composite resin or bonding with a Kevlar® or glass fiber splint. In 56 teeth, no splinting was carried out for various reasons. In the present study, only pre-injury and injury factors were analyzed. In a second study, treatment variables will be analyzed. The average observation period was 3.1 years ± 2.6 SD. The clinical and radiographic findings showed that 120 teeth out of 400 teeth (30%) had healed by hard tissue fusion of the fragments. Interposition of periodontal ligament (PDL) and bone between fragments was found in 22 teeth (5%), whereas interposition of PDL alone was found in 170 teeth (43%). Finally, non-healing, with pulp necrosis and inflammatory changes between fragments, was seen in 88 teeth (22%). In a univariate and multivariate stratified analysis, a series of clinical factors were analyzed for their relation to the healing outcome with respect to pulp healing vs. pulp necrosis and type of healing (hard tissue vs. interposition of bone and/or PDL or pulp necrosis). Young age, immature root formation and positive pulp sensibility at the time of injury were found to be significantly and positively related to both pulpal healing and hard tissue repair of the fracture. The same applied to concussion or subluxation (i.e. no displacement) of the coronal fragment compared to extrusion or lateral luxation (i.e. displacement). Furthermore, no mobility vs. mobility of the coronal fragment. Healing was progressively worsened with increased millimeter diastasis between fragments. Sex was a significant factor, as girls showed more frequent hard tissue healing than boys. This relationship could possibly be explained by the fact that girls experienced trauma at an earlier age (i.e. with more immature root formation) and their traumas were of a less severe nature. Thus, the pre-injury or injury factors which had the greatest influence upon healing (i.e. whether hard tissue fusion or pulp necrosis) were: age, stage of root development (i.e. the size of the pulpal lumen at the fracture site) and mobility of the coronal fragment, dislocation of the coronal fragment and diastasis between fragments (i.e. rupture or stretching of the pulp at the fracture site). [ABSTRACT FROM AUTHOR]

Abstract – This retrospective study consisted of 208 root‐fractured, 168 splinted and 40 not splinted incisors in young individuals (aged 7–17 years) treated in the period 1959–1973 at the Pedodontic Department, Eastman Institute, Stockholm. Clinical and radiographic analyses showed that 69 teeth (33%) had developed hard tissue (fusion) healing of fragments. Interposition of periodontal ligament (PDL) and bone between the fragments was found in 17 teeth (8%). Interposition of PDL alone was found in 74 teeth (36%). Finally, non‐healing with pulp necrosis and inflammatory changes between fragments was seen in 48 teeth (23%). Various clinical factors were analyzed for their relationship to the healing outcome with respect to healing/no healing and type of healing (hard tissue versus interposition of bone and/or PDL). Immature root and positive pulp sensitivity at time of injury was found to be significantly related to both pulp healing and hard tissue repair of the fracture. The same applied to concussion or subluxation of the coronal fragment compared to luxation with displacement (extrusive or lateral luxation). This relation was also represented by the variable millimeter diastasis between fragments before and after repositioning. Repositioning appeared to enhance the likelihood of both pulp healing and hard tissue repair. A positive effect of splinting, splinting methods (cap splints or orthodontic bands with an arch wire) or splinting periods could not be demonstrated on either pulp healing or type of healing (hard tissue versus interposition of bone and/or PDL). In conclusion, the findings from this retrospective study have cast doubts on the efficacy of long‐term splinting and the types of splint used for root fracture healing. It is suggested that the role of splinting and splinting methods be examined in further studies. [ABSTRACT FROM AUTHOR]

Four hundred avulsed and replanted permanent teeth were examined for pulpal healing. In 110 teeth, the apical foramen was either open or half-open. In 16 teeth, the pulps were extirpated prophylactically. Thus, pulpal revascularization was considered possible in 94 teeth. Revascularization occurred in 32 teeth (34%). Pulp necrosis could usually be demonstrated after 3 weeks. Positive pulpal sensibility and radiographis signs of pulp canal obliteration were usually observed after 6 months. The effect of various clinical factors was examined, such as sex, age, type of tooth replanted, stage of root formation, type and length of extra-alveolar storage, clinical contamination of the root surface, type of cleansing procedure of the root surface, type and length of splinting and the use of antibiotics. Finally, the width of the apical foramen and the length of the root canal were measured on radiographs taken at the time of injury. A multivariate statistical analysis revealed that pulpal revascularization was more frequent in teeth with shorter distances from the apical foramen to the pulp horns. Furthermore, that wet storage (saliva and/or saline) for more than 5 min decreased the chance of pulpal revascularization; whereas dry extraalveolar storage had a monotonous effect on pulpal revascularization, i.e. decreasing chance of revasculatization with increasing length of the extraalveolar dry storage. Based on these findings, immediate replantation after brief cleansing in either tap water or saline is recommended. [ABSTRACT FROM AUTHOR]