Ben Cole

Dental trauma: Variations in the presenting and treatment features in reimplanted permanent incisors in children and their effect on the prevalence of root resorption

Objective To examine variations in the presentation and treatment of reimplanted incisors in children and to determine the effect of these on the prevalence of external root resorption.Setting Departments of Paediatric Dentistry, Belfast and Newcastle upon Tyne.Design Recording of the timing of the injury and the storage mediums (including air) and of reimplantation, the stage of root development, the degree of contamination and the time of commencement of root treatment. Cases were reviewed clinically and radiographically at intervals of 3 months. Root resorption was classified as present or absent. Logistic regression and cross-tabulations were produced with the presence of resorption set as the outcome.Results 128 reimplanted permanent incisor teeth, their median dry time prior to reimplantation being 15 minutes (range 4-52 mins), the median time in a liquid medium being 45 minutes (range 0-650 mins), with a median splinting time of 15 days (range 4-52 days) and a median pulp extirpation time of 15 days (range 0-612 days). There was a lower prevalence of resorption when the period of dryness was less than or equal to 5 minutes (p=0.025). The prevalence of resorption in teeth with no visible contamination was 57.1%, for those with contamination which were washed clean it was 75%, in those rubbed clean it was 87.5%, and it was 100% for those reimplanted with visible contamination still present (p=0.014). The corrected odds ratio for contamination was 2.99 and for an extension of 10 minutes of dryness it was 1.29.Conclusion The degree of contamination and the period of dryness were the major risk factors for resorption in this study of reimplanted teeth in children.

Discoloration of Teeth after Avulsion and Replantation: Results from a Multicenter Randomized Controlled Trial

INTRODUCTION There is evidence to suggest that Ledermix, placed as an intervisit root canal dressing, might improve periodontal healing after replantation of avulsed teeth. As a part of a multicenter randomized controlled trial, we aimed to compare the effect of 2 root canal medicaments, Ledermix and Ultracal XS, on the discoloration of replanted teeth. METHODS Discoloration was investigated by using 3 methods: patient satisfaction with the color of replanted teeth, clinical photographs taken at baseline and 12-month reviews, and estimation of color change by using CIELAB scores for baseline and 12-month photographs. RESULTS Twenty-two patients (27 teeth) were recruited. Ten patients (12 teeth) were randomized to the Ledermix group and 12 patients (15 teeth) to the Ultracal XS group. At 12 months, 8 patients were concerned with the discoloration of their teeth. Seven came from the Ledermix group and 1 from the Ultracal XS group. This difference was significant (Fisher exact test, P = .009). Standardized photographs were taken for the patients recruited at one center only (17 patients). There was significant discoloration of teeth from baseline with Ledermix, causing a darkening and gray-brown discoloration (mean change from baseline to 12 months, L∗ = -5.1, a∗ = 0.3, b∗ = -1.2, and ΔE = 8.1) and Ultracal XS, causing a yellowing and lightening of teeth (L∗ = 1.9, a∗ = 0.3, b∗ = 3.3, and ΔE = 5.4). There was a significant difference for the L∗ and b∗ variables (independent t test) between the 2 groups. CONCLUSIONS Both root canal medicaments cause discoloration, with Ledermix proving less acceptable to patients.

The influence of two different dental local anaesthetic solutions on the haemodynamic responses of children undergoing restorative dentistry: a randomised, single-blind, split-mouth study.

Objectives This investigation was designed to study the haemodynamic effects of two different local anaesthetic solutions during restorative dental treatment in children.Design A randomised, single-blind, split-mouth cross-over design was employed using children undergoing bilaterally similar restorative treatments over two visits.Setting The study was performed in a dental hospital paediatric dentistry department.Methods Ten children participated. At one visit the local anaesthetic was 2% lidocaine (lignocaine) with 1:80,000 epinephrine (adrenaline); at the other the anaesthetic was 3% prilocaine with 0.03IU/ml felypressin. Local anaesthetic was administered at a dose of 0.5 ml/10 kg body weight. Blood pressure and heart rate were measured before and during treatment with an automatic blood pressure recorder. Data were analysed by ANOVA and Students paired t test.Results Significant differences between treatments in diastolic blood pressure (F = 2.37; P = 0.05) and heart rate (F = 2.98; P < 0.02) were noted. The heart rate increased ten minutes following the injection of the epinephrine-containing solution. The diastolic blood pressure fell 20 minutes after injection of lidocaine with epinephrine.Conclusion The choice of local anaesthetic solution influences the haemodynamic response during restorative treatment in children.

Dental manifestations in severe combined immunodeficiency following bone marrow transplantation

Severe combined immunodeficiency (SCID) is a rare primary immunodeficiency disorder with an estimated overall frequency of 1 in 75 000 live births. Bone marrow transplantation is the only curative treatment available. Using T cell-depleted HLA non-identical bone marrow requires preconditioning with a short course of cytotoxic chemotherapy. We report severe dental developmental anomalies in three such patients under long-term follow up. Bone Marrow Transplantation (2000) 25, 1007–1009.

Efficacy of spirally filled versus injected non-setting calcium hydroxide dressings

The aim of this study was to evaluate the adequacy of spirally filled vs injected non-setting calcium hydroxide (NS Ca(OH)(2)) in the management of traumatized permanent teeth undergoing endodontic treatment for apexification, control of infection or the management of root resorption. A random selection of patients with traumatized teeth undergoing endodontic procedures was made. A total of 100 cases were assigned for placement of NS Ca(OH)(2) by spiral filling and 50 cases by injection of the dressing directly into the canal. Post-operative radiographs were assessed for complete canal obturation and in particular, the density and length of the dressing within the canal. The results revealed that the injected NS Ca(OH)(2) dressing consistently produced better results than the spirally placed dressings. It also completely removed the chance of instrument fracture and as a result of this trial, the department of child dental health has now adopted the use of this injectable system.

Severe hypodontia in a set of triplets

Hypodontia is the developmental absence of one or more teeth from the dentition and constitutes one of the most common developmental anomalies in humans with a reported prevalence of 1.6 to 9.6% in the permanent dentition. Hypodontia may occur in association with other genetic diseases, or as an isolated familial or sporadic form. This article describes the rare phenomenon of severe hypodontia in a set of triplets. The triplets presented with congenital absence of the second molars, second premolars in all quadrants and lower central incisors. An additional five teeth (upper canines, upper lateral incisors and upper left first premolar) were missing in one of the triplets. The treatment plan and the possible genetic mode of inheritance are discussed.

Auto-transplantation in the Restorative Management of Traumatized Anterior Teeth: A Case Report

UNLABELLED Auto-transplantation can be used to replace missing anterior teeth following traumatic injuries. This technique has the advantage (over other forms of treatment) of maintaining alveolar bone height which allows orthodontic and further restorative intervention by way of implants later in life. Careful restorative management of transplanted teeth is vital to their long-term survival as inadequate maintenance post transplant may result in root resorption and eventual tooth loss. This paper describes the restorative management of two cases following transplantation. CLINICAL RELEVANCE Dental practitioners should be aware of the option to auto-transplant teeth as part of an overall treatment plan and the subsequent interventions often required.