G. S. Heithersay

Combined endodontic-orthodontic treatment of transverse root fractures in the region of the alveolar crest

Abstract A new method involving the use of combined endodontic-orthodontic treatment to allow treatment of transverse root fractures near the gingival crevice is described, and three case reports illustrating the procedures are presented. The method appears to provide a solution to an otherwise difficult clinical problem.

Stimulation of root formation in incompletely developed pulpless teeth

Abstract A series of twenty-one incompletely developed pulpless human teeth have been treated conservatively with calcium hydroxide and methylcellulose as a root-filling material. Observation times varied from 14 to 75 months. Elimination of bacteria was achieved by routine endodontic procedures in conjunction with irrigation and dressing with an aqueous solution of 0.03 per cent chlorhexidine and 0.3 per cent cetrimide. Of the twenty-one cases, fourteen showed complete, five partial, and two no root development during the period of observation. Periapical repair was complete in twenty of the twenty-one cases and is proceeding satisfactorily in the remaining case. A clinical evaluation of success showed nineteen cases to be successful and two doubtful, with no failures over the period of observation. Histologic material has been presented which revealed that new tissue had been formed, both apically and within the old canal. This consisted of pulp, interglobular dentine, cementum, and attached periodontal membrane fibers. Two calcified layers of interglobular dentine extended into the old canal and lined it. However, no calcific barrier was present at the coronal extremity of the canal. Thick deposits of cellular and acellular cementum not only covered the newly formed tissue but extended beyond the junction with the old root. The results of the clinical series and the histologic material support the conservative approach to the treatment of pulpless, incompletely developed teeth. The method is indicated because of its simplicity, the lack of surgical trauma, and the improved prognosis afforded by the further root development.

A preclinical dental trauma teaching module

A dental trauma exercise using the anterior segment of a sheep mandible as a model has been incorporated into the undergraduate dental programme at the University of Adelaide since 2011. Students are required to replant a simulated tooth avulsion, reposition a laterally luxated tooth injury and then apply a flexible splint consisting of 40 lb fishing nylon attached with a resin-modified glass ionomer cement, GC Fuji Ortho LC. The exercise concludes with the simple removal of the splint with a spoon excavator. The acrylic mounted formalin-fixed sheep mandible is reusable, which has obvious economic and practical advantages.

Life cycles of traumatized teeth: long-term observations from a cohort of dental trauma victims.

Life cycles of dental trauma victims can provide important clinical information, especially when viewed over many years. In this first series of life cycles, the pulp and periodontal responses to traumatic injuries of four patients are documented over periods varying from 26 to 51 years. The dynamics of pulp survival following an intrusive luxation and two avulsions are followed, with particular reference to pulp canal calcification to which a new term, root canal stenosis, has been proposed. The life cycles include the successful management of inflammatory root resorption in a replanted tooth with an open apex contrasting with the early prophylactic endodontic treatment of two replanted teeth in a patient with mature apices. The long-term development of invasive cervical resorption in one of the patients life cycle highlights the importance of ongoing follow-up examinations for dental trauma victims.

Sequelae to trauma to immature maxillary central incisors: a case report

This case report highlights (i) a rare example of spontaneous apexification despite pulp necrosis and periradicular pathosis, and (ii) pulpal necrosis and periapical pathosis following secondary trauma. The initial trauma occurred in a seven-year-old female who received secondary trauma 4 years later. The diagnosis and management of both maxillary central incisors as well as follow-up assessments for both immature and mature teeth subjected to trauma is discussed.

Splinting of teeth following trauma: a review and a new splinting recommendation

With advances in the understanding of healing processes of the periodontium, pulp and alveolar bone following various injuries, the role of splinting has become relatively well defined. This is generally reflected in the guidelines for trauma management published by the International Association of Dental Traumatology. While the widespread use of composite resin as an adhesive in various functional/flexible splinting systems has over many years allowed ease of application, removal of the material is not only time consuming but more seriously accompanied by minor or major iatrogenic damage to enamel. Dental materials science has continued to provide new materials and amongst them the development of resin activated glass-ionomer cement suitable for orthodontic bracket cementation has allowed the development of an alternative simplified splinting regimen for traumatized teeth which offers ease of application and removal with minimal or no iatrogenic damage to enamel.