K. Ebeleseder

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Guidelines for the Management of Traumatic Dental Injuries: 1. Fractures and Luxations of Permanent Teeth.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

A retrospective classification of tooth injuries using a new scoring system.

Abstract The WHO classification presently in use categorises dental trauma only according to the main injury. A new scoring system will now enable more precise and complete diagnosis of tooth injuries. In an initial retrospective investigation, 100 traumatised teeth were classified according to the WHO and the new scoring systems. Clinical and radiological examinations and another evaluations using the new scoring system were made at the time of follow-up examination. Avulsion, intrusion, and root fractures (score <30) showed the most unfavourable findings at the time of the accident. In comparison, the most favourable findings were shown by concussion and first degree crown fracture (score >70). A comparison to the WHO classification occasionally revealed noticeable score variations within a single WHO type of injury. Generally, a strong interdependence was observed between the evaluations at the time of the accident and at the time of the follow-up examination (P<0.001). If the score at the time of the accident was equal to or larger than 57, a successful therapy was usually ensured (P<0.001). The new scoring system enables more complete diagnosis as well as permitting statements to be made concerning prognosis.

Secretoneurin, a novel neuropeptide, in the human dental pulp

Secretoneurin is a neuropeptide that is stored in and released from primary afferent neurones. By radioimmunoassay and immunohistochemistry, secretoneurin was here demonstrated in the human dental pulp and localized in varicose nerve fibres that were frequently associated with blood vessels. No significant correlation was found between the levels of immunoreactive secretoneurin and immunoreactive calcitonin-gene related peptide. The results suggest that primary afferent neurones of the human dental pulp contain secretoneurin, which may influence local inflammatory responses if it is released together with other neuropeptides.

Arrest and Calcification Repair of internal root resorption with a novel treatment approach: Report of two cases

AIM We report a novel treatment option for teeth with internal root resorption (IRR) in which the lesion had perforated to the PDL and was located in the coronal aspect of the root. Arrest and calcification of IRR can be achieved by local application of calcium hydroxide without further intracanal instrumentation. CASE REPORT Two cases of severe IRR without periapical inflammation were treated with a novel technique: The vital pulp including the granuloma was left in place and subjected to long-term disinfection with application of calcium hydroxide in the coronal aspect of the IRR. In both cases, the radiolucent areas were reduced and showed progressive calcification. Solid barriers were found in the coronal layers of the IRRs, and mineral trioxide aggregate (MTA) was placed as definitive fillings. No apical periodontitis was seen during the follow-up period of 6 years. The root canals appeared to gradually be narrowed. The results were similar to those obtained after successful cervical pulpotomy. Thus, the biological outcome was improved in comparison with pulp extirpation and conventional root canal treatment. KEY LEARNING POINTS OF THIS ARTICLE A treatment option for internal root resorption without periapical inflammation.

Influence of Extraoral Apicoectomy on Revascularization of an Autotransplanted Tooth: A Case Report

Abstract Autotransplantation is considered a standard procedure with a poorer prognosis for mature than for immature teeth. In this case report, the root tip of an almost fully developed tooth was resected during autotransplantation to fit into a deficient recipient site. As a positive side effect, the apical foramen was enlarged, with potential improvement of the probability of revascularization. Clinical and radiologic follow‐up examinations up to 18 months indicated revascularization and uneventful periodontal regeneration and thus successful autotransplantation. This case supports the hypothesis that intraoperative apicoectomy can improve the prognosis for revascularization of mature autotransplanted teeth. Further prospective controlled clinical studies are needed to confirm this innovative surgical approach.

Temperaturverlauf in der Pulpa während der Präparation mit dem Er:YAG-Laser im Vergleich zum konventionellen Bohrer. Eine In-vitro-Studie

Zusammenfassung In einer In-vitro-Untersuchung an palatinalen Klasse-I-Kavitaten wurde der Einfluβ der Praparationen mit dem Er:YAG-Laser auf den Temperaturverlauf in der Pulpa untersucht. Dabei wurde wahrend der Praparation der mit dem Er:YAG-Laser entstandene Temperaturverlauf mit jenem verglichen, der wahrend einer konventionellen taktilen Priiparation mit dem Diamanten aufgezeichnet wurde. Die Versuchsanordnung wurde so gewahlt, daβ das Pulpenkavum mitsamt der Meβsonde von der Wurzel aus konstant auf 37 oc gehalten wurde, wahrend die Krone, davon thermisch isoliert, der Praparation ausgesetzt war. Dabei zeigte sich wahrend der Laserpraparation nach wenigen Sekunden ein Abfall der Temperatur durch die Kuhlung mit Wasser und Luft von 37°C auf ein Niveau von 25 bis 30 °C. Selbst bei Trepanation kam es nur zu einer Temperaturerhohung in der Pulpa, wenn die Temperaturmeβsonde direkt getroffen wurde. Bei der konventionellen Praparation wurde im Vergleich dazu schon vor der Trepanation ein Temperaturanstieg auf uber 60 °C registriert. Die bereits publizierte Reduktion der Schmerzsensibilitat in der klinischen Anwendung des Er: YAG-Lasers bei Klasse-V-Kavitaten konnte auch zusatzlich durch die verminderte intrapulpale Temperaturerhohung im Vergleich zur konventionellen Praparation bedingt sein. Insgesamt kann man davon ausgehen, daβ bezuglich der thermischen Pulpenschonung die Praparation mit dem Er:YAG-Laser der herkommlichen taktilen Praparation mit dem konventionellen Winkelstuck uberlegen ist.

Klinische Anwendbarkeit und Patientenakzeptanz des Er:YAG-Lasers im Vergleich zum konventionelten Bohrer. Eine Pitotstudie

Zusammenfassung In einer klinischen Untersuchung wurden die Anwendbarkeit und die Akzeptanz von zwei unterschiedlichen Zahnhartsubstanzpraparationsmethoden der besonders schmerzsensiblen Lasione im Zahnhalsbereich bestimmt. Wir wollten feststellen, wie sich Behandler als auch Patient zu diesem Problem stellen. Es wurden der konventionelle rotierende Bohrer der Praparation mit dem Er:YAG-Laser gegeniibergestellt. Fur these Untersuchung kamen funf Kriterien zur Anwendung. Als drei objektive Kriterien wurden die Messung der reinen Praparationszeit, de Verlauf des systolischen Blutdruckes und der Pulsverlauf beide Behandlungsmethoden wahrend der Behandlung verglichen. Die zwei subjektiven Kriterien bildeten die personliche Beurteilung des Behandlungsverlaufes sowohl durch den Behandler als auch durch den Patienten. Bei der konventionellen Praparation wurde ein Anstieg des systolischen RR beobachtet und ein statistisch signifikanter Anstieg des Pulses. Im Gegensatz dazu gibt es bei der Laserpraparation keinen Anstieg bei Puls und systolischen RR, sondern sogar einen Abfall des Pulses wahrend der Behandlung. Der Zeitaufwand lag bei der Laserpraparation um 35% hoher. Die subjektive Beurteilung des Behandlers fiel zugunsten des Er:YAG-Lasers aus. Noch deutlicher sprachen sich die Patienten fur den Laser aus. Der um 35% erhohte Zeitaufwand wird durch den Wegfall der Lokalanasthesie vor der Behandlung mehr als kompensiert. Das Verhalten von Pulsverlauf und Blutdruckverlauf spricht fur eine stresfreiere Behandlung mit dem Er:YAGLaser. Am deutlichsten fur die Laserzahnbehandlung aber spricht, das er besonders bei schmerzsensiblen Patienten gegenuber dem konventionellen, rotierenden Instrument den Vorteil einer schmerzarmeren Behandlung bietet und damit auch von den Patienten fsr die Praparation der Zahnhalslasionen im Vergleich zum Bohrer im Rahmen unserer Untersuchung liebend gerne akzeptiert wurde.