[Mandibular fracture during tooth extraction].
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A case of incomplete fractures occurring bilaterally in intact maxillary first molars is described. The etiology, diagnosis, and treatment of incomplete tooth fractures are discussed. The clinical results in this case showed that early diagnosis and treatment can prevent further extension of the crack into the pulp and subsequent complete tooth fracture.
A vertical crown-root fracture of the mandibular first primary molar in a 21-month-old child is presented. The mandibular primary first molar was fractured vertically and split into 2 pieces. The tooth fracture had not been noticed for about 5 months after the accident, and the tooth was left without any treatment. The pulp tissue of the mesial root maintained its vitality, but the distal root was nonvital.
PURPOSE: This study reported on the modes of failure and the influence of various clinical characteristics on the outcome of 515 metal-ceramic fixed partial dentures (FPD) involving 1,209 abutment and 885 pontics placed by one operator in a specialist prosthodontic practice between January 1984 and December 1997. MATERIALS AND METHODS: Fifty-three percent of maxillary and 84% of mandibular FPDs involved one or more nonrigid abutment-pontic connections. Patients were recalled in 1993 (review 1) and 1998 (review 2) and clinically examined by the author. The modes of failure and influence of clinical characteristics, including abutment-pontic connection, post design in nonvital abutments, and regularity of professional maintenance, were evaluated. RESULTS: At review 2, 80% of the FPDs were still in function, while 9% required retreatment. Tooth fracture accounted for 38%, caries for 11%, loss of retention for 13%, and periodontal breakdown for 27% of retreatments. Nonrigid abutment-pontic connection in posterior FPDs and regular professional maintenance were associated with significantly reduced failure rates. Except in posterior molars, there was no difference in failure rates between parallel-sided preformed stainless steel serrated posts and cast-gold alloy posts. CONCLUSION: Tooth fracture was the most common reason for retreatment of the FPDs, although the rate of periodontal breakdown and caries increased significantly with time. Nonrigid abutment-pontic connection and regular professional maintenance were associated with significantly reduced failure rates. Post design and composition were not related to outcome.
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PURPOSE: This study assessed changes in the incidence and causes of mandibular fractures occurring in innsbruck, Austria between 1984 and 1993. PATIENTS AND METHODS: Records from 712 patients sustaining 982 mandibular fractures were reviewed and analyzed according to age, sex, date of fracture, place of trauma, cause, anatomic site of fracture, and associated orofacial and craniocerebral injuries. RESULTS: Sports were the most common cause of mandibular fractures, accounting for 31.5% of the entire sample, followed by road traffic accidents (27.2%) and falls (20.8%). The yearly distribution of sport-related mandibular fractures showed an increase from 28.6% in 1984 to 1988 to 34.5% in 1989 to 1993. The major causative factor in sports-related mandibular fractures was skiing (55.3%), whereas cycling and soccer accounted for 25.4% and 8.9%, respectively. Significant changes in the occurrence of cycling-related mandibular fractures were observed, with an increase of 19.3% from 1984 to 1988 to 1989 to 1993, whereas skiing-related mandibular fractures showed a decrease of similar magnitude (19.5%). Sex distribution showed a male-to-female ratio of 2.5:1, with the percentage of females involved increasing. In cases of cycling-related accidents, there was a considerable prevalence of associated injuries (133.3 injuries per 100 mandibular fractures), with significantly higher rates of facial lacerations (73.2), tooth fractures (39), tooth luxations (24.4), and orbital fractures (3.7) than in the case of skiing-related injuries, whereas in patients sustaining mandibular fractures caused by soccer, mucosal lacerations, tooth luxations, and cerebral concussions were the only associated injuries found. CONCLUSIONS: The results of this study indicate a considerable change in the cause of mandibular fractures, showing that sporting injuries are becoming increasingly common. The high incidence of associated maxillofacial injuries in patients involved in skiing and cycling accidents may suggest an increasing need for preventive and protective measures.
Advances in adhesive dentistry have led to increasingly predictable conservative aesthetic restorative procedures. When trauma results in a clean tooth fracture, perhaps the ultimate in conservation dentistry is achieved by rebonding the fractured piece. The learning objective in this article is the clinical technique for rebonding fractured off tooth segments in posterior teeth.
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The purpose of this study was to investigate the knowledge of a group of physical education (PE) teachers about the emergency management of dental trauma in Hong Kong. A postal questionnaire was sent to PE teachers in 100 randomly selected secondary schools in Hong Kong. A total of 166 teachers from 65 schools responded. Results show that a majority of the respondents have received formal teaching training (98.8%). While all but one teacher had received formal first aid training, only eight of them recalled that they had received advice on the management of dental trauma. Concerning the management of tooth fracture, 118 respondents (71.1%) gave an appropriate answer. In contrast, only 29 teachers (17.5%) were able to indicate the appropriate management for an avulsed tooth. Over 60% (102) of the respondents indicated it was "very urgent" to seek professional assistance if a permanent tooth has been avulsed, but they had little knowledge of the correct procedures for replanting or transporting avulsed teeth. Only 15 respondents (9%) pointed out that milk was the medium of choice for transporting avulsed teeth. Finally, over 90% (157) of respondents indicated that they had never received advice on the emergency procedures for the management of dental avulsion. The present study showed that the level of lay knowledge of management of dental injuries in a selection of PE teachers in Hong Kong is inadequate and educational campaigns are necessary to improve their emergency management of dental injuries.
BACKGROUND: Direct, real-time visualization of the hard and soft tissues within the gingival sulcus may aid the clinician in diagnosis and therapy of periodontal disease. This report describes an endoscope specifically designed for this purpose and the interpretation of dental endoscopic images. METHODS: Medical endoscope technology was modified for application in the dental environment. A fixed, fused fiber optic bundle, less than 1 millimeter in diameter, was coupled to an active matrix LCD-TFT flat panel video monitor for viewing by the clinician. A bilumen sheath was designed to provide irrigation of the sulcus and a sterile barrier between the patient and the fiber bundle. Standard dental curets and ultrasonic scalers were adapted for instrumentation aided by the endoscope. RESULTS: Endoscope technology has been successfully adapted for use in periodontal diagnosis and therapy. Techniques for identification and interpretation of the hard and soft tissue images, as well as the location of root deposits and caries, have been developed. CONCLUSIONS: The dental endoscope gives the clinician direct, real-time visualization and magnification of the subgingival tooth root surface, aiding in the location of deposits on the tooth root. The subgingival soft tissue, including the gingival attachment, sulcus wall, and sulcus contents, can be assessed. Identification and location of subgingival caries, root fractures, tooth root deposits, post perforations, and open restoration margins may aid the clinician in diagnosis and therapy.
As the population keeps their teeth longer the problem of tooth fracture and severe fracture of the root is becoming increasingly significant for the restorative dentist. This paper discusses hemisection, an alternative to extraction in cases of vertical root fracture in patients capable and willing to carry out proper oral hygiene measures.
The periodontal, orthodontic, and prosthetic management of four indications for subgingival or subosseous tooth fractures has been discussed. The importance of having the aveolar crest a minimal distance of 2.5 mm from the margin of the restoration has been explained. The pitfalls of an external, rather than internal, bevel and flap procedure were assessed. Coordinated interspecialty therapy provides diverse, conservative treatment for the general practitioner and successful restorations for the patient.
Fractured teeth are difficult to treat effectively. Currently, such as root fractures are usually treated by full-coverage restoration, root amputation, or tooth extraction. If the fusion of tooth fracture by laser were possible, it could offer a different therapy to repair fracture teeth. We tried to use a developed DP-bioactive glass paste to fuse or bridge the tooth crack line by a medium energy continuous-wave CO2 laser. The present report was focused on the phase transformation and rescrystallization of DP-bioactive paste during expose to the CO2 laser. The materials will examine by means of XRD, FTIR, DTA/TGA, and SEM. From the study, we could expect that the temperature increase due to laser irradiation must be over than 900 degrees C and the DP-bioactive glass paste could be melted in a short period of time after irradiation. In the study, we successfully developed a DP-bioactive glass paste which could form a melting glass within minutes after exposed to a medium energy density continuous-wave CO2 laser. The paste will be used to bridge the enamel or dentine surface crack by the continuous-wave CO2 laser in the near future.
AIMS: The purpose of the study was to apply established methods to survey reasons for the placement and replacement of crowns in general dental practice in the United Kingdom. MATERIALS AND METHODS: One hundred and twenty-eight general dental practitioners were recruited. Participants recorded the principal reason for the provision of each initial and replacement crown they provided over a 12-week period. RESULTS: Overall, data were collected from 92 practitioners in respect of 1714 patients and 2164 crowns, of which 1452 (67%) were initial placements and 712 (33%) replacements. The teeth most frequently crowned were maxillary incisors (33%), with 72% of the crowns surveyed being of the porcelain bonded to metal variety. Overall 64% of the initial placement crowns were provided because of restoration failure (26%) or tooth fracture (38%). The most common reason for crown replacement was crown failure (27%). CONCLUSION: It is concluded that surveys of the type reported may provide new insights into the reasons for and pattern of provision of initial placement and replacement crowns in clinical practice. In this study the most common reason for the provision of initial placement crowns was tooth fracture. The most common reason for the replacement of crowns, notably porcelain jacket crowns, was crown fracture.
OBJECTIVES: (a) To determine the force-time trace that occurs when a spring mounted simulated upper jaw is impacted; (b) to examine if mouthguards of variable quality have significant influence on such force-time traces; (c) to attempt to relate physical events to the profile of the force-time traces recorded. METHODS: A simulated jaw, consisting of ceramic teeth inserted into a hard rubber arch reinforced with a composite jawbone, was fitted with various mouthguards as part of a previous round robin study. A clinical assessment distinguished good, bad, and poor mouthguards, and these were each fitted to the jaw, which was then submitted to instrumental impact tests under conditions expected to produce tooth fractures. The force-time trace was recorded for such impact events. RESULTS: The spring mounting method caused two distinct peaks in the force-time trace. The initial one was related to inertia effects and showed an increase in magnitude with impactor velocity as expected. The second peak showed features that were related to the differences in the mouthguards selected. CONCLUSIONS: The use of a force washer within a conical ended impactor enabled force-time traces to be recorded during the impact of a spring mounted simulated jaw fitted with mouthguards of variable quality. The spring mounting system causes an initial inertial peak followed by a second peak once the spring mount has fully compressed. Good fitting guards, which keep most teeth intact, result in high stiffness targets that in turn generate high reaction forces in the impactor. If the spring mounting is omitted, the two peaks are combined to give even higher reaction forces. The force-time trace offers some potential for assessing both overall mouthguard performance and individual events during the impact sequence. Mouthguards with good retention to the jaw remained attached during the impact event and helped to preserve the structural integrity of the target. This in turn developed high forces in the second part of the force-time trace. Guards that detached during impact and allowed tooth fractures showed lower forces in the second part of the test. The force profile measured offered some quantitative support to, and agreement with, the observed clinical quality of the mouthguards.
Through a standardized procedure using clinical examination, interviews, and dental history, this 2-year study documents 100 cases of tooth fracture in 98 patients. For comparison, pertinent information was also recorded for more than 2,000 teeth in a randomly selected sample population. Two chief types of fracture were found: incomplete crown-root fractures and root fractures associated with earlier endodontic therapy.
Restorative treatment planning is often confounded when periodontal attachment loss, caries or tooth fracture involves the furcation area of the tri-rooted maxillary molars. Although such involvement invariably diminishes the long-term prognosis of the affected teeth, extraction is not always an option. Root resective therapy, which removes the involved root plus its associated crown portion (trisection), is one of several treatment modalities that can be used in such cases. This article reviews the indications and contraindications for root resective therapy, describes the techniques of surgical trisection and presents a case in which combined resective, endodontic and prosthetic management resulted in a successful outcome.
OBJECTIVES: The purpose of this study was to measure the oral health and hygiene status among 265 South Florida nursing home residents aged between 45 and 98 years. METHODS: The oral health and hygiene status of the residents were assessed by noting the presence of calculus, caries, gingivitis, cheilitis, apthous ulcer, dry mouth and red or white lesions. RESULTS: The incidence of nursing home residents with calculus was 79.6% and the remaining 20.4% were edentulous. More than half of residents had oral problems (50.6%) the commonest was gingivitis (36.6%), followed by caries (26%) and tooth fracture (15.9%). Almost half the residents wore dentures (47.2%). Statistical analysis was conducted using analysis of variance (P-values). Ageing of the residents was statistically correlated to a worsening of oral hygiene status (P<0.0066), absence and presence of one or two dentures (P<0.0034) and a loss of teeth (P<0.0001). CONCLUSIONS: The ageing of residents is correlated to increasing oral health problems and the loss of teeth. Oral health neglect affects almost all of the nursing home residents. Care providers should receive education and training from dental hygienists to improve the standard of oral hygiene and health of the elderly.