[Changes of the pulp in dislocated teeth].
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Successful treatment of traumatic injuries depends on timely action by the patient and a quick and accurate diagnosis by the dentist. Although most injuries are minor and of an urgent nature, displaced or missing teeth are true emergencies. The mismanagement of dental traumatic injuries has provided much information as well as questions for research that have resulted in the increased retention of teeth with as little treatment as possible. Maintaining pulp vitality when possible, utilizing the therapeutic effects of calcium hydroxide, and returning teeth to function as soon as possible are keys to predictable prognosis.
The major emphasis of this review should rest on articles written within the past 12 months. Many of these papers comprise comprehensive surveys of treatment of various aspects of dental trauma in the primary and permanent dentition, as well as epidemiological studies. There have also been some very good experimental studies which have attempted to standardize luxation injuries as well as tooth replantation in order to study pulpal and periodontal healing in reproducible animal models. However, it can be seen from the reference list that one year's production in dental traumatology would not suffice to cover the scope of the treatment needs nor to adequately orient the reader on the progress made with respect to our present knowledge of wound healing following injury and the most recent developments in the restoration of the traumatized dentition. To present an overall view of the philosophy which has evolved concerning wound healing in the dental pulp and periodontium following injury as well as innovations in the treatment of acute dental trauma, this review must of necessity delve back into the mid-80's and probe forward into publications which are on the way in 1991. In 1984, in Dallas, Texas, the American Association of Endodontists' Endowment and Memorial Foundation convened the first International Conference on Oral Trauma. In 1989, in Stockholm, Sweden, this was followed up with the second International Conference on Dental Trauma. The one-day program summarized the state of the art of dental traumatology with respect to various aspects of epidemiology, diagnosis, treatment and prevention as well as the biological principles which form a basis for our present knowledge about healing and healing complications in the pulp and periodontium after traumatic dental injuries. The proceedings from this conference have been compiled in a newly published volume. Where applicable, these presentations have been cited as current reviews. It could also be mentioned that at the conclusion of the second conference, in recognition of the need to promote research and propagate knowledge in the area of dental traumatology, the International Association of Dental Trauma (IADT) was founded. The third International Conference on Dental Trauma was convened in Copenhagen, Denmark, June 1991. The major theme was restoration of the traumatized dentition. Proceedings from this conference are to be published. However, new information from that program is also cited in the following where applicable. Finally, the second Charlotte Conference on Pathobiology of the Dentin/Pulp Complex was held in Charlotte, North Carolina in May 1991.(ABSTRACT TRUNCATED AT 400 WORDS)
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The endodontic, restorative, and orthodontic treatment sequence of the accidental injury of three maxillary incisors has been presented. The treatment objective was to achieve an esthetically acceptable result for a young adult, until a definitive fixed prosthetic restoration can be planned. The ankylosed maxillary right permanent central incisor (11) is being maintained for reasons of arch-length space and alveolar bone height.
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The absence of the temporary incisors could be to a genetic illness or to some multiple premature extractions. These extractions are the aftermaths of the carious lesions or some traumatisms underwent by the temporary incisors. Beyond measure the loss of the space, the premature loss some temporary incisors very often assign the relational development of the child and disturb its psychological development and the aesthetic function. Across some cases clinics, the authors show that the replacement of the temporary incisors is the therapeutic ideal solution. Indeed, the child prosthesis, replacing the temporary absent incisors, solves the psychological, aesthetic and relational problems of the child.
PURPOSE: The objectives of the present study were to determine the prevalence of residual extrusion, pulpal necrosis, and resorption for extruded permanent teeth and to establish the effect of presentation and treatment factors. METHODS: Seventy-two traumatically extruded permanent incisors were studied at the Departments of Paediatric Dentistry in Belfast, Newcastle upon Tyne, and Glasgow. The mean age of the patients was 10.1 years (range=6 to 18 years). Clinical and radiographic outcomes were analyzed and related to presenting and treatment factors. RESULTS: The initial degree of extrusion was moderate for 46 teeth (64%), and the median delay prior to repositioning was 3 hours (range=1 to 168 hours). Pulp necrosis occurred in 31 teeth (43%), residual extrusion was present in 16 teeth (23%), and inflammatory resorption occurred in 11 teeth (15%). Residual extrusion was significantly associated with a delay in repositioning the tooth, pulpal necrosis was significantly more common in teeth with closed apices and in severely extruded teeth, and inflammatory resorption was more common after pulpal necrosis. CONCLUSIONS: Residual extrusion could be minimized by earlier presentation and repositioning. The risk of pulpal necrosis is greatest for severely extruded teeth and for those with closed apices.
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The principal factors that affect the prognosis of a posttraumatic reimplantation are the length of the extra-alveolar persistence and the manner in which the extracted tooth is preserved. Both are fundamental for the maintenance of the fiber vitality of the periodontal ligament. The necrosis of these fibers cause ankylosis. It is observed that the conditioning of the radicular surface with fluoride solutions before the reimplantation is likely to slow down the evolution of radicular resorption. To evaluate the effectiveness of such methodology six cases of traumatic extractions, characterized by a length of extra-alveolar persistency (not longer than 24 hours), and unfavorable conditions of the preserved tooth have been treated by conditioning the radicular surface with the Na-fluoride solution before the reimplantation. Another group of reimplantation cases with the same characteristics have been examined without proceeding first to the radicular conditioning. The results of the study, although preliminary, verified the positive influence of the Na fluoride upon the radicular resorption.
The dentist will be confronted unexpectedly with a dentoalveolar trauma patient. This patient has to be seen immediately and has to be treated adequately. The risk of overlooking trauma-related signs when examining these patients, can be minimized by following a strict protocol. This article describes a protocol for examination and treatment of a patient with a dentoalveolar trauma. The prognosis after treatment of the trauma is discussed. Also some recommendations regarding aftercare and prevention are presented.
In dentistry complications are undesirable adventures provoked by oral health care delivery. If there is any risk of a complication, the patient needs to be informed before treatment. Occurrence of complications can be minimized by adequate diagnostics and planning sufficient time for treatment. The most common complications during and after dentoalveolar surgery are discussed, such as complications during or after producing local anaesthesia, nerve injuries, complications during or after tooth extraction, aspiration, jaw luxation, disturbed wound healing, and complications during or after implantation procedures.