Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted (Review)

Background: Traumatic dental injuries are common. One of the most severe injuries is when a permanent tooth is knocked completely out of the mouth (avulsed). In most circumstances the tooth should be replanted as quickly as possible. There is uncertainty on which interventions will maximise the survival and repair of the replanted tooth. This is an update of a Cochrane Review first published in 2010. Objectives: To compare the effects of a range of interventions for managing traumatised permanent front teeth with avulsion injuries. Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 March 2018), Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 2) in the Cochrane Library (searched 8 March 2018), MEDLINE Ovid (1946 to 8 March 2018), and Embase Ovid (1980 to 8 March 2018). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria: We considered randomised and quasi‐randomised controlled trials that included a minimum follow‐up period of 12 months, for interventions for avulsed and replanted permanent front teeth. Data collection and analysis: Two review authors independently selected studies, extracted data and assessed the risk of bias. Authors were contacted where further information about their study was required. Main results: Four studies, involving a total of 183 participants and 257 teeth were identified. Each of the interventions aimed to reduce infection or alter the inflammatory response or both at the time of or shortly after the tooth or teeth were replanted. Each study assessed a different intervention and therefore it was not appropriate or possible to numerically synthesise the data. All evidence was rated as being of very low quality due to problems with risk of bias and imprecision of results. This means that we are very uncertain about all of the results presented in this review. One study at high risk of bias with 69 participants (138 teeth) compared a 20‐minute soak with gentamycin sulphate for both groups prior to replantation with the experimental group receiving daily hyperbaric oxygen for 80 minutes for the first 10 days. There was some evidence of a benefit for the hyperbaric oxygen group in respect of periodontal healing, tooth survival, and pulpal healing. One study at unclear risk of bias with 22 participants (27 teeth) compared the use of two root canal medicaments, Ledermix and Ultracal. There was insufficient evidence of a difference for periodontal healing or tooth survival. This was the only study to formally report adverse events with none identified. Study authors reported that Ledermix caused a greater level of patient dissatisfaction with the colour of avulsed and replanted teeth. A third study at high risk of bias with 19 participants compared extra‐ or intra‐oral endodontics for avulsed teeth which were stored dry for longer than 60 minutes before replantation. There was insufficient evidence of a difference in periodontal healing. The fourth study at high risk of bias with 73 participants compared a 10‐minute soak in either thymosin alpha 1 or saline before replantation followed by daily gingival injections with these same medicaments for the first 7 days. There was some evidence of a benefit for thymosin alpha 1 with respect to periodontal healing and tooth survival. Authors' conclusions: Based on the results of the included studies, there is insufficient evidence to support or refute the effectiveness of different interventions for avulsed and replanted permanent front teeth. The overall quality of existing evidence was very low, and therefore great caution should be exercised when generalising the results of the included trials. There is urgent need for further well‐designed randomised controlled trials

Revitalisation endodontic treatment of traumatised immature teeth: a prospective long-term clinical study

Purpose Continuation of root development following revitalisation endodontics (RET) has been shown to be unpredictable with lower success rates in traumatised teeth. This study reports the outcomes for RET in traumatised teeth over a review period of 4 years. Methods A prospective uncontrolled study, where RET was performed on traumatised upper immature anterior teeth with necrotic pulps in 15 children (mean age = 8.3 years), was conducted. Patients were reviewed at 3, 9, 12, 24, and 48 months, where clinical and radiographic assessments were performed. At the last review appointment, patients and parents answered questions assessing their perception and acceptance of tooth colour change over time. McNemar’s Exact test and linear mixed model assessment were used to assess changes in pulpal electrical response and radiographic evidence of continuation of root development over time, respectively. Results There was 83.3% healing with no significant changes in EPT responses, and no significant changes in root lengths, while significant changes in root widths (p < 0.05) and root apex widths (p < 0.001) were found over time. Twenty-five percent of patients and 33% of parents felt that there were changes in tooth colour following RET over time. Conclusion Within the limitations of this study, traumatised teeth treated using RET showed no significant root lengthening, however, acceptable periapical healing, slow thickening of root dentinal walls, and rapid development of apical closure were evident over a period of 43 months. Using Portland cement and omitting minocycline, did not eliminate crown colour change following RET

An unusual presentation of erythema multiforme in a paediatric patient

Background: Erythema multiforme (EM) is an acute, vesiculobullous disease of skin and mucous membranes with symptoms ranging from mild to severe. A complex interaction of different factors has been implicated the condition; the majority with a preceding herpes simplex infection. This report describes an unusual presentation of erythema multiforme affecting the lips and oral mucosa of a healthy 7-year-old boy in the form of lip adherence. Case report: Two weeks following eruption of oral ulcerations, a 7-year-old healthy boy developed severe erosive ulceration of both lips, causing complete lip adherence. This was accompanied by marked bilateral submandibular and cervical lymphadenopathy, tremor and sweating. Clinical and laboratory investigations led to a diagnosis of erythema multiforme. The patient was treated initially with gentle application of Vaseline between the lips using cotton buds in an attempt to release lip adhesion, followed by surgical release of the lips under general anaesthesia. Analgesics and topical steroid mouthwash were provided. Follow-up: Seven months later, the patient presented with a recurrence of his EM which included lesions on the skin. The patient was treated with antivirals, topical and systematic steroids to suppress the recurrent attacks of EM. Eighteen months following the initial presentation the patient and parent reported considerable decrease in the frequency, severity and duration of the occurrence of intra-oral ulcers, with no major episode of target lesions on the skin. Conclusion: Erythema multiforme is rare in children, however it should be considered in the differential diagnosis of recurrent erosive oral ulcerative lesions especially when the oral lesions resemble those of primary herpetic gingivostomatitis

Use of remote sensing data in assessment land cover changes, land use patterns and land capabilities in AL-Qassim region, Saudi Arabia

© 2017 by International Journal of Ecology & Development. The Qassim region of central Saudi Arabia is one of the most important agricultural regions in the country especially for date cultivation. In the present study, Land sat TM and ETM+ data for the period 1999-2013 are used to study the land use, land cover changes in the area. Satellite images from path/row 168/042 constitute the study area. Three major land use/land cover classes are considered: hilly areas (364,407 ha), vegetated land (1,776,698 ha), and sand dunes (1,523,669 ha). The vegetated land constitutes the class 1, which is comprised of the wades mainly devoted used for for date production. Sand dunes are designated the class 11 and covered a large portion of the study area whereas the Hilly areas are unproductive and constitute as class 111.The vegetative land are surrounded by sand dune which is the most fragile system of the area and leads to damage some productive lands in the area. It is necessitates to study the area for suitable land management practices and for possible approach to stop the sand drifting or sand encroachment in the area. The land use capabilities classification of the study area includes three main classes: LUC I, LUCII, and LUC III. Slopes ranging between 0°and 20°correspond to areas that areflat, gently undulating, undulating, rolling, strongly rolling, moderately steep and steep, respectively. The slope categories dictate the usage patterns of the lands in the study area, which range from suitable to unsuitable to productive lands

The use of behaviour management techniques amongst paediatric dentists working in the Arabian region: a cross‑sectional survey study

Purpose The purposes of this study were to investigate paediatric dental practitioners’ training and confidence in using dental behaviour management techniques in the Arabian region and to assess the factors influencing the application of advanced behaviour management techniques. Methods: An online questionnaire was distributed to paediatric dental practitioners in the Arabian region. Data were analysed using descriptive statistics and Pearson Chi Square. Results A total of 113 responses were obtained. Of these, the majority were from Egypt (45%, n = 51). Just over half of the respondents were registered as specialists at the country where they were practicing paediatric dentistry (53%, n = 60). The use of behaviour management techniques varied amongst participants with tell-show-do (95%, n = 107) and positive reinforcement (89%, n = 101) being the most routinely used techniques. The majority of participants reported using voice control (83%) and parental separation (68%) techniques. Hand over mouth exercise (HOME) was only used by 24% (n = 27) of participants, whilst just over half of the participants, 53%, reported using protective stabilisation. A significant association was shown between country of practice, country of obtaining paediatric dental training, speciality status and the use of advanced behaviour management techniques, whilst confidence in using HOME and sedation were associated with work setting and country of practice, respectively. Conclusion The use of advanced behaviour management techniques was found to be high amongst respondents in the Arabian region. The lack of training in using these techniques, however, is of concern. Further assessment of the factors affecting the use of and confidence in applying advanced behaviour management techniques in the Arabian region is needed

Regenerative endodontic therapy (RET) for managing immature non-vital teeth: a national survey of UK paediatric dental specialists and trainees

Background: Several guidelines have been published advocating the use of regenerative endodontic therapy (RET) in managing non-vital immature permanent teeth. It is unclear, however, how many UK paediatric dental specialists routinely use this technique and their opinion of its outcomes, and barriers to its use. Aim: To assess the knowledge, experience and the opinion of UK based paediatric dental specialists/trainees (UKPDS/T) and practitioners working in the capacity of paediatric dental specialists on the use of RET. Design: A cross-sectional study using a 22-item questionnaire was developed using the Bristol Online Survey tool and circulated electronically to members of the British Society of Paediatric Dentistry between August and November 2016. Results: Ninety-eight UKPDS/T completed the survey. A quarter of respondents (N = 24, 24.5%) reported using RET. Reasons cited for not using RET included lack of: training (N = 48, 45%), materials (N = 28, 26%), evidence (N = 17, 16%) and suitable cases (N = 6, 6%). Different protocols in terms of disinfection, medicaments, scaffolds, and obturation material were identified. Conclusions: This survey highlights a low uptake of RET by current UKPDS and trainees with several barriers identified. Deviations from the current RET guidelines were identified. Recommendations addressing the use of RET in light of the findings of this survey were made

Regenerative Endodontic Technique using a combination of Amoxicillin and Metronidazole. A review and report of two cases

The management of non vital anterior permanent teeth in children is a challenge for the clinicians. Once the tooth becomes non vital, the root development ceases, which renders the tooth weak and unable to withstand the physiological forces of mastication. This results in a high fracture rate, and therefore a poor prognosis in the medium to long term. Recently there has been a paradigm shift in the approach to this clinical problem through the use of regenerative endodontics. Despite many case reports, and a few case series that have been reported, the procedure is still shrouded in uncertainty as differing interventions have been used, though broadly based on similar principles. In the Department of Paediatric Dentistry at the Leeds Dental Institute we have used a particular regenerative endodontic technique (RET), using a mixture of two antibiotics (Amoxicillin and Metronidazole). In this paper, we aim to present the rationale for this technique and present two cases successfully treated and followed for up to two years

What the future holds for regenerative endodontics: novel antimicrobials and regenerative strategies

Regenerative/revitalisation endodontic techniques are increasingly used as a treatment approach for the management of immature permanent teeth with necrotic pulps. Different chemical irrigants and medicaments are routinely used clinically for intra-canal disinfection. However, despite remarkable progress in this field, coronal discolouration, cell cytotoxicity, difficulty of removal of organic biofilm from the root canal, development of sensitisation and antimicrobial resistance are still challenges to this line of treatment. This review critically discusses and challenges the current status quo of antimicrobials used in regenerative endodontics and sheds the light on future alternative antimicrobial materials with regenerative potential

A prospective clinical study of regenerative endodontic treatment of traumatized immature teeth with necrotic pulps using bi-antibiotic paste

Aim: To evaluate the treatment outcomes of a revitalization endodontic technique (RET) for the management of traumatized immature teeth with necrotic pulps in children. Methodology: Fifteen healthy children (age range = 7–10 years) with traumatized immature maxillary incisors with necrotic pulps treated with bi-antibiotic revitalization endodontic technique were prospectively assessed over approximately two years (mean = 22 months). One operator undertook all treatments, clinical reviews and standardized radiographic exposures with radiographic analysis being carried out by two calibrated experienced clinicians. Crown colour change was assessed using an objective published methodology. Wilcoxon signed-rank test was used to compare root lengths, root dentinal widths and apical foramen widths over time. Results: Interoperator measurement reliability was consistently strong for all measurements. There was no significant difference in root lengths or root dentinal wall widths following RET. A significant difference in apical foramen widths was observed after 2 years (P = 0.013) with resolution of clinical signs of infection in all cases. Despite omitting minocycline and using Portland cement (nonbismuth containing cement), a noticeable crown colour change (yellower, redder and lighter), as measured by an objective colour measurement system with ΔE = 7.39, was recorded. Most patients, however, were satisfied with the aesthetic outcome. Conclusion: Traumatized immature teeth with necrotic pulps treated with revitalization endodontic technique did not demonstrate continuation of root development or dentine formation when assessed by periapical radiographs. However, apical closure and periodontal healing were observed. A measurable change in crown colour (yellower, redder and lighter), with mostly no aesthetic concern to the patients/parents, was also observed