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In dentistry, over-retained deciduous teeth pose a distinct issue due to their endurance during the expected exfoliation period. This case study describes a clinical situation with a male patient who is seven years old and complaining of painful swelling over the maxillary anterior region of the jaw and clinically showing dark red-colored, firm, non-tender, purulent swelling extending from alveolar mucosa of the upper anterior to the gingival margin of the 51, 52, 53 region. The treatment plan includes the extraction of the primary teeth. This case report also highlights the importance of minimal surgical intervention for treating peri-radicular cysts to minimize healing time and damage to the underlying developing permanent tooth.

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BACKGROUND/OBJECTIVES: The use of different models for the fabrication of custom-fit mouthguards (MTGs) can affect their final thickness, adaptation, and shock-absorption properties. This study aimed to evaluate the adaptation, thickness, and shock absorption of ethylene-vinyl acetate (EVA) thermoplastic MTGs produced using conventional plaster or three-dimensional (3D) printed models. MATERIALS AND METHODS: A typical model with simulated soft gum tissue was used as the reference model to produce MTGs with the following two different protocols: plast-MTG using a conventional impression and plaster model (n = 10) and 3DPr-MTG using a digital scanning and 3D printed model (n = 10). A custom-fit MTG was fabricated using EVA sheets (Bioart) plasticized over different models. The MTG thickness (mm), internal adaptation (mm) to the typodontic model, and voids in the area (mm2) between the two EVA layers were measured using cone-beam computed tomography images and Mimics software (Materialize). The shock absorption of the MTG was measured using a strain-gauge test with a pendulum impact at 30° with a steel ball over the typodont model with and without MTGs. Data were analyzed using one-way analysis of variance with repeated measurements, followed by Tukey's post hoc tests. RESULTS: The 3DPr-MTG showed better adaptation than that of the Plast-MTG at the incisal/occlusal and lingual tooth surfaces (p < 0.001). The 3DPr-MTG showed a thickness similar to that of the Plast-MTG, irrespective of the measured location. MTGs produced using both model types significantly reduced the strain values during horizontal impact (3DPr-MTG 86.2% and Plast-MTG 87.0%) compared with the control group without MTG (p < 0.001). CONCLUSION: The MTGs showed the required standards regarding thickness, adaptation, and biomechanical performance, suggesting that the number and volume of voids had no significant impact on their functionality. Three-dimensional printed models are a viable alternative for MTG production, providing better adaptation than the Plast-MTG at the incisal/occlusal and lingual tooth surfaces and similar performance as the MTG produced with the conventional protocol.

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Immediate care and accurate diagnosis are essential for treating dental trauma. This report presents a 7-year-old boy suffered a bicycle accident with direct trauma to the mouth and extrusive luxation of teeth #11 and #21. The emergency treatment was performed within the first hour. Clinical examinations showed that both teeth exhibited 3 mm extrusion from comparing their incisal edges to their neighboring teeth, had edematous gingiva, showed grade 3 mobility and were painful to percussion. Radiographic exams showed incomplete root formation, widened periodontal spaces along their entire lengths and absence of bone or root fractures. The treatment consisted of immediate repositioning and semi-rigid splinting. After 15 days, tooth #11 exhibited no clinical signor symptom and tooth #21 was diagnosed with pulp necrosis, with an acute dentoalveolar abscess and intraoral edema. Immediate endodontic treatment was initiated (intracanal dressing with calcium hydroxide paste). At 30 days, another pulp sensibility test was performed on tooth #11, which had a negative response. In the same visit, the intracanal dressing of tooth #21 was replaced. The Ca(OH)2 medication was replaced every 6 months until the formation of an apical barrier. The final dressing consisted of gutta-percha and Grossman's sealer and was placed two and a half years after the first dressing appointment. The extrusive luxation resulted in two different sequelae: complete root obliteration in tooth #11 and anomalous root development after the formation of an apical barrier in tooth #21. The patient received orthodontic treatment after 6 years from the initial treatment with no negative outcome. After 18 years follow-up, both teeth were stabilized with no symptom or sign. It's important to follow the evolution of every trauma case continuously because the sequelae can be unpredictable.

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Fractures of the anterior teeth are a common form of dental trauma. This article includes three case reports of uncomplicated fractures of upper anterior teeth in which collaborators had different treatment protocols. The choice of the treatment method is based on the direction of the specific clinical case and the clinical findings. Of great importance to the treatment approach are the measures taken by the patient to preserve the fractured fragment, the age of the fracture, and the time available to patients and clinicians. When the fractured fragment is available and is well-preserved, the best approach is to fix it to the crown of the tooth. This protocol is extremely fast and inexpensive, with minimal potential for problems in esthetics and function. In the absence of the fractured fragment, the treatment approaches are different, as described in cases 2 and 3. If the patient or the clinician is unable to make a repeat visit, the restoration is carried out using a freehand technique. Protocols involving fracture repair using composite materials are more labor-intensive. Esthetic complications are often observed, which may be due to wrong determined shade, loss of luster, and change over the years in the color of the restoration, as well as fracture of the restoration. With advances in dentistry, these disadvantages have been minimized.

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BACKGROUND: Studies on oral health status of adults are sparse and rarely include data on endodontic treatment and trauma. In the military, those data are available because recruits are routinely assessed with a clinical and radiological examination at the start of their career. This study aimed to identify differences in oral health status of Dutch Armed Forces recruits between cohorts, departments, sex, age and rank, with DMF-T, endodontic treatment and dental trauma as outcome measures. METHODS: Data from Electronic Patient Files from all recruits enlisted in 2000, 2010 and 2020 were used for analysis in a hurdle model resulting in the estimated cohort effect, controlled for the demographic variables. The total number of recruits was 5,764. Due to the retrospective character of the study a proxy was used to compose D-T and dental trauma. RESULTS: The mean DMF-T number in recruits decreases from 5.3 in cohort 2000 to 4.13 in cohort 2010 and 3.41 in cohort 2020. The percentage of endodontically treated teeth increases from 6% in cohort 2000 to respectively 9% in 2010 and 8% in 2020. The percentage of recruits showing signs of dental trauma did not change significantly between cohort 2000 (3.1%) and cohort 2010 and 2020 (both 2.7%). CONCLUSIONS: Oral health in Armed Forces recruits is improving over the years, following a similar trend as the general population in the Netherlands. Lower SES represented by enlisted rank showed substantial lower oral health status.

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THE AIM: Jf the study was to assess the efficacy of mineral trioxide aggregate for treatment of children with complicated permanent teeth trauma. MATERIAL AND METHODS: The study comprised 29 children aged 6-13 years (mean age 8.6±1.7 years) with 36 injured constant teeth, from which 30 had immature roots, 27 (75%) teeth had necrotic pulp at baseline examination, 12 (33.3%) teeth showed radiological signs of external imflammatory root resorbtion, 2 teeth were diagnosed with of the root fracture (5.6%). MTA was used for pulp regeneration procedure in 25 (69.5%) teeth, external closure of resorbtion site in 3 (8.3%) teeth, root canal filling in 4 (11.1%) teeth, apical plug creation in 4 teeth (11.1%). The patients were folowed up for 1 to 9 years. RESULTS: From 36 teeth only one was extracted 9 years after regenerative endodontic procedure because of cervical root fracture. In 2 teeth with external imflammatory resorbtion progession of replacement resorption took place, in 1 tooth necrosis of regenerated pulp tissue occurred 2 years after the procedure because of restoration marginal seal failure. In 25 teeth favorable outcome was registered with stabilisation of external root resorbtion, continous root growth in 24 teeth and radioluscent lesions healing in 6 teeht showing them at baseline examination. Change of external imflammator root resorbtion to replacement resorption was detected in 1 teeth from 3 with external closure of resorbtion site. Root calan filling with MTA was performed in 3 avulsed teeth with replantation delayed for more than 1 day and in 1 tooth with root fracture. All teeth were clinically asymptomatic during more than 5 years follow-up. Favorable outcome was received in all cases of apicl plug formation. CONCLUSION: MTA is highly effective for preservation of constant teeth in children with clinically complicated situations. In many cases with hopeless long-term prognosis for a teeth MTA allows stabilization of dental tissue level with the teeth being an object for guided tissue regeneration.

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Mid-root fractures are rare injuries in young permanent teeth and tend to have poor prognoses. This study presents a case of oblique root fracture of both maxillary immature central incisors in the middle third accompanied by delayed dental visit and severe caries of all primary teeth. After restoring all the primary and permanent teeth that needed stabilization, the coronal fragments were repositioned and stabilized with a flexible splint consisting of orthodontic wire and composite resin. A comprehensive and sequential dental treatment for other oral diseases and oral hygiene instructions were provided. A 16-month follow-up revealed that the two injured young permanent incisors were healed, surrounded by hard tissues and continued to grow both in length of the root and thickness of the root canal wall, with significant improvement in oral hygiene. Based on the outcome of this case, initial stabilization without endodontic therapy could be considered a successful treatment modality for young permanent teeth with oblique root fracture due to the growth of fractured teeth with vital pulp and the maintenance of natural dentition.

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Foreign bodies may access the oral cavity by trauma or iatrogenically. Iatrogenic foreign bodies that are frequently encountered include amalgam, obturation materials, shattered equipment, needles, broken teeth, and so on. Impaction of a tooth or bone fragment in the soft tissues is one type of dental trauma. When foreign bodies are found in the teeth, it's a highly grave scenario that requires prompt diagnosis. Thorough case histories, clinical assessments, and radiographic analyses are required to draw conclusions regarding the type, dimensions, location, and challenge of the foreign body retrieval. Due to the well-known tendency of children to put foreign objects in their mouths, it is more frequently observed in them. From time to time, children get strange items lodged in their teeth, which they are afraid to tell their parents about. These foreign objects might store possible infections, which could eventually result in a painful condition. This paper discusses the presence of unusual foreign bodies-a broken pencil and tooth fragment-and their management. How to cite this article: Kaul B, Gulbar S, Gupta A, et al. Be Qui Vive: Unravel the Mystery of Undiagnosed for Better Prognosis. Int J Clin Pediatr Dent 2024;17(4):501-509.

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Preschoolers frequently experience traumatic dental injuries, particularly during their two to four years of life. The majority of these injuries result in tooth avulsion because of the alveolar bone resiliency around the primary teeth. This study explains an instance of damage sustained during play that resulted in an early knockout of the primary incisor. Hence, a biogenic tooth-integrated space maintainer was created using the natural crown of the traumatized tooth, and the child was asked to come for a regular follow-up. This treatment may be viewed as a great alternative for natural aesthetic rehabilitation as it promotes speech development, improves oral cleanliness, restores aesthetics and masticatory function, and inhibits the development of aberrant tongue habits and malocclusions.

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Forensic odontologists often must identify human remains with damaged teeth. This damage is due to high-impact accidents, violence, or disasters. This 2-part study aimed to create two 3D digital models. They should show the destructive effects of physical and chemical agents on human teeth and popular dental materials. Researchers created an e-survey to investigate how digital models are perceived as an educational tool for Forensic Odontology. Also, a systematic review assessed experimental studies on the effects of high temperature on various prosthodontic materials. According to the results of the survey, most participants (n=69; 79%) agreed that they would find a 3D model useful for training. Participants misidentify images of burned and broken teeth under Ellis and Davey system (1970). The systematic review identified dental implant and dental crown as the most studied prosthodontic materials exposed to heat. The researchers designed dental damage model 1 to represent restored and unrestored burnt teeth, postmortem pink teeth, and traumatic injuries. The dental damage model 2 was created to demonstrate the effects of various types of damage to different prosthetic and restorative dental materials, as well as the impact of acid, water, and burial on restorative materials as additional information. Both models were edited, sculpted and painted using 3D modelling software ZBrush (2020. 1.4) and Blender (version 3.6.2). The dental damage models were uploaded and labelled on Sketchfab (Cédric Pinson, Paris, France). The study's materials could transform the teaching of complex tooth changes.

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OBJECTIVE: To investigate the associations between family structure and social vulnerability with TDIs in children and adolescents. METHODS: An electronic search was conducted in seven databases (PubMed, Scopus, LILACS, Embase, Web of Science, ProQuest, and Google Scholar) to retrieve observational studies that evaluated the prevalence of TDIs. The risk of bias was assessed using the JBI Critical Appraisal Tools. Meta-analyses were also conducted using odds ratios (ORs) and 95% confidence intervals (CIs). The certainty of evidence was evaluated using the GRADE approach. RESULTS: Out of 7,424 records, seventeen articles were included (n = 18,806 children and adolescents aged between 0 and 19 years). Only two studies had a low risk of bias. Children and adolescents from nonnuclear families were more likely to suffer from TDIs (OR: 1.39; 95% CI: 1.17; 1.66). On the other hand, the level of social vulnerability did not show a positive association with TDIs (OR - 1.21; 95% CI: 1.00; 1.47). The GRADE approach assessed the certainty of evidence as low. CONCLUSION: Despite the uncertainty of the evidence, children and adolescents from nonnuclear families are more likely to have TDIs than are those from nuclear families. On the other hand, social vulnerability does not seem to be associated with episodes of TDIs in children and adolescents. CLINICAL RELEVANCE: Through knowledge of the risk factors for TDIs, it is possible to develop public policies for their prevention.

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BACKGROUND: The aim of this study was to calculate the stress distribution of fiberglass post associated with resin composite crown restoration and fiberglass posts with zirconia restorations in mature and immature endodontically treated central maxillary incisor under various loading conditions. MATERIALS AND METHODS: The study created six different study models in a virtual environment: healthy mature maxillary central teeth, intact immature maxillary central teeth, mature maxillary central teeth with fiberglass post associated with resin composite crown restoration, immature maxillary central teeth with fiberglass post associated with resin composite crown restoration, mature maxillary central teeth with fiberglass posts and zirconia restoration, and immature maxillary central teeth with fiberglass posts and zirconia restoration. Loading conditions simulating mastication, trauma, and bruxism were applied to each of the models at different angles and amounts. The von Mises and the maximum and minimum principal stress values in tooth structures (dentin) and support structures (bone, PDL) and materials were observed using finite element stress analysis. RESULTS: The highest stress values in the tissue and the restoration structure were observed for masticating force and crowns rehabilitated with zirconia restorations. None of the compared loading conditions and restorations showed destructive stress values on periodontal ligament or bone. CONCLUSION: The mature and immature endodontically treated central maxillary incisors can be better rehabilitated using fiberglass post associated with resin composite crown restoration and may be preferred to zirconia restorations in order to reduce the stresses on the surrounding tissues and teeth. However, further clinical studies are needed to fully explore this topic.

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BACKGROUND: Traumatic dental injury (TDI) is a growing public health concern worldwide, and children and adolescents are commonly affected. Because TDI often occurs at school, the response of teachers to these injuries is crucial. However, teachers in various countries have been shown to lack knowledge of effective TDI first-aid response and need an intervention to improve their knowledge. The aim of the study presented here was to ascertain and analyze teachers' knowledge of and attitude about TDI in Mongolia. MATERIALS AND METHODS: A cross-sectional study of full-time teachers in Mongolia was performed using an online questionnaire (compiled from relevant studies) from September 2022 to December 2022. The questionnaire consists of 47 items and among them 14 were used to assess the teacher's knowledge, and 5 were for attitude towards TDI. The maximum possible score was 14 points and grouped as follows good, moderate, and poor. T-test, ANOVA test (post-hoc) and linear regression analysis were performed. RESULTS: The online survey provided quantitative data from 2821 participants: 28% were elementary school teachers, 29% middle school teachers, and 42% high school teachers. Their mean age was 36.7 ± 9 years, and 2433 (86%) were female. The mean score of the TDI knowledge of the teachers was 5.3 ± 2.1 out of 14. The ANOVA test showed that older (p < 0.01) and more experienced teachers (p < 0.01) had higher scores. Teachers in the eastern (5.46 ± 2.2) and southern (5.49 ± 2.2) provinces had higher mean scores than in the other provinces (p < 0.02). Teachers majored in natural sciences (5.4 ± 2.2) had a higher score than those in the social sciences (5.2 ± 2.1) and difference were significant (p < 0.02). The multiple regression model statistically significantly predicted a one-year increase in experience, the TDI score increased 0.034 (95% CI 0.026, 0.043) unit. CONCLUSIONS: The knowledge regarding TDI and effective first-aid response to such injury is low in teachers in Mongolia. However, the teachers' attitude about TDI was positive and they wanted to learn and improve their knowledge. Therefore, further education and training programs are advised.

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Transverse root fracture (TRF) is classified as a cervical, middle or apical third root fracture on a periapical radiograph. The International Association of Dental Traumatology (IADT) suggests that cone-beam computed tomography (CBCT) should be considered, when conventional radiographs provide 'insufficient' information for diagnosis and treatment planning. Considering that CBCT can divulge additional information, it would be beneficial to have a clinically pertinent three-dimensional classification for TRF. The proposed alphanumeric classification includes the traumatised tooth number, describes the number of TRF, the facial and lingual location of each fracture line on the anatomic root, and its position relative to the crest of the alveolar bone. Further, diastasis, displacement of the coronal fragment and status of the alveolar bone at the site of TRF are also documented. This comprehensive classification system would provide a standard format for reporting, aid in referral communication and can be applied for future outcome studies on TRF.

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Introduction: Dental trauma is known as main concern for public health and is a prevalent issue among children as it leads to functional, aesthetic, and psychological complications. This study aimed to evaluate the awareness and knowledge of primary school teachers regarding emergency first aid management for tooth avulsion at Agadir. Methods: The study was conducted in 46 randomly selected primary schools in Agadir and included all teachers from these schools. Data collection was carried out through a self-administered questionnaire focusing on teachers' socio-demographic characteristics, understanding of the importance of emergency management and familiarity with emergency procedures. Data analysis was performed using Jamovi Version 2.3.21.0. Results: A total of 202 teachers participated in the study, 61% being female and 39% male. It has been found that 59.4% of the teachers had encountered an avulsed tooth accident at school. Of these, 23.9% indicated they would immediately replant the avulsed tooth, while 76.7% would contact the child's parents. Regarding storage, 6.8% would preserve the avulsed tooth in milk, while 30.1% preferred using paper. No significant differences were found in term of seniority and age groups (p>0.05). Discussion: An educational programs is needed to enhance the management and prognosis of permanent tooth avulsion among children in Morocco.

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This study examines decoronation as a treatment option for teeth with progressive external cervical root resorption (ECR). Six young patients aged 9.5-13, with a total of nine incisor teeth affected by ECR due to previous dental trauma, were treated by decoronation. Six teeth were classified as class 4 and two as class 3, according to Heithersay's classification. Another tooth with class 2 resorption also had a perforation. After decoronation, all cases showed favorable outcomes during a follow-up period of 2.5-8 years. The procedure halted the progression of ECR and promoted vertical and horizontal ridge development above the submerged root. Decoronation can be considered for the successful treatment of advanced cases of ECR in young patients.

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AIM: To explore self-reported dentofacial trauma and their potential endodontic sequelae in boxers using a questionnaire, followed by clinical and radiographic assessment to (1) compare the nature and number of self-reported dentofacial injuries with physical evidence of injury sequelae; and (2) investigate potential risk factors influencing dentofacial trauma and their endodontic sequelae. METHODOLOGY: A focus group validated questionnaire was completed by 176 boxers recruited from 16 London boxing clubs; 61 boxers from this cohort then attended a London dental hospital, for a clinical and radiographic assessment. Data from the questionnaire and clinical assessments were then collated and analysed using Chi-squared or t-tests. RESULTS: Questionnaire data revealed 87.5% of boxers reported a history of dentofacial trauma during boxing activity. The clinical and radiographic assessment detected evidence of dentofacial trauma in 91.8% of boxers and dental injury or endodontic-related injury sequelae in 68.9% of boxers. There was a significant association between dentofacial trauma and boxers who did not participate in weekly neck weight sessions (p < .001), and there was a significant association between trauma-related endodontic sequelae and: boxer age (p = .01); competitions per month (p = .002); and defensive skill (p = .007). CONCLUSIONS: A majority of the cohort had suffered dentofacial injuries and endodontic sequelae. The questionnaire data under-reported musculoskeletal injuries and endodontic sequelae, suggesting that some hard-tissue injuries following repetitive dentofacial trauma may have a subclinical presentation. Injury risk may be related to increased boxer age, defensive skills, frequency of participation in competitions, and frequency of neck weight sessions per week.

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INTRODUCTION: This multicentered cohort study evaluated the radiographic outcomes of regenerative endodontic procedures (REPs) and apexification treatments (APEX) of immature teeth with endodontic disease. MATERIALS AND METHODS: This cohort study included a retrospective record review and prospective data collection of pediatric patients with teeth treated with REPs or APEX between 2005 and 2014. Data including the presence of a periapical lesion, external root resorption, obliteration, apical hard tissue, apical closure, intracanal calcifications, and radiographic root area (RRA) change based on measurements were collected/measured from radiographic images. Univariate and multivariate analyses were conducted. RESULTS: The cohort included 190 subjects (204 teeth (92 REPs; 112 APEX)). The frequency of pretreatment periapical pathology was similar between cases in which the clinical treatment failed versus successful treatment cases. However, the frequency of pretreatment external root resorption was higher in failed cases than in successful cases (P = .007). The mean RRA change was greater than twenty percent in 21% of the REPs cases. In traumatized teeth, REPs resulted in less hard tissue formation than other endodontic disease etiologies measured by RRA (P = .001). Fifty-three percent of cases with ERR (16/30) showed signs of healing/arrest and were mostly treated with REPs (11/16). CONCLUSIONS: The presence of ERR negatively affected the treatment outcome. There was significant variability in RRA change in REPs. Signs of healing/arrest of the resorptive lesion were radiographically visible in many cases treated with REPs.

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Background: A number of challenges are being faced by children in orphanages, a major one being their oral health as a common unmet need. Studies have shown high prevalence of dental caries and oro-facial trauma. This has been attributed to overcrowding, lack of adequate staff, poor oral hygiene, improper dietary habits, inadequacies in the orphanage system, as well as inadequacies in the healthcare system.This study aimed at assessing the prevalence and factors affecting dental caries and trauma among children in orphanages in Ibadan. Materials and Method: All the children within the age group (7 - 15 years) in all the 18 registered orphanages in the 5 Local Government Areas within Ibadan metropolis were recruited into the study. Intra-oral examination was done under natural light and caries detection was done using tactile and visual method. Sterile mouth mirrors and CPI probes were used for this purpose. Dental caries status and the predisposing factors in each child were assessed. Presence of dental trauma and the predisposing factors were also assessed. Data processing was carried out with the aid of SPSS version 21. Results: One hundred and forty-six children participated in the study, 51.4% of them were males while 48.6% were females. The age range and the mean age of the children were 7 - 15 years 9. 69 ± 3.78 respectively. The prevalence of dental caries among the children was 17.8% while that of dental trauma was 7.5%. The mean DMFT/dmft was found to be 0.42 ± 1.06. Gender and the presence of deep pits and fissures were the statistically significant predictors of dental caries. Conclusion: Oral health is of utmost importance across all ages, much more pertinent among institutionalized children who are prone to dental caries and trauma as revealed by this study. An average child in an orphanage may be affected by both dental caries and trauma, but appears to be more prone to dental caries in this environment.

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Background: Oral health conditions, such as dental caries, periodontal disease, tooth loss, dental fluorosis, dental trauma, and oral cancer, are prevalent in the WHO Eastern Mediterranean Region. However, there has been no systematic review of oral health promotion interventions in the region. Aims: To review existing literature on oral health promotion programmes in the Eastern Mediterranean Region and recommend improvements for the future. Method: We reviewed on PubMed and Google Scholar 61 articles published in the Eastern Mediterranean Region between 2010 and 2023. Quality assessment of included studies was performed using established criteria. We used the content analysis approach to create appropriate themes from the studies and to document meaningful conclusions about oral health promotion. Results: Majority of the studies were cross-sectional, a few were randomized controlled, quasi-experimental, longitudinal studies, or reviews. Oral health problems identified included poor oral health knowledge, dental caries, periodontal disease, tooth loss, dental fluorosis, and oral cancer. Although oral disorders were common in most of the countries, very few have implemented oral health promotion programmes. Conclusion: We recommend prioritization of oral health promotion programmes in the Eastern Mediterranean Region to tackle the diverse oral health challenges. To be effective, such programmes should be region- and context-specific. More studies on oral health promotion are needed in the region.

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