What's Next in Dental Trauma? Innovations, Preventive Strategies, and Future Treatment Paths

IF 2.3 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE
Ana Beatriz Cantao, Liran Levin
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In this issue, Avgerinos et al. emphasized the need for mouthguards made from FDA-approved materials and offered a position statement for the proper selection, construction, clinical use, and maintenance of mouthguards [<span>3</span>]. These guidelines highlight the importance of educating both dental professionals and athletes about the benefits of mouthguards in reducing the prevalence of TDIs in sports. The lack of a standardized approach to mouthguard fabrication underscores the need for global consistency to ensure that all athletes receive optimal protection against dental injuries.</p><p>Dental trauma is a prevalent concern in the field of dentistry, affecting individuals across various age groups, with the anterior teeth being the most commonly injured [<span>4, 5</span>]. The most frequent types of dental trauma include crown fractures, avulsions, and luxations, with varying degrees of severity in pulp and surrounding periodontal tissues [<span>6, 7</span>]. Effective treatment of these injuries is essential to restore both function and aesthetics [<span>7, 8</span>]. Among the available treatment options, dental fragment reattachment has emerged as an ideal solution for rehabilitating fractured teeth. This technique involves reattaching the fractured dental fragment using adhesive materials, offering both aesthetic and functional benefits while maintaining the integrity of the original tooth structure [<span>9</span>]. In this issue, Mulinari et al. conducted a bibliometric and altimetric analysis to explore the evolution of publications on this topic [<span>10</span>]. This analysis provides insights into the scientific trends surrounding dental fragment reattachment, highlighting the growing body of research and its implications for clinical practice.</p><p>Traumatic dental injuries to the permanent dentition are a significant health problem with potential life-long consequences [<span>11</span>]. One common and serious complication following dental trauma in children and adolescents is pulp necrosis in immature permanent teeth [<span>12, 13</span>]. The treatment of these injuries can be particularly challenging due to the unique anatomical and physiological characteristics of immature teeth, such as open apex, unfavorable crown-to-root ratio, thin dentinal walls, and a higher risk of root fractures. These factors complicate treatment options and necessitate a careful approach [<span>14, 15</span>]. Although various interventions are available for managing pulp necrosis in immature teeth, including apexification with calcium hydroxide, apexification with calcium silicate-based materials (MTA), and regenerative endodontic treatment (RET) [<span>6, 14, 16, 17</span>], the growing number of publications on these topics has made it difficult to form definitive conclusions. Discrepancies and variations in the reported outcomes of these treatments underscore the need for further comparative evaluation of the existing evidence. In this issue, Tewari et al. conducted an umbrella review to analyze the available scientific evidence on the effectiveness of these three techniques [<span>18</span>]. This evaluation compared the three approaches and assessed the quality of the published evidence, providing insights into the most effective treatment options for pulp necrosis in immature permanent teeth.</p><p>Several factors and mechanisms contribute to traumatic dental injuries, including falls, sports injuries, and road traffic accidents [<span>19, 20</span>]. The existing literature extensively documents these common causes of dental trauma. However, additional underlying factors, such as the proclination of anterior teeth, inadequate lip coverage, neuromotor disorders, and impaired postural balance, can also increase the risk of injury [<span>21-23</span>]. Although there is ample literature, there is a noticeable gap in research regarding the role of sensorineural systems, particularly hearing loss and vestibular dysfunction, in the occurrence of TDIs. In this issue, Rajeswary et al. conducted a comparative study examining the prevalence and patterns of TDIs among children and adolescents with severe-to-profound hearing impairments versus those without hearing impairments [<span>24</span>]. This study emphasized the importance of addressing the unique needs of children with hearing loss to reduce the risk of traumatic dental injuries.</p><p>Oral and maxillofacial injuries (OMFIs) are among the most frequently affected body regions in cases of urban violence, making them a significant concern for trauma management in high-risk areas [<span>25, 26</span>]. While both men and women face similar risk factors associated with OMFIs in violent urban environments, behavioral, social, and even cultural factors can significantly influence the prevalence, nature, and outcomes of these injuries between the sexes [<span>25, 26</span>]. As a consequence, the etiology, frequency, severity, and anatomic distribution of OMFIs may exhibit differences depending on sex. In this issue, Fernandes et al. assessed the distinct characteristics of OMFIs in women and men admitted to a referral hospital in Brazil, with a specific focus on their correlation with urban violence [<span>27</span>]. By analyzing these injuries, the authors identified significant differences in the underlying causes of OMFIs between the sexes, highlighting the variations in trauma mechanisms. The study also emphasized noteworthy differences in the incidence of dentoalveolar injuries, as well as the frequency of multiple facial fractures.</p><p>Dental avulsion is a serious injury where a tooth is completely displaced from the alveolar socket and can lead to functional and psychological issues, especially when maxillary central incisors are involved [<span>28</span>]. Delayed replantation of avulsed teeth is a key issue as it leads to periodontal ligament (PDL) necrosis and worsens the prognosis, increasing the risk of resorption. This is influenced by factors like extra-alveolar storage time, storage medium, and root development stage [<span>6, 29</span>]. In this issue, Sheikholaemeh and Sengul evaluated the long-term PDL healing patterns and the factors influencing the survival of avulsed teeth [<span>30</span>]. By investigating these factors, the study seeks to better understand how root development stages impact the healing and survival of replanted teeth after an avulsion injury.</p><p>Facial trauma, often involving maxillofacial skeletal fractures, is a common issue in emergency departments, with about one-third of trauma cases including fractures in the maxillofacial region [<span>11, 31</span>]. These types of trauma can lead to significant functional, aesthetic, and psychological issues, placing a burden on individuals and society [<span>32, 33</span>]. Orbital fractures are frequently associated with complex midface fractures, and about 36.3% of maxillofacial trauma cases involve orbital fractures [<span>34</span>]. Ophthalmic injuries accompanying maxillofacial trauma can range from mild issues like subconjunctival hemorrhage to severe conditions such as corneal lacerations, globe rupture, and retinal detachment. These injuries, particularly those related to orbital fractures, can result in potentially blinding complications [<span>35</span>]. However, these injuries are often not immediately apparent and can be easily overlooked, leading to delayed or inadequate treatment. In this issue, Khan et al. assessed the patterns of ophthalmic injuries in maxillofacial trauma patients over a 12-year period at a Medical College in India [<span>36</span>]. By evaluating these injury patterns, the research aimed to provide valuable insights into regional trauma trends, which could help in formulating preventive strategies and improving treatment planning for ophthalmic injuries in maxillofacial trauma cases.</p><p>Iatrogenic factors like endotracheal intubation during general anesthesia might cause TDIs in some cases [<span>37-39</span>]. TDIs associated with general anesthesia are a major cause of malpractice claims against anesthesiologists. Despite being a frequent complication, there is a notable lack of education among anesthesiologists concerning dental anatomy, the risk of TDIs associated with endotracheal intubation, and effective management strategies. In this issue, Al- Shiekh assessed the awareness, knowledge, practices, and attitudes of anesthesiologists regarding TDIs associated with endotracheal intubation during general anesthesia [<span>40</span>]. This research aimed to identify gaps in knowledge and suggest measures to reduce the risk of peri-anesthetic traumatic dental injuries, ultimately improving patient care and minimizing complications during anesthesia procedures.</p><p>Tooth loss in the anterior maxilla of young individuals is commonly attributed to TDI or congenital agenesis [<span>32, 41, 42</span>]. This loss can present both functional and aesthetic challenges, complicating the process of tooth replacement [<span>20</span>]. When it comes to addressing these challenges, several treatment options are available, including implant-supported restorations, conventional fixed dental prostheses, resin-bonded bridges, and autotransplantation [<span>43, 44</span>]. While implant-supported restorations offer excellent aesthetic results, they come with limitations, particularly for growing patients. Among the treatment alternatives, autotransplantation of premolars to the anterior maxilla is often overlooked despite showing high survival rates [<span>45</span>]. However, the existing studies on the long-term survival of autotransplanted teeth are limited, and few have addressed the prognostic factors influencing the success of this treatment. Additionally, the aesthetic outcomes and patient-reported outcomes are less studied compared to treatments involving implant-supported restorations, leaving gaps in understanding the full potential of autotransplantation [<span>46</span>]. In this issue, Akhlef et al. reported the long-term survival rate, success rate, aesthetic outcomes, and patient-reported outcomes of premolar autotransplantation to the anterior maxilla in 122 patients [<span>47</span>]. This study evaluated the prognostic factors that could influence both the survival and aesthetic success of the treatment, providing valuable insights for clinicians and patients considering autotransplantation as a viable alternative for tooth replacement.</p><p>Dental injuries often occur during childhood, especially when learning to walk, with many incidents taking place at home [<span>32, 48, 49</span>]. While the emergency management of TDIs is critical, public awareness remains insufficient [<span>8, 50-52</span>], prompting many individuals to seek guidance from online platforms. As technology advances, Artificial Intelligence (AI) tools like chatbots have become more popular for accessing health information, especially in emergencies [<span>53, 54</span>]. However, concerns remain about the accuracy and reliability of these tools. For conditions like TDIs, timely and accurate advice is crucial, as misinformation can lead to serious consequences. Despite this, many people turn to online platforms for guidance due to insufficient public awareness of TDI emergency management. In this issue, Guven et al. evaluated the performance of AI chatbots, comparing the readability and reliability of responses to patient queries about TDIs [<span>55</span>]. The evaluation highlighted the strengths and limitations of AI tools like ChatGPT, helping healthcare professionals and patients navigate dental emergencies more effectively.</p><p>Vertical root fractures (VRFs) are often caused by excessive occlusal forces in restored teeth, particularly in mandibular molars and premolars, as well as the insertion of retention pins or screws. Early detection of VRFs is vital to prevent damage to surrounding tissues [<span>56, 57</span>]. However, VRFs' diagnoses are challenging because they often present subtle or no symptoms [<span>58</span>]. In clinical practice, intraoral periapical radiographs are the standard imaging technique, but they have limitations in detecting VRFs due to the two-dimensional nature of the images. To address these challenges, AI-based image enhancement techniques are being explored to improve diagnostic accuracy. While Cone-Beam Computed Tomography (CBCT) offers three-dimensional imaging, it is prone to metallic artifacts and is not considered the primary diagnostic tool for VRFs due to its limitations [<span>58-60</span>]. Therefore, there is a significant need for an improved and reliable method to diagnose VRFs without unnecessary radiation exposure. In this issue, Ozsari et al. evaluated the use of AI-based transfer learning techniques to enhance VRF detection from intraoral periapical radiographs [<span>61</span>]. Deep learning models such as DenseNet, ConvNext, Inception, MobileNetV2, and fusion approaches were applied. These AI-based models aim to address the limitations of traditional radiography and provide a cost-effective solution for better VRF detection in clinical practice.</p><p>Facial injuries, particularly to the teeth, are common in sports-related accidents. These injuries are particularly prevalent in contact sports, which present a much higher risk than non-contact sports [<span>2, 62</span>]. TDIs can result in serious, long-term damage to teeth and surrounding structures, significantly impacting an athlete's health and performance. Despite the well-known effectiveness of mouthguards in preventing such injuries, a large number of athletes still fail to wear them consistently, and many of those who do use them experience discomfort or inadequate protection due to poor fit or substandard quality [<span>63, 64</span>]. It is well known that sports mouthguards should be designed and custom-fabricated to guarantee an ideal fit and maximum comfort for the athletes. The stock and boil-and-bite mouthguards are commonly available in sports stores; however, they often provide poor adaptation to the unique shape of the mouth and fail to offer sufficient retention, compromising their effectiveness and comfort [<span>65</span>]. This highlights the need for improved sports mouthguards that offer both robust protection and comfort. In this issue, Mizuhashi et al. proposed a design criterion for fabricating sports laminate mouthguards with sufficient thickness to protect orofacial structures [<span>66</span>]. The study emphasized the importance of maintaining appropriate measurements on the labial, buccal, and occlusal surfaces to ensure optimal protection.</p>","PeriodicalId":55180,"journal":{"name":"Dental Traumatology","volume":"41 3","pages":"241-245"},"PeriodicalIF":2.3000,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/edt.13069","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Dental Traumatology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/edt.13069","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
引用次数: 0

Abstract

Sport-related traumatic dental injuries (TDIs) are prevalent, particularly in contact sports like football, hockey, and basketball, where athletes face a higher risk of injury [1, 2]. Custom-made sports mouthguards are widely recognized as one of the most effective preventive measures for preventing TDIs, offering superior protection compared to over-the-counter or boil-and-bite alternatives [1]. Despite their proven effectiveness, there is no globally standardized approach to the design, fabrication, or usage of mouthguards, leading to inconsistencies in their protection quality. In this issue, Avgerinos et al. emphasized the need for mouthguards made from FDA-approved materials and offered a position statement for the proper selection, construction, clinical use, and maintenance of mouthguards [3]. These guidelines highlight the importance of educating both dental professionals and athletes about the benefits of mouthguards in reducing the prevalence of TDIs in sports. The lack of a standardized approach to mouthguard fabrication underscores the need for global consistency to ensure that all athletes receive optimal protection against dental injuries.

Dental trauma is a prevalent concern in the field of dentistry, affecting individuals across various age groups, with the anterior teeth being the most commonly injured [4, 5]. The most frequent types of dental trauma include crown fractures, avulsions, and luxations, with varying degrees of severity in pulp and surrounding periodontal tissues [6, 7]. Effective treatment of these injuries is essential to restore both function and aesthetics [7, 8]. Among the available treatment options, dental fragment reattachment has emerged as an ideal solution for rehabilitating fractured teeth. This technique involves reattaching the fractured dental fragment using adhesive materials, offering both aesthetic and functional benefits while maintaining the integrity of the original tooth structure [9]. In this issue, Mulinari et al. conducted a bibliometric and altimetric analysis to explore the evolution of publications on this topic [10]. This analysis provides insights into the scientific trends surrounding dental fragment reattachment, highlighting the growing body of research and its implications for clinical practice.

Traumatic dental injuries to the permanent dentition are a significant health problem with potential life-long consequences [11]. One common and serious complication following dental trauma in children and adolescents is pulp necrosis in immature permanent teeth [12, 13]. The treatment of these injuries can be particularly challenging due to the unique anatomical and physiological characteristics of immature teeth, such as open apex, unfavorable crown-to-root ratio, thin dentinal walls, and a higher risk of root fractures. These factors complicate treatment options and necessitate a careful approach [14, 15]. Although various interventions are available for managing pulp necrosis in immature teeth, including apexification with calcium hydroxide, apexification with calcium silicate-based materials (MTA), and regenerative endodontic treatment (RET) [6, 14, 16, 17], the growing number of publications on these topics has made it difficult to form definitive conclusions. Discrepancies and variations in the reported outcomes of these treatments underscore the need for further comparative evaluation of the existing evidence. In this issue, Tewari et al. conducted an umbrella review to analyze the available scientific evidence on the effectiveness of these three techniques [18]. This evaluation compared the three approaches and assessed the quality of the published evidence, providing insights into the most effective treatment options for pulp necrosis in immature permanent teeth.

Several factors and mechanisms contribute to traumatic dental injuries, including falls, sports injuries, and road traffic accidents [19, 20]. The existing literature extensively documents these common causes of dental trauma. However, additional underlying factors, such as the proclination of anterior teeth, inadequate lip coverage, neuromotor disorders, and impaired postural balance, can also increase the risk of injury [21-23]. Although there is ample literature, there is a noticeable gap in research regarding the role of sensorineural systems, particularly hearing loss and vestibular dysfunction, in the occurrence of TDIs. In this issue, Rajeswary et al. conducted a comparative study examining the prevalence and patterns of TDIs among children and adolescents with severe-to-profound hearing impairments versus those without hearing impairments [24]. This study emphasized the importance of addressing the unique needs of children with hearing loss to reduce the risk of traumatic dental injuries.

Oral and maxillofacial injuries (OMFIs) are among the most frequently affected body regions in cases of urban violence, making them a significant concern for trauma management in high-risk areas [25, 26]. While both men and women face similar risk factors associated with OMFIs in violent urban environments, behavioral, social, and even cultural factors can significantly influence the prevalence, nature, and outcomes of these injuries between the sexes [25, 26]. As a consequence, the etiology, frequency, severity, and anatomic distribution of OMFIs may exhibit differences depending on sex. In this issue, Fernandes et al. assessed the distinct characteristics of OMFIs in women and men admitted to a referral hospital in Brazil, with a specific focus on their correlation with urban violence [27]. By analyzing these injuries, the authors identified significant differences in the underlying causes of OMFIs between the sexes, highlighting the variations in trauma mechanisms. The study also emphasized noteworthy differences in the incidence of dentoalveolar injuries, as well as the frequency of multiple facial fractures.

Dental avulsion is a serious injury where a tooth is completely displaced from the alveolar socket and can lead to functional and psychological issues, especially when maxillary central incisors are involved [28]. Delayed replantation of avulsed teeth is a key issue as it leads to periodontal ligament (PDL) necrosis and worsens the prognosis, increasing the risk of resorption. This is influenced by factors like extra-alveolar storage time, storage medium, and root development stage [6, 29]. In this issue, Sheikholaemeh and Sengul evaluated the long-term PDL healing patterns and the factors influencing the survival of avulsed teeth [30]. By investigating these factors, the study seeks to better understand how root development stages impact the healing and survival of replanted teeth after an avulsion injury.

Facial trauma, often involving maxillofacial skeletal fractures, is a common issue in emergency departments, with about one-third of trauma cases including fractures in the maxillofacial region [11, 31]. These types of trauma can lead to significant functional, aesthetic, and psychological issues, placing a burden on individuals and society [32, 33]. Orbital fractures are frequently associated with complex midface fractures, and about 36.3% of maxillofacial trauma cases involve orbital fractures [34]. Ophthalmic injuries accompanying maxillofacial trauma can range from mild issues like subconjunctival hemorrhage to severe conditions such as corneal lacerations, globe rupture, and retinal detachment. These injuries, particularly those related to orbital fractures, can result in potentially blinding complications [35]. However, these injuries are often not immediately apparent and can be easily overlooked, leading to delayed or inadequate treatment. In this issue, Khan et al. assessed the patterns of ophthalmic injuries in maxillofacial trauma patients over a 12-year period at a Medical College in India [36]. By evaluating these injury patterns, the research aimed to provide valuable insights into regional trauma trends, which could help in formulating preventive strategies and improving treatment planning for ophthalmic injuries in maxillofacial trauma cases.

Iatrogenic factors like endotracheal intubation during general anesthesia might cause TDIs in some cases [37-39]. TDIs associated with general anesthesia are a major cause of malpractice claims against anesthesiologists. Despite being a frequent complication, there is a notable lack of education among anesthesiologists concerning dental anatomy, the risk of TDIs associated with endotracheal intubation, and effective management strategies. In this issue, Al- Shiekh assessed the awareness, knowledge, practices, and attitudes of anesthesiologists regarding TDIs associated with endotracheal intubation during general anesthesia [40]. This research aimed to identify gaps in knowledge and suggest measures to reduce the risk of peri-anesthetic traumatic dental injuries, ultimately improving patient care and minimizing complications during anesthesia procedures.

Tooth loss in the anterior maxilla of young individuals is commonly attributed to TDI or congenital agenesis [32, 41, 42]. This loss can present both functional and aesthetic challenges, complicating the process of tooth replacement [20]. When it comes to addressing these challenges, several treatment options are available, including implant-supported restorations, conventional fixed dental prostheses, resin-bonded bridges, and autotransplantation [43, 44]. While implant-supported restorations offer excellent aesthetic results, they come with limitations, particularly for growing patients. Among the treatment alternatives, autotransplantation of premolars to the anterior maxilla is often overlooked despite showing high survival rates [45]. However, the existing studies on the long-term survival of autotransplanted teeth are limited, and few have addressed the prognostic factors influencing the success of this treatment. Additionally, the aesthetic outcomes and patient-reported outcomes are less studied compared to treatments involving implant-supported restorations, leaving gaps in understanding the full potential of autotransplantation [46]. In this issue, Akhlef et al. reported the long-term survival rate, success rate, aesthetic outcomes, and patient-reported outcomes of premolar autotransplantation to the anterior maxilla in 122 patients [47]. This study evaluated the prognostic factors that could influence both the survival and aesthetic success of the treatment, providing valuable insights for clinicians and patients considering autotransplantation as a viable alternative for tooth replacement.

Dental injuries often occur during childhood, especially when learning to walk, with many incidents taking place at home [32, 48, 49]. While the emergency management of TDIs is critical, public awareness remains insufficient [8, 50-52], prompting many individuals to seek guidance from online platforms. As technology advances, Artificial Intelligence (AI) tools like chatbots have become more popular for accessing health information, especially in emergencies [53, 54]. However, concerns remain about the accuracy and reliability of these tools. For conditions like TDIs, timely and accurate advice is crucial, as misinformation can lead to serious consequences. Despite this, many people turn to online platforms for guidance due to insufficient public awareness of TDI emergency management. In this issue, Guven et al. evaluated the performance of AI chatbots, comparing the readability and reliability of responses to patient queries about TDIs [55]. The evaluation highlighted the strengths and limitations of AI tools like ChatGPT, helping healthcare professionals and patients navigate dental emergencies more effectively.

Vertical root fractures (VRFs) are often caused by excessive occlusal forces in restored teeth, particularly in mandibular molars and premolars, as well as the insertion of retention pins or screws. Early detection of VRFs is vital to prevent damage to surrounding tissues [56, 57]. However, VRFs' diagnoses are challenging because they often present subtle or no symptoms [58]. In clinical practice, intraoral periapical radiographs are the standard imaging technique, but they have limitations in detecting VRFs due to the two-dimensional nature of the images. To address these challenges, AI-based image enhancement techniques are being explored to improve diagnostic accuracy. While Cone-Beam Computed Tomography (CBCT) offers three-dimensional imaging, it is prone to metallic artifacts and is not considered the primary diagnostic tool for VRFs due to its limitations [58-60]. Therefore, there is a significant need for an improved and reliable method to diagnose VRFs without unnecessary radiation exposure. In this issue, Ozsari et al. evaluated the use of AI-based transfer learning techniques to enhance VRF detection from intraoral periapical radiographs [61]. Deep learning models such as DenseNet, ConvNext, Inception, MobileNetV2, and fusion approaches were applied. These AI-based models aim to address the limitations of traditional radiography and provide a cost-effective solution for better VRF detection in clinical practice.

Facial injuries, particularly to the teeth, are common in sports-related accidents. These injuries are particularly prevalent in contact sports, which present a much higher risk than non-contact sports [2, 62]. TDIs can result in serious, long-term damage to teeth and surrounding structures, significantly impacting an athlete's health and performance. Despite the well-known effectiveness of mouthguards in preventing such injuries, a large number of athletes still fail to wear them consistently, and many of those who do use them experience discomfort or inadequate protection due to poor fit or substandard quality [63, 64]. It is well known that sports mouthguards should be designed and custom-fabricated to guarantee an ideal fit and maximum comfort for the athletes. The stock and boil-and-bite mouthguards are commonly available in sports stores; however, they often provide poor adaptation to the unique shape of the mouth and fail to offer sufficient retention, compromising their effectiveness and comfort [65]. This highlights the need for improved sports mouthguards that offer both robust protection and comfort. In this issue, Mizuhashi et al. proposed a design criterion for fabricating sports laminate mouthguards with sufficient thickness to protect orofacial structures [66]. The study emphasized the importance of maintaining appropriate measurements on the labial, buccal, and occlusal surfaces to ensure optimal protection.

Abstract Image

牙外伤的下一步是什么?创新,预防策略和未来的治疗途径
运动相关的创伤性牙齿损伤(TDIs)很普遍,特别是在足球、曲棍球和篮球等接触性运动中,运动员面临更高的受伤风险[1,2]。定制的运动护齿器被广泛认为是预防tdi最有效的预防措施之一,与非处方或煮沸后咬的替代品[1]相比,它提供了更好的保护。尽管它们已被证明有效,但没有全球标准化的方法来设计,制造或使用护齿器,导致其保护质量不一致。在这期杂志中,Avgerinos等人强调了使用经fda批准的材料制作护齿器的必要性,并对护齿器bbb的正确选择、构造、临床使用和维护提供了立场声明。这些指南强调了教育牙科专业人员和运动员关于护齿器在减少运动中tdi患病率方面的好处的重要性。缺乏一个标准化的方法来制作护齿强调需要全球一致性,以确保所有运动员获得最佳的保护,防止牙齿损伤。牙外伤是牙科领域普遍关注的问题,影响各个年龄组的个体,其中前牙是最常见的损伤[4,5]。牙外伤最常见的类型包括牙冠骨折、撕脱和脱位,在牙髓和周围牙周组织中有不同程度的严重程度[6,7]。有效治疗这些损伤对于恢复功能和美观至关重要[7,8]。在现有的治疗方案中,牙片再附着已成为修复断裂牙齿的理想解决方案。这项技术包括使用粘合材料重新连接断裂的牙齿碎片,在保持原始牙齿结构完整性的同时,提供美学和功能上的好处。在本期中,Mulinari等人进行了文献计量学和测高分析,探讨了关于该主题的出版物的演变[10]。这一分析提供了对周围牙齿碎片再附着的科学趋势的见解,突出了越来越多的研究及其对临床实践的影响。恒牙外伤是一个严重的健康问题,具有潜在的终身后果[10]。儿童和青少年牙外伤后常见且严重的并发症是未成熟恒牙的牙髓坏死[12,13]。由于未成熟牙齿独特的解剖和生理特征,如开放的尖牙、不利的冠根比、薄的牙本质壁和较高的根骨折风险,这些损伤的治疗尤其具有挑战性。这些因素使治疗方案复杂化,需要谨慎的方法[14,15]。尽管有多种干预措施可用于治疗未成熟牙髓坏死,包括氢氧化钙根尖化、硅酸钙基材料根尖化和再生牙髓治疗(RET)[6,14,16,17],但关于这些主题的出版物越来越多,很难形成明确的结论。这些治疗结果的差异和差异强调了对现有证据进行进一步比较评估的必要性。在本期中,Tewari等人进行了一项概括性综述,分析了这三种技术有效性的现有科学证据b[18]。本评估比较了三种方法并评估了已发表证据的质量,为未成熟恒牙髓坏死的最有效治疗方案提供了见解。一些因素和机制导致创伤性牙齿损伤,包括跌倒、运动损伤和道路交通事故[19,20]。现有文献广泛地记录了这些常见的牙外伤原因。然而,其他潜在因素,如前牙前倾、嘴唇覆盖不足、神经运动障碍和姿势平衡受损,也会增加损伤的风险[21-23]。虽然有大量的文献,但对于感觉神经系统,特别是听力损失和前庭功能障碍在TDIs发生中的作用的研究存在明显的空白。在这一期中,Rajeswary等人进行了一项比较研究,研究了重度至重度听力障碍儿童和青少年与无听力障碍儿童和青少年中tdi的患病率和模式[10]。这项研究强调了解决听力损失儿童独特需求的重要性,以减少创伤性牙齿损伤的风险。 在城市暴力事件中,口腔和颌面损伤(OMFIs)是最常受影响的身体区域之一,使其成为高风险地区创伤管理的重要关注点[25,26]。尽管在暴力的城市环境中,男性和女性都面临与omfi相关的相似风险因素,但行为、社会甚至文化因素可以显著影响性别间这些伤害的发生率、性质和结果[25,26]。因此,omfi的病因、频率、严重程度和解剖分布可能因性别而异。在本期中,Fernandes等人评估了巴西一家转诊医院收治的女性和男性的omfi的独特特征,并特别关注了它们与城市暴力的相关性[10]。通过分析这些损伤,作者确定了两性之间omfi的潜在原因的显著差异,强调了创伤机制的差异。该研究还强调了牙槽损伤发生率的显著差异,以及多发性面部骨折的频率。牙齿撕脱是一种严重的损伤,牙齿完全脱离牙槽窝,可导致功能和心理问题,特别是当上颌中门牙受损伤时。脱脱牙的延迟再植是一个关键问题,因为它会导致牙周韧带(PDL)坏死,恶化预后,增加吸收的风险。这受牙槽外储存时间、储存介质和根发育阶段等因素的影响[6,29]。在这期杂志中,Sheikholaemeh和Sengul评估了撕脱牙bbb的长期愈合模式和影响生存的因素。通过调查这些因素,本研究旨在更好地了解牙根发育阶段如何影响撕脱伤后再植牙齿的愈合和存活。面部创伤常涉及颌面骨骼骨折,是急诊科的常见问题,约三分之一的创伤病例包括颌面骨折[11,31]。这些类型的创伤会导致严重的功能、审美和心理问题,给个人和社会带来负担[32,33]。眶部骨折常合并复杂的中面部骨折,约36.3%的颌面部外伤病例合并眶部骨折。伴随颌面外伤的眼部损伤可以从轻微的结膜下出血到严重的角膜撕裂、眼球破裂和视网膜脱离。这些损伤,特别是与眶部骨折有关的损伤,可能导致潜在的致盲并发症。然而,这些损伤往往不会立即显现,很容易被忽视,导致延误或治疗不足。在这期杂志中,Khan等人评估了印度一所医学院12年来颌面外伤患者眼部损伤的模式[10]。通过对这些损伤模式的评估,旨在为了解区域外伤趋势提供有价值的见解,从而有助于制定预防策略和改进颌面部外伤患者眼外伤的治疗计划。在某些情况下,全麻气管插管等医源性因素可能导致TDIs[37-39]。与全身麻醉相关的tdi是针对麻醉医师的医疗事故索赔的主要原因。尽管tdi是一种常见的并发症,但麻醉医师在牙齿解剖、tdi与气管插管相关的风险以及有效的管理策略方面的教育明显缺乏。在这一期中,Al- sheikh评估了麻醉医师对全麻期间与气管插管相关的TDIs的认识、知识、实践和态度。本研究旨在确定知识的差距,并提出措施,以减少麻醉周围创伤性牙齿损伤的风险,最终改善患者护理,最大限度地减少麻醉过程中的并发症。年轻人上颌前牙缺失通常归因于TDI或先天性发育不全[32,41,42]。这种缺失会带来功能和美学上的挑战,使牙齿置换过程更加复杂。当涉及到解决这些挑战时,有几种治疗方案可供选择,包括种植体支持的修复体,传统的固定义齿,树脂结合桥和自体移植[43,44]。虽然种植体支持的修复体提供了出色的美学效果,但它们也有局限性,特别是对于生长中的患者。在治疗方案中,自体前磨牙移植到前上颌虽然有很高的存活率,但经常被忽视。 然而,现有的关于自体移植牙长期存活的研究有限,并且很少有研究涉及影响这种治疗成功的预后因素。此外,与涉及种植体支持修复的治疗相比,美学结果和患者报告的结果研究较少,在了解自身移植的全部潜力方面留下了空白。在这期杂志中,Akhlef等人报道了122例患者前臼齿自体移植到前上颌的长期存活率、成功率、美观结果和患者报告的结果[0]。本研究评估了可能影响治疗生存和美学成功的预后因素,为临床医生和考虑将自体移植作为替代牙齿的可行选择的患者提供了有价值的见解。牙齿损伤通常发生在儿童时期,特别是在学习走路时,许多事故发生在家里[32,48,49]。虽然tdi的应急管理至关重要,但公众意识仍然不足[8,50 -52],促使许多人从网络平台寻求指导。随着技术的进步,聊天机器人等人工智能(AI)工具在获取卫生信息方面越来越受欢迎,特别是在紧急情况下[53,54]。然而,人们仍然担心这些工具的准确性和可靠性。对于像tdi这样的情况,及时和准确的建议至关重要,因为错误信息可能导致严重后果。尽管如此,由于公众对TDI应急管理的认识不足,许多人转向网络平台寻求指导。在这一期中,Guven等人评估了AI聊天机器人的性能,比较了患者对TDIs[55]查询的响应的可读性和可靠性。评估强调了ChatGPT等人工智能工具的优势和局限性,帮助医疗保健专业人员和患者更有效地应对牙科紧急情况。垂直牙根骨折(VRFs)通常是由于修复牙齿,特别是下颌磨牙和前磨牙的咬合力过大,以及插入固位针或螺钉引起的。早期发现vrf对于防止周围组织损伤至关重要[56,57]。然而,vrf的诊断是具有挑战性的,因为他们经常表现出轻微或没有症状。在临床实践中,口腔内根尖周x线片是标准的成像技术,但由于图像的二维性质,它们在检测vrf方面存在局限性。为了应对这些挑战,人们正在探索基于人工智能的图像增强技术,以提高诊断的准确性。虽然锥形束计算机断层扫描(CBCT)提供三维成像,但它容易出现金属伪影,由于其局限性,不被认为是vrf的主要诊断工具[58-60]。因此,迫切需要一种改进的、可靠的方法来诊断vrf,而不需要不必要的辐射暴露。在这一期中,Ozsari等人评估了使用基于人工智能的迁移学习技术来增强口腔内根尖周x线片的VRF检测[61]。深度学习模型如DenseNet、ConvNext、Inception、MobileNetV2和融合方法被应用。这些基于人工智能的模型旨在解决传统放射摄影的局限性,并为临床实践中更好地检测VRF提供经济有效的解决方案。面部损伤,尤其是牙齿损伤,在运动相关事故中很常见。这些损伤在接触性运动中尤为普遍,其风险比非接触性运动高得多[2,62]。TDIs会对牙齿和周围结构造成严重的长期损害,严重影响运动员的健康和表现。尽管护齿器在预防此类伤害方面的有效性众所周知,但仍有大量运动员未能持续佩戴,许多使用了护齿器的运动员由于不适合或质量不合格而感到不适或保护不足[63,64]。众所周知,运动护齿应该设计和定制,以保证一个理想的适合和最大的舒适度的运动员。在体育用品商店里,通常可以买到高汤和煮一口的护齿器;然而,它们往往不能很好地适应口腔的独特形状,不能提供足够的固位,从而影响了它们的有效性和舒适性[65]。这突出了需要改进的运动护齿器,提供强大的保护和舒适。在本期中,Mizuhashi等人提出了一种制造具有足够厚度以保护口腔面部结构的运动层叠护齿的设计准则[66]。该研究强调了在唇、颊和咬合表面保持适当测量以确保最佳保护的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Dental Traumatology
Dental Traumatology 医学-牙科与口腔外科
CiteScore
6.40
自引率
32.00%
发文量
85
审稿时长
6-12 weeks
期刊介绍: Dental Traumatology is an international journal that aims to convey scientific and clinical progress in all areas related to adult and pediatric dental traumatology. This includes the following topics: - Epidemiology, Social Aspects, Education, Diagnostics - Esthetics / Prosthetics/ Restorative - Evidence Based Traumatology & Study Design - Oral & Maxillofacial Surgery/Transplant/Implant - Pediatrics and Orthodontics - Prevention and Sports Dentistry - Endodontics and Periodontal Aspects The journal"s aim is to promote communication among clinicians, educators, researchers, and others interested in the field of dental traumatology.
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