Implementation of Public Health Policies and Integration of Artificial Intelligence and Social Media in Dental Traumatology—Cornerstones for Effective Dental Trauma Management

Traumatic dental injuries (TDI) are a significant public health issue affecting the teeth and surrounding oral structures, often resulting from accidents that require immediate attention. Classified as the second most prevalent oral condition and the fifth most common disease or injury globally, TDI particularly impacts younger populations [1]. The widespread incidence of these injuries across both primary and permanent dentitions underscores the need for effective prevention and management strategies in dental care [1, 2]. Concerns have been raised about the availability, organization, and management of emergency services for addressing TDIs [3]. In this issue, Brandini, Carvalho de Souza Cantão, and Levin [4] aimed to emphasize the importance of creating comprehensive public health policies in dental traumatology, recognizing the strategic relevance of this approach. Public health policies in dental traumatology will play a vital role in reducing the incidence and impact of dental injuries through initiatives that promote preventive measures, standardize treatment protocols, and increase public awareness about the importance of immediate care and protective practices.

Regenerative endodontics represents a pioneering approach in the management of traumatized teeth, focusing on the revitalization of the dental pulp and the stimulation of root development in teeth with incomplete root formation [5]. This technique aims to restore vitality and function by employing methods such as pulp revascularization and the use of biomaterials to encourage natural tissue regeneration, offering a promising alternative to traditional root canal treatments and enhancing the long-term prognosis of affected teeth [5-8]. In this issue, Khaler, Lu, and Taha [9] reviewed the evidence available for regenerative endodontic treatment in traumatized immature teeth with apical periodontitis in terms of outcome, potential prognostic factors, and comparisons with other treatment modalities, including apexification and apical plugs. Regenerative endodontic procedures represent a promising advancement in dental treatment for immature permanent teeth affected by trauma and pulp necrosis, as the integration of innovative techniques, including various scaffolds and biomaterials, has shown potential to enhance healing and promote pulp regeneration. Ultimately, the continued exploration and refinement of regenerative endodontics may lead to improved patient outcomes and a paradigm shift in the management of dental pulp injuries.

Autotransplantation, a surgical procedure involving the transfer of a tooth from one location in the mouth to another, offers a viable alternative to dental implants for replacing missing or severely damaged teeth, providing a method to restore both function and aesthetics [10, 11]. Recent research has highlighted significant surgical advances in autotransplantation, demonstrating improved techniques and outcomes that enhance the viability and success rates of this procedure [12-15]. In this issue, Ainiwaer et al. [16] explored the efficacy of the application of artificial bone powders and concentrated growth factor membranes to mature tooth transplantation in cases with wider recipient sockets along with smaller donor teeth. A total of 36 cases who underwent autotransplantation over a 5-year period were enrolled in this study. Overall, 33 of the 36 transplanted teeth remained without clinical or radiographic complications, with an overall success rate of 91.7%.

Computer-aided autotransplantation utilizes advanced imaging technologies and computer-assisted planning to possibly enhance the precision and success of tooth transplantation procedures. This approach could enable accurate assessment of the donor and recipient sites and facilitate optimal alignment of the transplanted tooth, which may improve clinical outcomes and reduce the risk of complications [12]. In this issue, Zhang, Han, and Zhong [17] evaluated the precision and efficacy of utilizing computer-aided design in combination with three-dimensional printing technology for tooth transplantation. This study analyzed 50 transplanted teeth from 48 patients who underwent tooth transplantation surgery using computer-aided design and positional guides, establishing a consistent coordinate system through preoperative and postoperative CBCT images to calculate linear displacements and angular deviations by identifying key regions in both virtual designs and actual transplanted teeth, while also exploring potential factors influencing these deviations. The advancements in surgical techniques for autotransplantation underscore the potential for improved clinical outcomes, not only enhancing the success rates of tooth transplantations but also expanding treatment options for patients facing dental trauma or tooth loss. Continued research in this field is essential to further refine these methods and optimize patient care.

Tooth apexification is an endodontic procedure aimed at inducing root development and formation of a calcified barrier in immature teeth with non-vital pulps, thereby facilitating their successful long-term preservation and function [18]. Still, apexification mostly results in insufficient dentin wall thickness and preternatural apical closure type but not root length [19]. In this issue, Wikström et al. [20] evaluated the long-term survival of immature traumatized incisors with pulp necrosis and apical periodontitis after endodontic treatment with two apexification techniques, (calcium hydroxide apexification and MTA-apical plug) to identify major factors affecting the survival of these teeth. Records of 2400 children and adolescents were screened for traumatic dental injuries to immature incisors treated with two apexification techniques, and were compared to a control group of mature teeth treated with conventional endodontic techniques. Longitudinal studies are vital for understanding the long-term effects and outcomes of treatments, as they provide comprehensive data that can inform clinical practices and enhance patient care over time.

Fragment reattachment following dental trauma is a pivotal restorative intervention designed to rehabilitate both the functional and aesthetic aspects of the affected tooth, particularly in instances of coronal fractures. Numerous studies have explored various methods for restoring teeth affected by enamel and dentin fractures, highlighting the importance of effective treatment strategies in dental trauma management [21-25]. Dentists should possess a comprehensive understanding of restoration protocols for crown fractures, as this expertise facilitates effective and timely interventions, thereby enhancing patient outcomes. In this issue, Pinheiro et al. [26] evaluated the knowledge and previous experience of dentists about the reattachment fragment technique in enamel and dentin fractures. An electronic form was designed to incorporate both objective and self-report questions specifically tailored for dentists. By employing evidence-based approaches, dentists can ensure optimal functional and aesthetic results. This expertise not only enhances patient care but also contributes to improved long-term dental health outcomes, underscoring the importance of continued education and adherence to established guidelines in the field of dental trauma management.

Maxillofacial trauma in the pediatric population presents unique challenges and considerations due to ongoing developmental changes in children and adolescents and can arise from a variety of causes, including road traffic accidents, falls, violence, and sports-related injuries [27-31]. Despite the critical importance of this area, research focusing on surgical treatments and standardized protocols for managing pediatric maxillofacial trauma remains limited, underscoring the need for comprehensive studies that address the current gaps in knowledge and contribute to establishing evidence-based guidelines for improving care in this vulnerable population. In this issue, Roccia et al. [32] analyzed choices and outcomes of open reduction and internal fixation for pediatric maxilla-zygomatic complex fractures among 14 maxillofacial centers around the world. Over a 10-year period, data were gathered from 14 centers on patients aged 16 years or younger who underwent surgery under general anesthesia for maxillofacial fractures. Multicenter studies are crucial for advancing our understanding of pediatric maxillofacial trauma, as they provide a broader, more representative dataset that can lead to more robust and generalizable findings, ultimately informing standardized treatment protocols and improving patient outcomes across diverse clinical settings.

It is well established that endodontically treated teeth are more fragile due to reduced dentinal elasticity and moisture loss, increasing their susceptibility to fractures and necessitating durable restorations for long-term stability. Proper restoration techniques and the use of advanced materials are essential to enhance the resilience of endodontically treated traumatized teeth and to ensure optimal functional and aesthetic outcomes [33, 34]. In this issue, Sultanoğlu et al. [35] calculated the stress distribution of fiberglass posts associated with resin composite crown restoration and fiberglass posts with zirconia restorations in mature and immature endodontically treated central maxillary incisors under various loading conditions. The loading conditions simulating mastication, trauma, and bruxism were applied to each model at varying angles and intensities. Endodontic treatment significantly weakens the mechanical properties, especially in already compromised traumatized immature teeth by removing the pulp tissue, making effective post-treatment restoration and reinforcement essential for maintaining the tooth's functional integrity and fracture resistance.

Mouthguards play a crucial role in sports by providing essential protection against dental injuries and oral trauma, thereby safeguarding athletes from potential long-term damage to their teeth, gums, and jaws during physical activities [36, 37]. Various types of mouthguards, including stock, boil-and-bite, and custom-fitted options, are commonly used in sports to reduce the risk of dental trauma by absorbing and distributing the impact of collisions [37, 38]. The design and protective performance of these mouthguards are undergoing further development, with the potential to produce appliances with improved fit and enhanced protective capabilities compared to conventionally fabricated devices [38]. In this issue, Arfi et al. [39] compared the shock absorption capacities of custom-made mouthguards manufactured by 3D printing with industrial mouthguards and thermoformed ethylene vinyl acetate (EVA) mouthguards. Each mouthguard underwent an impact performance test to evaluate the maximum deceleration and force transmitted during impact, with measurements of thickness taken at the impacted inter-incisal area before and after a series of five impacts. Continued development and research into mouthguards are essential to enhance their design and protective efficacy, with the hope of promoting wider usage and improving safety across various high-risk activities.

The role of social media in disseminating knowledge about dental trauma has become increasingly significant, offering both a platform for widespread educational outreach and a forum for the exchange of real-time information among dental professionals and the general public [40, 41]. Nonetheless, a significant issue with social media resources on dental trauma is the risk of disseminating misinformation or unverified advice, which can result in confusion and weaken effective treatment and prevention efforts [41-43]. This highlights the need for further research to ensure the accuracy of information and improve the reliability of guidance available to the public. In this issue, Cagay Sevencan and Erener assessed the reliability and quality of YouTube videos on root resorption and whether the videos referred to orthodontic treatment and other stimulation factors [44]. Overall, 95 videos were first viewed independently by two researchers. Following the independent assessments, the researchers discussed their evaluations, ultimately reaching a consensus on the quality assessment of each video. Ensuring the dissemination of accurate and evidence-based information through social media is crucial for enhancing public understanding and promoting effective dental trauma management. Future efforts should focus on improving the quality of online content and developing strategies to guide users towards reliable sources, thereby optimizing the benefits of social media as an educational tool in dental care.

Artificial intelligence is increasingly becoming an integral part of everyday life, seamlessly integrating into various aspects of society, from healthcare and education to transportation and communication. However, the presentation of incorrect or inconsistent information on trauma-related inquiries poses a significant risk, as it can severely compromise the initial treatment and adversely affect tooth prognosis [45-47]. In this issue, Ozden et al. [48] assessed the consistency and accuracy of responses to questions related to dental trauma provided by general-purpose language models. Two artificial intelligence applications were questioned based on the IADT guidelines, and responses were recorded and compared with the correct answers. Artificial intelligence has the potential to transform the management of general health-related inquiries by utilizing advanced algorithms to analyze large volumes of medical data, possibly offering personalized health recommendations, and providing real-time responses to patient queries. This could improve the accessibility and efficiency of healthcare information and support in the future.