A Systematic Review of Sensibility Testing And Assessment of Trauma Cases In Permanent Anterior Teeth Presented At Hbmcdm From January 2008 to December 2016
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The work presented here consists of two distinct parts. Part I: A systematic review of sensibility testing The assessment of pulp vitality during pain response is traditionally performed using an electric, hot, or cold pulp tester. However, these methods have the capability to assess only the vitality of the sensory supply or the blood supply of the dental pulp and they are viewed as better measurement approaches of true health than sensibility. Since such conventional tests may be unreliable for post-traumatic dental conditions, it is imperative to clinically evaluate such teeth using alternative approaches of pulp vitality such as laser doppler flowmetry and pulse oximetry. This study aims to systematically review the literature concerned with sensibility and vitality pulp testing involved in the diagnostic approaches for traumatic injuries of permanent anterior teeth. We conducted our search according to PRISMA reporting system. We selected English articles only without date limitation using the following scientific databases: Medline (PubMeD), EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews. The data from all included studies were extracted independently using thorough reading and observation. The search consisted of using specific search terms as well as a manual hand searching using either the reference lists in the included articles or using “google scholar” search. The following studies were excluded during our search: 1) Animal studies 2) studies concerned with primary teeth 3) studies concerned with the assessment of diagnostic approaches of permanent anterior teeth after trauma in their predecessors 4) studies investigating assessment of pulp condition following trauma concurrent with any oral pathological condition which may impact the pulp. Results: The range of the selected articles was between 1936-2016. Initially, we found a total of 739 articles through searching in the aforementioned databases. After duplicate removal and screening for eligible studies, we narrowed the articles to 30 in this review. The diseased pulp after trauma might undergo unfavourable complications such as inflammatory root resorption. Therefore, a careful follow-up of such teeth is required at periodic intervals up to six months after trauma as the nerves may regain their function later. Despite the lack of response of traumatized teeth to sensibility neurological testing, in what is known as “pulp shock”, during the first few weeks after trauma, several studies have proved pulp vitality by showing the signs of pulpal blood flow using laser doppler flowmetry and pulse oximetry. As a result, the accurate treatment plans can be decided immediately as per reported by the pulp vitality assessment tests without waiting for the positive response yielded by the conventional tests. The follow-up process of the traumatized anterior teeth should be associated with accurate interpretations depending on several evidences from various results of clinical examination and the assistive diagnostic techniques. Part II: Assessment of trauma cases in permanent anterior teeth presented at HBMCDM from January 2008 to December 2016 Introduction: The assessment of Traumatic Dental Injuries (TDIs) in young and adult patients is important as it gives an opportunity to track the possible trauma reasons in each group as well as identify its consequences and complications. However, the lack of reporting of TDIs as a result of behavioral cultural diversities among different communities may relatively hinder obtaining accurate and significant results in the retrospective evaluations. A retrospective study was conducted in Hamadan Bin Mohammed College of Dental Medicine between January 2008 and December 2016 in United Arab Emirates using the documentation of 64 patients with 114 traumatized teeth. Materials and Methods: Hamadan Bin Mohammed College of Dental Medicine patient data base was used. The data were collected from patient notes via the application of certain treatment codes. Radiographs were also assessed and all the extracted information was recorded in excel spread sheets. Statistical tests were applied to check for significant differences (P<0.05). Results: It was found that the most frequently traumatized teeth were detected in tooth 21 (f= 41, 36%), tooth 11 (f= 35, 30.7%) and tooth 12 (f= 12, 10.5%). TDIs were significantly associated with patient gender (p< 0.001). Of the males, only 4 patients (7.8%) experienced uncomplicated TDIs, while the remaining male patients (n=47, 92.2%) had complicated TDIs. The most frequent TDI cases were recorded in patients aged more than 18 years (64 cases, 56.1%), followed by patients with age range 12-17 years (26 cases, 22.8%) while the prevalence of TDIs within the age range 7-11 years was 24 recorded cases (21.1%). There was a significant relationship between type of TDIs, whether being complicated or uncomplicated, and the associated periapical pathologies (p< 0.001). Of the total population (n=114), periapical pathologies occurred in 53 affected teeth, while there were 61 teeth presented without pathologies. The incidence of periapical pathology was less prominent in the uncomplicated dental injuries (n=3) while more reported with complicated injuries (n=50). There was a significant relationship between the type of treatment provided and the associated periapical pathological conditions (p < 0.001). This study concludes with the following; 1. Traumatic dental injuries occurred almost in equal proportion amongst males and females with a slight tendency toward females. 2. Complicated injuries were more prominent in males than female patients. 3. The most frequent traumatic dental injuries were reported in patients aged more than 18 years old.