International Dental Traumatology Conference Fakulti Pergigian Faculty of Dentistry dentistryUM um_dentistry https://dentistry.um.edu.my/ 2 nd and 3rd March 2024 Nexus, Level 3A, Connexion Conference & Event Centre, Bangsar South, No7, Jalan Kerinchi, 59200 Kuala Lumpur, Malaysia Exploring Global Perspectives: From Diagnosis to Rehabilitation
2 Table of content Fakulti Pergigian Faculty of Dentistry Introduction 3 Welcome Message 4 Organizing committee 7 Conference speakers and Speakers abstracts 9 Conference Schedule 22 E-poster presentation abstracts. Case report category 24 E-poster presentation abstracts. Research report category 48 Sponsors and Partners 58 Acknowledgement 64
Ташкент- 2020 год Introduction
4 Welcome Message Dear distinguished guests, esteemed colleagues, and fellow participants, It is my distinct pleasure to extend a warm welcome to all attendees of the International Dental Traumatology Conference, hosted by the Universiti Malaya, Faculty of Dentistry. As we gather here to explore the latest advancements in dental traumatology under the theme "Advancements in Dental Traumatology: From Diagnosis to Treatment," I am filled with a sense of excitement and anticipation for the knowledge sharing and collaboration that lie ahead. I would like to express my sincere appreciation to the conference organizers for their dedication and hard work in bringing together experts, practitioners, and researchers from around the globe. Your efforts have undoubtedly contributed to the success of this event and have provided a platform for meaningful discourse and innovation in our field. Throughout this conference, I encourage each of you to actively engage in discussions, share your insights, and network with fellow participants. Together, we have the opportunity to shape the future of dental traumatology by leveraging our collective expertise and embracing new approaches to diagnosis and treatment. I am confident that the presentations and discussions scheduled over the coming days will inspire us to push the boundaries of what is possible in dental care. Let us seize this opportunity to learn from one another, foster collaboration, and ultimately improve patient outcomes. I extend my best wishes for a productive and enriching conference experience. May our time together be marked by fruitful exchanges, innovative ideas, and lasting connections that propel our field forward. Thank you for your participation, and I look forward to the insights and discoveries that will emerge from our time together. Warm regards, YBhg. Dr Mohmmad Salleh Yahya Deputy Director Universiti Malaya Medical Centre, Senior Consultant Emergency Trauma Fakulti Pergigian Faculty of Dentistry
5 Welcome Message Dear Esteemed Colleagues and Participants, It is with great pleasure and enthusiasm that I extend a warm welcome to each of you to the International Dental Traumatology Conference hosted by the Faculty of Dentistry at Universiti Malaya. In my capacity as the Dean of this esteemed institution, I am filled with immense pride to witness the convergence of experts, researchers, and practitioners from around the globe to share insights, exchange knowledge, and collectively advance our understanding in the field of dental traumatology. This conference serves as a dynamic platform for collaboration and dialogue, cultivating innovative ideas and disseminating cutting-edge research findings. Through engaging discussions and presentations, our shared goal is to explore the latest advancements, techniques, and best practices that will shape the future of dental traumatology and enhance patient care on a global scale. Universiti Malaya has consistently demonstrated its commitment to fostering excellence in education, research, and clinical practice. Our dedicated faculty members are focused on nurturing the next generation of dental professionals, equipped with the skills, expertise, and compassion needed to address the diverse needs of our communities. I encourage all participants to actively engage in the conference proceedings, seize the opportunity to network with peers, and leverage this platform to forge meaningful collaborations that will drive positive change in the field of dental traumatology. On behalf of the organizing committee and the entire faculty, I extend my heartfelt gratitude to all the speakers, sponsors, and attendees for their invaluable contributions and unwavering support in making this conference a resounding success. I wish you all a fruitful and enriching experience at the International Dental Traumatology Conference, and I eagerly anticipate the exchange of ideas and insights that will undoubtedly shape the future of our noble profession. Warm regards, Professor Dr. Zamri Radzi Dean of the Faculty of Dentistry, UM Fakulti Pergigian Faculty of Dentistry
6 Welcome Message Dear Esteemed Colleagues, It is with great pleasure and excitement that I extend my warmest welcome to each one of you to the first prestigious International Dental Traumatology Conference 2024 here in Malaysia. As the Chairman of this esteemed gathering, I am thrilled to see the culmination of efforts from distinguished professionals, researchers, and practitioners from across the globe, all converging to share their expertise and insights in the field of dental traumatology. This conference serves as a platform for fostering collaboration, exchanging knowledge, and exploring innovative solutions to the challenges we face in our profession. Over the course of our time together, we will engage in stimulating discussions, attend insightful presentations, and forge meaningful connections that will undoubtedly contribute to the advancement of dental traumatology. I encourage you to seize this opportunity to not only expand your professional network but also to gain new perspectives that will inspire and elevate your practice. I am confident that this conference will provide you with valuable experiences and knowledge that will enrich your journey in the dental field. On behalf of the organizing committee, I extend my heartfelt gratitude to all our sponsors, speakers, volunteers, and attendees for their unwavering support and dedication. Your contributions have been instrumental in making this conference a reality, and I am deeply appreciative of your commitment to advancing our collective mission. In closing, I wish you all a stimulating and enriching experience at the International Dental Traumatology Conference 2024. May our time together be filled with learning, inspiration, and fruitful collaborations that will shape the future of our profession. Warm regards, Associate Prof. Dr. Hany Mohamed Aly Ahmed Chairman, International Dental Traumatology Conference 2024 Fakulti Pergigian Faculty of Dentistry
7 Organizing committee CHIEF EXECUTIVE TEAM Advisor Prof. Dr. Zamri Radzi Co-Chairperson A/P Dr. Noor Azlin Yahya SPONSORSHIP TEAM Committee Dr. Yeoh Oon Take Committee Puan Roslina Yahya Committee A/P Dr. Jacob John PROMOTION & PUBLICATION CERTIFICATES & PRINTING Secretary Dr. Sofya Zulkiffli Treasurer Dr. Zubaidah Zanul Abidin LOGISTICS Committee A/P Dr. Nor Azlida Mohd Nor Committee Dr. Yasmin Kamarudin Committee En Muhammad Fairos Jenal Committee Dr. Noorhidayah Zainal Aalam Committee Dr. Nabihah Dziaruddin Committee Cik Nursyafiqah Abdul Malek Treasurer Puan Norshidah Abdul Manan Committee En Abdull Zainol Committee En Mohd Afif Abu Bakar Committee Dr. Aisyah Ahmad Fisal SECRETARIAL TEAM TREASURER Asst Secretary Puan Norhayati Mat Fakulti Pergigian Faculty of Dentistry Treasurer Puan Asiah Ishak Organizing Chairperson A/P Dr. Hany Mohamed Aly Ahmed
Organizing committee PROGRAMS AND BOOKS OPENING & CLOSING CEREMONY Committee Dr. Ainol Haniza Kherul Anuwar Committee Dr. Faris Azim Mohd Zuhairi Committee Dr. Mohd Zamri Hussin Committee Mohamad Mukhlis Azman Committee Puan Helen Ng Lee Ching Committee Puan Nur Atika Sabri Committee Dr. Tuygunov Nozimjon REGISTRATION Committee Dr. Wan Izlina Wan Ibrahim Committee Dr. Lee Jian Sheng Committee Dr. Hoda Mohamed Elnawawy 8 AUDIOVISUAL & TECHNICAL Committee A/P Dr. Lim Ghee Seong Committee Dr. Nur Diyana Mohamed Radzi Committee En Mohamad Firdaus Abd Rahaman FOOD & BEVERAGE Committee Dr. Syarifah Nur Syed Abdul Rahman Committee Tan Chin Hoong Committee Dr. Enas Abdalla Etajuri Fakulti Pergigian Faculty of Dentistry Committee Chan Jia Yu Committee Dr. Shafira binti Mohd Zairi Committee Dr. Noorhayati Raja Mohd
9 Conference speakers Professor Dr. Paul V. Abbott BDSc, MDS, DDSc, FRACDS(Endo), FPFA, FADI, FICD, FACD, FIADT Paul Abbott is Emeritus Professor of Dentistry at The University of Western Australia. He is a Specialist Endodontist. Prior to taking a full-time University position in 2002, he spent 17 years in private specialist endodontic practice and he also held part-time academic positions at The University of Western Australia and the University of Melbourne. He was Dean and Head of the School of Dentistry at The University of Western Australia and Director of the Oral Health Centre of Western Australia from 2003-2009. He has presented over 1000 lectures and courses in 51 countries. He has published 238 articles in refereed journals, 25 textbook chapters and 47 Newsletter articles. From 2015-2022, he was the Editor-in-Chief of the international journal Dental Traumatology. Prof. Abbott’s main research and clinical interests revolve around dental traumatology, tooth resorption, and the diagnosis and management of pulp, root canal and peri-radicular conditions, with particular emphasis on pain control and disinfection of the root canal system. He has won numerous awards for his teaching and service to the dental profession. Fakulti Pergigian Faculty of Dentistry
10 Speakers abstracts Professor Dr. Paul V. Abbott University of Western Australia, Australia Day 1: 2nd March (Saturday) 2024 1. Classification, Examination, and Diagnosis of Dental Traumatic Injuries. Traumatic dental injuries are potentially very complex. Hence, it is essential to have a thorough understanding of the various injuries that can occur so appropriate management can be undertaken. The first stage in managing all traumatic dental injuries (TDI’s) is to obtain a thorough history of how, when, where and why the injury occurred. This will facilitate the subsequent clinical examination which must be comprehensive and include all tests and adequate radiographs, photographs, etc. Once all the information has been gathered, then the appropriate diagnoses can be made. In order to diagnose TDI’s effectively and consistently, it is important to know and understand the classification of such injuries. The most widely used classification is the one developed by Andreasen and adopted by the World Health Organisation. There is also a new system that can be used to more thoroughly document TDI’s and this will be outlined. 2. Root Fractures. Transverse root fractures (commonly called horizontal root fractures) are a complex injury, but they usually require little in the way of invasive or irreversible treatment. Unfortunately, this type of injury appears to be poorly understood by many dentists and this has resulted in many teeth with such fractures being poorly managed in the past. This lecture will specifically discuss this type of injury and how it should be managed. A variation of the classification of root fractures will be explained and this will help dentists in the management of these fractures. The long-term prognosis of sub-crestal coronal third root fractures, middle third root fractures and apical third root fractures is usually very good, if managed appropriately and conservatively. However, supra-crestal coronal third root fractures have a poorer prognosis with respect to the pulp and restoration of the tooth due to the location of the fracture, which is similar to a complicated crown:root fracture. Management of these fractures poses dilemmas for the dentist and some guidelines will be presented to help the decision-making when a supra-crestal coronal third root fracture is present. 3. Luxation Injuries. There are three types of luxation injuries – extrusion, lateral luxation and intrusion – where the tooth is displaced from its normal position. These injuries all cause damage to the periodontal ligament (PDL) and possibly also to the cementum. In addition, the pulp’s neurovascular supply can be either severed or reduced through stretching as the tooth is displaced. It is important to reposition luxated teeth as soon as possible in order to minimise the consequences of these injuries, and there are specific techniques for repositioning after each injury. Once repositioned, the tooth should be stabilised with a splint while the initial PDL healing takes place. Root canal treatment is indicated in some cases and these will be outlined to guide participants. There are also two minor injuries that can damage the PDL – concussion and subluxation – and these will also be discussed. Fakulti Pergigian Faculty of Dentistry
11 Speakers abstracts Day 2: 3rd March (Sunday), 2024 4. Infection and Inflammatory Root Resorption. External inflammatory resorption is a complex topic but one that has been well researched so the dental profession now has a good understanding of how it occurs and when it occurs. This allows us to predict the injuries that are likely to result in this type of resorption so we can then focus our management on preventing its occurrence. However, sometimes, external inflammatory resorption will already be present by the time a patient presents for treatment. Hence, interceptive treatment will be needed in order to arrest the resorptive process and to stimulate healing and repair of the lost hard dental tissues and periodontal ligament. In this lecture, detailed protocols for both the preventive and interceptive management of external inflammatory resorption will be outlined. 5. Emergency Management of Dental Trauma. In order to minimise the consequences of all traumatic dental injuries, it is essential that the appropriate emergency management be provided. This will have a major influence on the long-term prognosis of the traumatised tooth. Before discussing specific ways to manage particular injuries to the teeth and supporting tissues, some general principles of management will be outlined. The general principles include the management of the pulp, management of the root surface, splinting and stabilisation of the teeth and any fractures of the alveolar bone, soft tissue management (such as suturing), restoration of coronal fractures, pain management following trauma and the regime for follow-up of the patient after the initial emergency management. This lecture will also outline how these general principles can be applied to specific injuries. Fakulti Pergigian Faculty of Dentistry
12 Conference speakers Professor Dr. Lars Andersson DDS, PhD Dr Odont Prof Andersson completed undergraduate and research training at Karolinska Institute in Sweden. He defended his doctoral thesis on experimental and clinical studies on replantation of teeth 1988. Specialist in Oral and Maxillofacial Surgery (OMFS). He was appointed Docent at Karolinska Institute in 1990. During all his professional career he has been clinically active as an Oral Maxillofacial Surgeon. In the 1990s he chaired a national specialist resident training program in OMFS and belonging to the first-generation implant surgeons he directed international implant training programs for surgeons from all continents of the world. During the same period, he was also regularly consulted to perform implant surgery abroad. During the period 2002-2017, he was appointed Professor of OMFS at Faculty of Dentistry, Kuwait University and Chairman of Department of Surgical Sciences, building up and leading education, research and developed, and run a university clinic in OMFS. Today semi-retired working as Senior Professor of Oral and Maxillofacial Surgery at Malmö University, Sweden. Board member of the Dental Trauma Guide Competence Centre in Copenhagen (Research basednot for profit-organization). He has lectured in more than 40 countries on all continents of the world and published more than 200 original research papers in international Medline indexed scientific journals. His papers have received more than 13000 scientific citations, H factor 56. He has supervised several PhD and Master theses and been opponent/external examiner on several PhD theses defences. He is editor of five textbooks and chapter author in several textbooks in the fields of Trauma and OMFS. He was Editor-in-Chief of the Medline indexed scientific journal, Dental Traumatology from 2007-2015 and President of the International Association of Dental Traumatology 2011-2014. Fakulti Pergigian Faculty of Dentistry
13 Speakers abstracts Professor Dr. Lars Andersson Malmö University, Sweden Day 1: 2nd March (Saturday), 2024 1. Trauma in the society: Epidemiology, aetiology, incidence, prevalence, trends, economic impact, and public health implications. This lecture will give a present status overview of trauma in the society, oral vs body injuries, incidence, prevalence, trends, economic impact of trauma, public health implications, how to decrease injuries and costs for the society and reduce complications, prevention, increasing lay and professional knowledge and how to best organize emergency services for traumatic dental injuries. 2. Tooth avulsion and replantation. The most serious dental injury is avulsion (exarticulation) of permanent teeth. This injury is most often seen in young growing patients, which presents special problems when it comes to treatment. The most important phase for the prognosis is the emergency management. An avulsed tooth can be replanted and successfully heal if properly managed immediately after the injury. Injuries to the periodontal membrane and the pulp will decrease the possibility for a successful healing. Information to the public such as children, parents and teachers who may be present at the place of accident is therefore important. Furthermore, clinicians must understand the principles of tissue injury and healing of tissues after replantation to be able to early diagnose and correctly manage potential later complications such as root resorption, ankylosis and infraposition, which is especially important in growing children. The lecture will address the important aspects of tooth avulsion and replantation such as correct first aid at the place of accident and emergency treatment in the dental clinic. The lecture will also present principles of healing, diagnosis and treatment of potential complications based on recent evidence from scientific literature. Results from recent long term clinical follow up studies of replanted teeth will be presented. 3. Ankylosis and replacement resorption: Management, decoronation and ridge preservation. Root resorption is sometimes seen after traumatic dental injuries and autotransplantation. While infection related root resorption today can be prevented or treated, ankylosis is the most serious complication for the tooth resulting in progressive replacement resorption of the root by bone and eventually causing loss of the tooth. Moreover, inhibition of growth and development of the alveolar process is also seen in young growing patients following ankylosis. The lecture will give a complete overview aiming at understanding the development, progression, and management of ankylosis based on in vivo- and clinical studies and an overview of the literature. An overview of various less successful methods to manage ankylosis will be given and the method of choice today, decoronation, will be presented. The recent shift in paradigm from “save the tooth” to “preserve the bone” will be presented. Fakulti Pergigian Faculty of Dentistry
14 Speakers abstracts Day 2: 3rd March (Sunday), 2024 4. The dental trauma guide- a web-based tool for diagnosis and treatment. Textbooks and manuals are not always available in all places around the world. However, the ease of availability of internet enables the clinician to access the internet based Dental Trauma Guide interactive program www.dentaltraumaguide.org easily and allows a direct comparison of the patient with the outcome of similar cases in the database in Copenhagen. The intention was that all dentists around the world should be able to get access to the best available evidence regarding diagnosis, treatment and prognosis within a few minutes. The website www.dentaltraumaguide.org displays the treatment guidelines, developed by the International Association of Dental Traumatology visualized with film animations, to make it easy and appealing for the users. Furthermore, DTG provides prognosis estimates for each individual injury type, as well as prognosis estimates for teeth with combinations of fracture and luxation injuries. The database includes 4000 patient case portfolios with long term follow up. This database covers all kinds of dental trauma as well as combination injuries in permanent and primary teeth. The risk of various healing complications such as pulp necrosis, pulp canal obliteration, repair related root resorption, infection related root resorption, ankylosis related root resorption, marginal bone loss and tooth loss was estimated based on survival analysis. 5. Treatment strategies of anterior tooth loss after trauma in the young still growing patient. The lecture will present strategies how to manage situations where teeth have been lost in the anterior region of the maxilla after trauma in young growing patients. Different treatment alternatives must be considered such as prosthetic treatment, orthodontic space closure and autotransplantation of another tooth to the anterior region. Implant treatment is contraindicated in the young growing patient because it interferes with growth and the lecture will present how to assess when implants at earliest can be placed in an adolescent patient. The various alternatives when treating a patient with tooth loss in the anterior region must always be related to the growth status of the individual patient and the aim of the lecture is to present strategies for the choice of treatment in each individual situation. The importance of timing and a multi-disciplinary approach to these cases will be emphasized. Fakulti Pergigian Faculty of Dentistry
15 Conference speakers Professor Dr. Hien Chi Ngo BDS, MDS, PhD, Grad Cert. HEd, FICD, FADI, FPFA, FRACDS, MAICD Dr. Ngo has extensive experience in private practice, research and education. For two decades, he was the principal of a dental practice located in the business district of Adelaide. He has maintained regular clinical sessions treating patients with advanced caries and erosion. As an educator, he has published and lectured extensively on dental materials, Minimal Intervention dentistry and clinical cariology. He serves on the editorial boards of several dental journals. Over the last 25 years, he has been very active as an international speaker and have contributed to numerous major international meetings. He was appointed Dean at the College of Dental Medicine, University of Sharjah (2016) and Dean of The University of Western Australia Dental School, University of Western Australia (2020). He is currently Adjunct Professor at the University of Western Australia and King’s College of London. In research, he is active in the areas of dental materials and cariology, and his current focus revolves around the clinical management of caries, especially in the elderly and medically compromised patients and the interactions between glass-ionomers and the oral environment, and silver diamine fluoride. He has been a technical consultant to several dental organisations and was coinventor of several dental products. Fakulti Pergigian Faculty of Dentistry
16 Speakers abstracts Professor Dr. Hien Chi Ngo University of Western Australia, Australia In dental traumatology, composite and glass ionomer materials play crucial roles in restoring damaged teeth and preserving their function and aesthetics. Composite resins offer excellent esthetics and mechanical properties, making them ideal for restoring anterior teeth affected by trauma. Their ability to mimic natural tooth structure ensures seamless integration with surrounding dentition, restoring both form and function in the least invasive and reversible manner. Recent development of fibre reinforced composite resins will be discussed On the other hand, glass ionomer cements offer unique advantages in certain traumatology cases. Their chemical adhesion to tooth structure, moisture tolerance, low coefficient of thermal expansion can be very useful in handling dental emergencies. Digital technologies have revolutionized dentistry by offering innovative solutions for diagnosis, treatment planning, and rehabilitation. Intraoral scanners enable fast, non-invasive digital impressions, eliminating the need for traditional impression materials and trays. These digital impressions can be seamlessly integrated with computer-aided design/computer-aided manufacturing (CAD/CAM) technology for the fabrication of splints. This presentation will review recent developments to allow clinicians to make informed decisions tailored to the specific needs of each patient, ultimately achieving successful outcomes in traumatic dental injuries. Fakulti Pergigian Faculty of Dentistry
17 Conference speakers Associate Professor Dr Siti Mazlipah BDS (Mal), FDSRCS (Eng) Dr Siti Mazlipah serves as a consultant Oral and Maxillofacial Surgeon in the Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry University Malaya Kuala Lumpur since 2000. She is the immediate past president of the Malaysian Association of Oral and Maxillofacial Surgeons having served from 2019-2023. Currently holds the position as the Deputy Dean of Clinical Services, Faculty of Dentistry, University of Malaya since 2021. She has held several other positions including: 2011-2015; 2016-2019 – Head, Department of Oral & Maxillofacial Clinical Sciences, Faculty of Dentistry, University Malaya 2002-2018 – Coordinator of Combined Cleft Clinic, University Malaya 2018-2019 – Chair of the medical ethics committee, Faculty Dentistry, Universiti Malaya 2016 till now - member of the National Dental Board Examination Committee 2019 till now - chairperson of the National Dental Specialty Sub-committee for Oral and Maxillofacial Surgery Fakulti Pergigian Faculty of Dentistry
18 Speakers abstracts Associate Professor Dr. Siti Mazlipah Ismail Universiti Malaya, Malaysia The main etiology for maxillofacial injuries is motor vehicle accident (MVA) followed by falls, assaults and industrial accidents. Majority of the injured victims are in their 3rd and 4th decade of lives. Mandible and maxilla are most susceptible to fractures. Since these bones bear teeth, therefore inevitably, dental injuries are commonly associated with them. However, it was observed that other acute injuries are often prioritized, leading to delay in the management of dental injuries. Often times, treatment provided are aimed at arresting bleeding, securing airway and quick pain relieving solutions. The resources for dental treatment in the emergency department and the wards are very limited hence potentially contribute to the insufficient early intervention of dental injuries. The cost and insurance coverage for dental injuries leaves much to desire when victims have to select between the more debilitating injuries and dental restorations. Fakulti Pergigian Faculty of Dentistry
19 Conference speakers Dr. Roshima Mohd Sharif BDS(Malaya); M.Clin.Dent.(Restorative)(Malaya) Pakar Perunding Pergigian Restoratif, Klinik Pergigian Cahaya Suria, WPKL. Dr. Roshima is the Head of Restorative Dentistry Specialty in the Ministry of Health (MOH), Malaysia. She graduated from University of Malaya in 1996 and later obtained her specialist qualification in the area of Restorative Dentistry in 2004 from UM. Over the 27 years of service in the MOH, she has worked in Perak, Melaka and WPKL. Her first achievement when appointed as head of the specialty in the MOH was to successfully get endodontic specialty on board of oral health programme, MOH under the Restorative Dentistry specialty in 2021. As a restorative dental specialist in the MOH for the past 19 years, her clinical work has been focused mainly on managing endodontic complications and problematic fixed prosthodontic cases. Dr Roshima is also actively involved in MQA accreditation, professional supervision and continuing education for dental officers. Fakulti Pergigian Faculty of Dentistry
20 Speakers abstracts Dr. Roshima Mohd Sharif Head of Restorative Dentistry Specialty in the Ministry of Health, Malaysia CROWN AND CROWN-ROOT FRACTURE. Traumatic dental injuries can result in different kind of injuries based on the extent, direction, and location of the impact. Crown fractures involve fractures or cracks of the enamel and/or dentin, with or without loss of tooth substance. They are defined as complicated, in the case of pulp exposure, or uncomplicated when the pulp is not exposed after trauma. When a fracture involves enamel, dentin, cementum and extends below the gingival margin, it is defined as crown-root fracture. They are also further classified as uncomplicated and complicated based on the presence of pulp exposure. In root fractures, only the root structure including dentin, cementum, and pulp is involved and it can be localized at the apical, middle, or cervical third. Following diagnosis of a traumatic dental injury, a treatment plan should be established according to the type of the fracture, stage of tooth development, endodontic prognosis and periodontal, restorative and prosthodontics considerations. Multidisciplinary management can result in an improved prognosis of the tooth and, in time, may be the most conservative and cost-effective solution for the patient. The IADT guidelines for management of traumatic dental injuries are available to assist dentists and patients in decision making and in providing the best care possible especially at emergency management, to increase probability of most favourable outcome. However from the perspective of public dental services in Malaysia, further measures need to be taken to strengthen the management of traumatic dental injuries at emergency and primary care level as specialist care services continue to receive increased traumatic dental injury cases with unfavourable outcome, which have affected patient’s quality of life. Fakulti Pergigian Faculty of Dentistry
21 Conference speakers Associate Professor Dr. Shani Ann Mani BDS, MDS, FDS RCPS(Glasg) Dr. Shani Ann Mani graduated in 1995 from The Tamil Nadu Dr.M.G.R Medical University, Chennai, India with a Bachelor in Dental Surgery and in 1998 from the Post Graduate Institute of Medical Education and Research (Panjab University), Chandigarh, India with a Master of Dental Surgery (Pedodontics and Preventive Dentistry). She is also a member of the Royal College of Surgeons and Physicians of Glasgow since 2007. She enjoys teaching having been in academia for more than 22 years, teaching Paediatric Dentistry to undergraduate and postgraduate students. She was appointed the postgraduate coordinator in Paediatric Dentistry at the Faculty of Dentistry, University Malaya since 2014. She has been an external and internal examiner for both undergraduate and postgraduate students during her career. She is also keen in research and has authored about 30 articles published in international and national peer-reviewed journals, majority being indexed in the ISI Web of Science database, and also contributed to chapters in books. She routinely reviews manuscripts for international journals in her field of specialisation and is on the editorial board of the European Archives of Paediatric Dentistry, Malaysian Journal of Paediatric Dentistry and BMC Oral Health. She has also obtained research grants pertaining to her research in Paediatric Dentistry over the course of her career. She is a member of the Indian Society of Pedodontics and Preventive Dentistry and Malaysian Association of Paediatric Dentistry besides other academic associations. Fakulti Pergigian Faculty of Dentistry
22 Speakers abstracts Assoc Prof. Dr. Shani Ann Mani Universiti Malaya, Malaysia Traumatic injuries to the primary dentition in young children are extremely distressing for both parent and child. They also present multiple challenges to the dental team. The challenges range from managing anxiety in both child and parent, arriving at a diagnosis, and managing the traumatic injury in an appropriate manner suitable to the child. The goals and objectives of managing trauma in the primary dentition are significantly different from those of permanent teeth. Most guidelines for trauma management in the primary dentition are consensus statements from experts or working groups due to the lack of extensive research in this area. This lecture will address the management options for traumatic injuries in primary teeth for the dental team. Fakulti Pergigian Faculty of Dentistry
23 Conference speakers Associate Professor Dr. Hany Mohamed Aly Ahmed BDS, HDD (Endo), PhD (Endo), FICD, MDTFEd RCSEd, FPFA, FADI Dr. Ahmed graduated with a BDS (2002) from the Faculty of Dentistry, Ain Shams University, Egypt. In 2006, he obtained a Higher Dental Diploma degree in clinical endodontics, followed by a PhD from the School of Dental Sciences, Universiti Sains Malaysia. He was awarded for his research including the IADR (SE Asian division) for the best laboratory research, in addition to the best publication award (2020), with a research group in Turkey, from the Journal of Endodontics. Dr. Ahmed has over 120 publications. In 2012, he introduced a new classification for endo-perio lesions, and in 2017, with experts in the field, he introduced a new system for classifying root and canal morphology, accessory canals, and dental anomalies, in addition to the PROUD-2020 reporting guidelines for root and canal anatomy studies. He is a registered Clinical Consultant in Endodontics with the Egyptian Dental Syndicate, international consultant for research projects in several countries, international speaker, and a key opinion leader for dental companies. Currently, Dr. Ahmed is an Associate Professor of Endodontics at the Faculty of Dentistry, Universiti Malaya (UM). He leads a number of grants related to root canal anatomy and endodontic bio-materials. In 2022, he was awarded the excellent service award from UM. Recently, Dr. Ahmed was awarded membership from the Faculty of Dental Trainers, Royal College of Surgeons (Edinburgh). Dr. Ahmed is a scientific reviewer and editorial board member for several journals. He is also the Deputy Editor-in-Chief of the European Endodontic Journal and Editorial Board member of the International Endodontic Journal. He is also one of the Editors for the book entitled "Endodontic Advances and Evidence-based Clinical Guidelines" published by Wiley in 2022. Fakulti Pergigian Faculty of Dentistry
24 Speakers abstracts Associate Professor Dr. Hany Mohamed Aly Ahmed Universiti Malaya, Malaysia Coronal discolouration after dental trauma: Diagnosis and management. Tooth colour, form and alignment contribute to the beauty of a smile. Coronal tooth discolouration is a common consequence after dental traumatic injuries, which if persists, it creates a range of aesthetic problems. This lecture aims to discuss the different pulp tissue responses to dental trauma, and its relation to the mechanism of coronal discolouration patterns. It also aims to outline the diagnostic procedures that would help the clinician for proper treatment plan. It also aims to highlight the recommended guidelines that should be followed by dental practitioners to manage tooth discolouration, in addition to potential challenges and prognosis of different bleaching protocols. Fakulti Pergigian Faculty of Dentistry
25 Conference Schedule Day 1: 2nd March (Saturday), 2024 Time Lecturer Speaker 8:00 am - 8:30 am 8:30 am -9:00 am Registration Opening ceremony 9:00 am - 9:40 am Lecture 1: Trauma in the society: Epidemiology, aetiology, incidence, prevalence, trends, economic impact and public health implications Prof Lars Andersson 940 am -10:40 am Lecture 2: Classification, examination and diagnosis of dental traumatic injuries Prof Paul Abhott 10:40 am -10:55 am BREAK 10:55 am -11:35 am Lecture 3: Crown and crown-root fractures Dr Roshima Mohd Sharif 11:35 am -12:20 pm Lecture 4: Root fractures Prof Paul Abbott 12:20 pm -1:00 pm Lecture 5: Luxation injuries Prof Paul Abbott 1:00 pm -2:00 pm Lunch & e-poster viewing 2:00 pm -3:00 pm Lecture 6: Avulsion and replantation Prof Lars Andersson 3:00 pm - 3:45 pm Lecture 7: An overview of dental injuries in maxillofacial trauma AP Dr Siti Mazlipah Ismail 3:45 pm -4:30 pm Lecture 8: Traumatic injuries in the primary dentition AP Dr Shani Ann Mani 4:30 pm -5:00 pm Q and A session with speakers All speakers Fakulti Pergigian Faculty of Dentistry
26 Conference Schedule Day 2: 3rd March (Sunday), 2024 Time Lecturer Speaker 9:00 am -10:00 am Lecture 1: An update an materials, techniques and technologies in dental traumatology Prof Hien Chi Ngo 10:00 am -10:45 am Lecture 2: Infection and inflammatory root resorption Prof Paul Abbott 10:45 am -11:00 am BREAK 11:00 am -11:45 am Lecture 3: Ankylosis and replacement resorption: Management, decoronation and ridge preservation Prof Lars Andersson 1145 am - 12 30 pm Lecture 4: Coronal discolouration after dental trauma: Diagnosis and management AP Dr Hany Mohamed Aly Ahmed 12:30 pm - 12 45 pm Q and A session with speakers 12:45 pm -1:45 pm Lunch & e-poster viewing 1:45 pm - 2:30 pm Lecture 5: Emergency management of dental trauma Prof Paul Abbott 2:30 pm -3:00 pm Lecture 6: The Dental Trauma Guide - a weh-hased tool for diagnosis and treatment Prof Lars Andersson 3:00 pm - 4:45 pm Seminar: Treatment strategies of anterior tooth loss after trauma in the young still growing patient Prof Lars Andersson 4:45 pm - 5:00 pm Q and A session with speakers All Speakers 5 00 pm - 515 pm Lucky draw, winner announcement & closing ceremony Fakulti Pergigian Faculty of Dentistry
Ташкент- 2020 год E-poster presentation abstracts. Case report category
28 Abstract 01 MANAGEMENT OF TRAUMATIC DENS INVAGINATUS USING REGENERATIVE ENDODONTICS IN AN ADULT PATIENT Wan NF1 , Ramlan NA1 1Centre of Comprehensive Care Studies, Faculty of Dentistry, University Teknologi MARA, Malaysia Department, Faculty, University INTRODUCTION: Immature teeth risk developing pulpal necrosis due to trauma, caries, and anatomic variations such as dens invaginatus. Dens invaginatus (DI) is a developmental anomaly that poses a significant challenge to the clinician if endodontic treatment is required. The type II (as per Oehlers) form exhibits complex internal anatomy and is frequently associated with incomplete root and apex formation. CASE PRESENTATION: This study presents a case report of a discoloured immature tooth related to type II DI in the maxillary lateral incisors in an adult patient (26 years old). The development of the root and apex were affected by pulp necrosis due to trauma. Despite the older age, the regenerative endodontic procedure (REP) was selected. Two visit procedures were executed successfully. On the first visit, the procedure involved debridement and placement of the Triple Antibiotic Paste, followed by the completion of the pulpal regeneration procedure on the second visit. After one year of follow-up, incomplete resolution of the pre-existing apical radiolucency was noted, with no signs of apical closure or thickening of the root canal walls and no increase in root length. However, a notable reduction of apical radiolucency was observed. CASE DISCUSSION: Early detection of teeth with DI type II and proper exploration of the internal anatomy are critical factors for successful management. REP is a more favorable alternative for managing open apex teeth with pulp necrosis in younger patients than traditional apexification techniques as they commit greater healing capacity or stem cell regenerative potential. CONCLUSION: Within the study’s limitation, our findings demonstrate that REP in immature adult teeth can successfully achieve the primary goal of resolving signs and symptoms along with apical radiolucency. KEYWORDS: dens invaginatus, open apex, pulp necrosis, regenerative endodontic procedure, trauma Fakulti Pergigian Faculty of Dentistry
29 Abstract 02 A LONG TERM SUCCESSFUL OF POST TRAUMATIC SURGICAL MANAGEMENT OF ANTERIOR TOOTH WITH CANAL CALCIFICATION (CASE REPORT) Nazih Shaban Mustafa1 1Associate Professor, Department of Oral Maxillofacial Surgery and Oral Diagnosis, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, Pahang, Malaysia INTRODUCTION: This case report deliberates on the modification of the treatment plan for a young female patient having a history of trauma to her anterior tooth for one year duration. In this case study we will highlight on the treatment options and how to save the tooth. Different modality of treatment has been raised to study the possibility of the survival of this tooth since the patient doesn’t want to lose it. CASE PRESENTATION: A 22-year-old female patient with a history of trauma of one year duration, presented with pain in the upper anterior left region, the pain is localized, the score was 7 /10 increasing by mastication, which makes the patient unable to eat. The duration of pain is about one week. She claimed that she had a history of trauma, but she cannot remember the details, she can recall that only there was a mild gum bleeding from the tooth area at the time of trauma, and patient didn’t seek any treatment at that time. The decision of a Periapical surgery made and a follow up have been done for period of more than ten years duration. CONCLUSION: Treatment of tooth with canal calcification is a challenging condition. The prognosis of which the treatment plan is the most recommended requires a thorough review of case by case. It is concluded that in the current case the treatment options are limited, challenging, and depend on the way and how to approach the patient, however, the prognosis remains uncertain and eventually occasionally unexpected. KEYWORDS: successful, traumatic, management, canal calcification, case report Fakulti Pergigian Faculty of Dentistry
30 Abstract 03 ENDODONTIC MANAGEMENT OF TRAUMATIZED PERMANENT CENTRAL INCISOR: A CASE REPORT Nor Hazwani bt Jamaludin1 , Nurul Ain bt Ramlan1 . 1 Centre of Study for Comprehensive Care, Faculty of Dentistry, Universiti Teknologi MARA Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia INTRODUCTION: Dental trauma is the fifth most prevalent disease or injury in the world with incidence highly reported in children. It may cause injuries not only to the surrounding oral structures but also to the tooth with the risk of losing vitality. Long-term follow-up is recommended especially when the incidence occurs in the developing dentition. CASE SUMMARY: This case reports the successful management of a non-vital central incisor with an open apex with an apexification procedure. A 21year old, Malay female was referred to the endodontic department for management of a traumatized permanent central incisor. The patient first reported pain and swelling at the palatal surface of the upper front tooth, and radiographic investigation revealed a periapical lesion with an open apex concerning tooth 11. The tooth was diagnosed with pulpal necrosis, and chronic apical abscess, and non-surgical root canal treatment was carried out. The canal was later obturated with mineral trioxide aggregate (MTA) for apical seal, followed by thermoplasticized gutta-percha and composite restoration. Patient was satisfied with the slight discoloration poses on the tooth 11 and decided for no intervention to date. CONCLUSION: Discolouration is one of the main concern in a non-vital tooth. Customization of treatment plans to accommodate not only the clinical complexities but also the unique expectations of each patient is a vital aspect in the management of traumatized tooth. The absence of the review follow up introduces a gap in my comprehensive assessment of the patient's progress. One notable consideration is the possibility of external bleaching, which may be explored if, at any point, the patient expresses dissatisfaction with her current tooth colour. KEYWORDS: dental trauma, mineral trioxide aggregate (MTA), open apex. Fakulti Pergigian Faculty of Dentistry
31 Abstract 04 APEXIFICATION V/S REVASCULARIZATION: A COMPARATIVE CASE SERIES Sivadas Ganapathy1 1 Department of Pediatric dentistry, AIMST University, Kedah, Malaysia. INTRODUCTION: Management of nonvital young permanent teeth poses several restorative and endodontic issues due to the age of presentation and complexity of child’s behavior. Traditionally, the most popular method for managing such teeth has been by apexification using calcium hydroxide. More recently, the use of mineral trioxide aggregate (MTA) to create an apical barrier followed by placement of a bonded core within the canal to strengthen the weakened roots has been the standard of care for nonvital teeth with open apices. Even though both these approaches have been used successfully over the years, both modalities have few important well documented drawbacks, one of which is the lack of continued root development. Recent improvements in dental materials and better understanding of the regenerative potential of pulp has led to a resurgence of interest in pulp regeneration techniques for management of open apices. Regeneration technique is not only a conservative approach but also enables the regeneration of a functional pulp-dentin complex. Since each of these procedures has a unique case-based indication, a thorough understanding of them is required. CASE REPORT: This case series compares apexification and revascularization for management of young non vital teeth. This case series explores the materials, outcome indications, advantages and disadvantages of both the procedure. The steps involved in each procedure will be briefly discussed. Fakulti Pergigian Faculty of Dentistry
32 Abstract 05 MANAGEMENT OF TRAUMATIC DENTAL INJURIES WITH EARLY AND LATE ENDODONTIC INTERVENTION: A TWO CASE REPORT Samsudin Nurulaqmar Iwani1,2 , Kamaruzaman Marlena1 , Jawami Afiq Azizi1 1 Centre of Comprehensive Care Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sg Buloh, Selangor, Malaysia 2 Conservative Dentistry Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu,16150, Kelantan Malaysia INTRODUCTION: Dark coronal darkening frequently occurs as a consequence of a traumatic dental injury. A number of publications have extensively discussed the diverse effects associated with dental trauma, including pulp necrosis, ankylotic root resorption, inflammatory root resorption, and pulp canal obliteration. CASE PRESENTATION: Case 1: A 26-year-old patient presented at our clinic with an acute apical abscess on the anterior upper teeth 11 and 12 associated with black discoloration. The patient had a history of trauma from more than 10 years ago. The patient suffered acute facial swelling on the right upper lips, and an incision and drainage were performed together with pus drainage from the canal. Root canal treatment (RCT) was performed on days 11 and 12. A review was done after 6 months with no clinical signs or symptoms and periapical healing on the radiograph. Case 2: The 21-year-old Malay man reported being involved in a motor vehicle accident (MVA) in June 2023, resulting in a dentoalveolar fracture on teeth 11, 12, 21, and 22 and soft tissue injuries. The fracture and mobility were stable after four weeks of post-operative care. The patient complained of pain on percussion and an endodontic evaluation of 11, 21, 22, and 12 patients diagnosed with pulp necrosis with an EPT-negative response. The RCT was conducted, and the review done after 6 months was successful. CASE DISCUSSION: In permanent teeth with vital pulps, intra-alveolar root fractures damage the pulp tissues. This mostly impacts the nerve and blood supply above the fracture line and frequently affects these particular upper front teeth. Continuous observation is necessary to achieve a conclusive diagnosis of the pulp, and immediate endodontic treatment reduces the coronal discoloration and other complications. CONCLUSION: Immediate management during dental trauma by a dentist has a significant effect on the long-term prognosis of the tooth. KEYWORDS: dentoalveolar fracture, endodontic treatment Fakulti Pergigian Faculty of Dentistry
33 Abstract 06 LOOK BEFORE YOU LEAP - MANAGEMENT OF COMPLICATED CROWN-ROOT FRACTURE: A CASE REPORT Selvaraj N1,3 , Mamat N1,3 , Taib H2,3 1Paediatric Dentistry Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia 2Periodontics Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia 3Hospital USM, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia INTRODUCTION: Complicated crown-root fracture is a severe dental injury that involves enamel, dentin, cementum, and pulp. Restorative treatment of complicated crown-root fractures is challenging due to the subgingival or subcostal location of the fracture. In these fractures, communication with the oral cavity to the pulp and periodontal ligament permits bacterial invasion and inflammation. As the healing cannot be anticipated, the treatment of complicated crown root fractures in children and young adults is often compromised. CASE PRESENTATION: A fourteen-year-old boy was referred to the Paediatric Dentistry Unit, School of Dental Sciences, for root canal treatment on the upper right central incisor. The patient has history of motor vehicle accidents two months prior and sustained soft tissue and dental injuries. Clinical and radiographical examinations were performed, and the diagnosis was a complicated crown-root fracture of tooth 21 as the fracture extends subgingiva, palatally. The case was discussed with a multidisciplinary team, and treatment options were given. Risks and benefits of the orthodontic extrusion, gingivectomy, or crown root lengthening and intentional replantation explained. Root canal treatment, post-placement, followed by gingivectomy and crown build-up were done. However, treatment for discolouration was overlooked. CASE DISCUSSION: Gingivectomy was performed to visualised the subgingival fracture and is used when the aesthetic part is not compromised. Surgical crown lengthening or gingivectomy are treatment options for a fractured tooth involving biological width. Violation of the supracrestal soft tissues may predispose apical migration of junctional epithelium leading to periodontal problems. Pulp necrosis, pulp tissue remnants, and inadequate removal of obturating material can cause discolouration of the crown. Intra-coronal bleaching is the treatment of choice and needs to be done before final restoration. CONCLUSION: Multidisciplinary management requires assessment and monitoring of the endodontic-periodontic status of complicated crown-root fractures for better prognosis. KEYWORDS: Biological width, Crown-root fracture, Discolouration, Gingivectomy Fakulti Pergigian Faculty of Dentistry
34 Abstract 07 MANAGEMENT OF TRAUMATIC MAXILLARY INCISOR WITH OPEN APEX USING BIOCERAMIC PUTTY IN A 27-YEAR OLD LADY: A CASE REPORT Mohd Nazrin Isa1 , Nurul Ain Ramlan1 , Afzan Adilah Ayoub1 1Centre of Studies for Comprehensive Care, Faculty of Dentistry, Universiti Teknologi MARA Sungai Buloh Campus, Jalan Hospital, 47000 Sungai Buloh, Selangor, Malaysia CASE PRESENTATION: A 27-year-old come with the primary concerns include poor aesthetics characterized by a dark grey look and awkwardness experienced while smiling. The patient had a history of bicycle accidents as a teenager. The tooth has never exhibited any symptoms. Upon clinical examination, it was seen that the right maxillary central incisor exhibited a dark grey coloration. The soft tissue surrounding the tooth appeared to be in a normal state. The periapical radiograph reveals a wide-open apex accompanied by a periapical lesion. Diagnosed as pulp necrosis with asymptomatic apical periodontitis associated with open apex. The treatment include root canal disinfection, apexification with bioceramic putty and intracanal bleach for aesthetic management. Subsequent follow-up at 6 months revealed good outcomes clinical and radiographically with no symptoms present and no signs of cervical resorption and resolution of periapical lesion. CASE DISCUSSION: The various applications of calcium hydroxide, including as its ability to disinfect and promote the formation of an apical barrier , emphasize its essential function in managing nonvital open apex cases. Nevertheless, the drawbacks of prolonged utilization of calcium hydroxide, such as an increased likelihood of root fracture, as well as the requirement for frequent monitoring and replacement of calcium hydroxide to ensure the creation of an apical barrier, should be taken into consideration. The case presents bioceramic putty as a highly effective material for creating an apical plug. It offers several advantages, including short setting time and good handling. This will overcome the long setting time issue commonly associated with other materials like MTA. These findings may be advantageous for future situations, prompting a re-evaluation of therapy and materials to achieve better outcomes. CONCLUSION: Implementing bioceramic putty as an apical barrier is a viable substitute for prolonged calcium hydroxide therapy. This approach effectively shortens the treatment duration and minimizes the number of patient appointments required. The use of a bioceramic putty as an apical plug can be highly effective in creating an apical barrier in immature permanent teeth with open apices. KEYWORDS: bioceramic putty; open apex; discolouration; maxillary incisor; trauma Fakulti Pergigian Faculty of Dentistry
35 Abstract 08 REVASCULARIZATION IN IMMATURE PERMANENT TEETH WITH NECROTIC PULP AND APICAL PATHOLOGY: A CASE SERIES Sivan HD1 , Azih NF1 1Unit Pakar Pergigian Restoratif, Klinik Pakar Pergigian Jalan Gambut, Kuantan, Pahang, Malaysia INTRODUCTION: Apexification, the treatment of choice when treating necrotic immature teeth has its shortcomings. Recently, the concept of revascularization of necrotic pulps has regained interest and became an alternative conservative treatment option. Here we present a case series of revascularization technique and results. CASE DESCRIPTION: Three healthy 18-year-old patients, one female and two males were referred for management of necrotic, immature, upper anterior tooth (21). All three patients experienced trauma to involved area about 8 years ago. Examination revealed generalized good oral hygiene. Tooth 21 in all 3 cases exhibit mobility (Grade 1), tender on percussion, and no carious cavities or abnormal probing depths. Periapical radiographs revealed periapical radiolucent lesions in relation to tooth 21 with root of normal length but thin, fragile walls and an open apex. Revascularization without the use of a scaffold was done on tooth 21 in all 3 cases. The 6- month follow-up review revealed mixed outcomes. Case DISCUSSION: The recommended protocol for revascularization includes the induction of bleeding to form a blood clot in the canal space which would consists of cross-linked fibrin that serves as a pathway for migration of stem cells, macrophages, and fibroblasts from the periapical area. Several studies have reported on revascularization using blood clot as a matrix. However, formation of an intracanal blood clot is not always predictable. Clinical outcomes could be improved with the use of a scaffold. CONCLUSION: This novel procedure, by exploiting the full potential of the pulp for dentine deposition produces a stronger mature root that is better able to withstand fracture, thus leading to better success rates. Fakulti Pergigian Faculty of Dentistry
36 Abstract 09 EXTRA ALVEOLAR ENDODONTIC TREATMENT FOR TOOTH AVULSION: AN UNPOPULAR APPROACH Wan Hassan W.N.S1 ., Puteh S.¹ 1Department of Paediatric Dentistry, Sultanah Nur Zahirah Hospital INTRODUCTION: Tooth avulsion is defined as the complete dislocation of a tooth from the alveolar bone and soft tissue socket. The prevalence of tooth avulsion among adults aged 18 years and above ranged from 5% to 15%. According to the Clinical Practice Guidelines for Avulsed Permanent Anterior Teeth by the Ministry of Health, Malaysia in 2019: immediate extra-oral endodontic treatment is recommended if dry time exceeds 60-minutes. This alternative is timeefficient and convenient for the patient, yet it is still uncommon among dental practitioners. CASE PRESENTATION: A 14-year-old boy was referred to the hospital five hours after alleged fall and sustained avulsion of tooth 21. The tooth was brought along in an empty container. The tooth was gently rinsed with normal saline, replanted, and splinted temporarily using glass ionomer cement from teeth 13 to 23. The patient was recalled a day later; however, the splint was dislodged, and tooth 21 was extremely mobile. Hence, extra-oral pulp extirpation and obturation was opted for. Later, the tooth was replanted and secured with composite-wire splint for up to 4 weeks. The intra-oral periapical x-ray, which was taken immediately after replantation revealed the well-positioned tooth 21 in the socket, and the root canal was obturated thoroughly. After 10 months, the tooth was asymptomatic, firm, and had no periapical radiolucency. CASE DISCUSSION: In this case, early pulp extirpation was done to minimize the possibility of inflammatory root resorption. The degree of contamination of the root surface of an avulsed permanent anterior tooth is a risk factor for root resorption, hence, contamination on the root surface was gently removed with damp gauze and by washing with saline. CONCLUSION: Immediate replantation of an avulsed permanent anterior tooth is the main philosophy for treatment success and offers long term prognosis, thus, satisfy the functional and aesthetic concerns. KEYWORDS: tooth avulsion, extra-alveolar endodontics, replantation Fakulti Pergigian Faculty of Dentistry
37 Abstract 10 REPLACEMENT OF THREE LOST MAXILLARY PERMANENT INCISORS DUE TO TRAUMA: A CASE REPORT Khalid NKN1 , Kamarudin A1 , Mamat N1 , Mat Ali UM2 , Ariffin A3 1Paediatric Dentistry Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan Malaysia 2Orthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan Malaysia 3Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan Malaysia INTRODUCTION: A quarter of all school children may experience traumatic dental injuries and in 3% of cases, the anterior teeth are lost as a result of avulsion. Missing anterior teeth due to trauma leads to negative consequences. Hence, appropriate management and long-term monitoring are essential for their successful rehabilitation. CASE PRESENTATION: A healthy 9-year-old boy was referred to the Paediatric Dentistry Unit, with the chief complaint of aesthetic concern associated with missing of tooth 11, 21 and 22 due to avulsion which occur 3 months earlier. During examination, patient was cooperative however, he seemed uncomfortable to smile. An acrylic removable partial denture was fabricated to replace the missing upper anterior teeth while retaining the mixed dentition's features, appearance, and functionality. At 1 month follow up, it demonstrated a successful achievement regarding patient’s satisfaction on aesthetic and functional rehabilitation. Regular follow-up appointments will be delivered to the patient to monitor the adaptation of the prosthesis, as well as the growth and development of dentition. CASE DISCUSSION: Loss of anterior teeth due to trauma can affect the child’s overall well-being, self-esteem, and quality of life. In addition to that, missing anterior teeth results in malocclusion, altered speech, development of oral habits, and it can compromise the overall arch integrity. Appropriate management strategies will prevent and reduce these physical and psychological trauma to the children. Removable partial denture with acrylic base is an effective option for replacing missing teeth in children as it is easily modified as the child grows. CONCLUSION: Removable partial denture rehabilitation exhibits satisfactory improvement in aesthetic, functional and psychological needs of growing patients. Regular follow-ups are required because of the growth and development in children and to plan for definitive prosthetic treatment once they reach adulthood. KEYWORDS: paediatric dentistry; rehabilitation; tooth loss Fakulti Pergigian Faculty of Dentistry
38 Abstract 11 RAPIDLY PROGRESSIVE EXTERNAL INFLAMMATORY ROOT RESORPTION: A CASE REPORT Mahdi ND1 and Kamarudin A1 1Unit of Paediatric Dentistry, Universiti Sains Malaysia INTRODUCTION: External inflammatory root resorption (EIRR) can occur in two locations, either at the apex of the tooth or at any other location along the length of the tooth root. If it occurs after trauma, it is most commonly lateral inflammatory resorption. CASE PRESENTATION: A 13-year-old, healthy Malay boy was referred for management of tooth avulsion of 21 and a few teeth with uncomplicated crown fractures. Total extraoral time and extraoral dry time were 17 hours and 5 hours, respectively. Extraoral pulp extirpation and intracanal medication with non-setting calcium hydroxide were placed before replantation. Flexible splinting for 4 weeks was placed. At the 2 week review, he presented with blackish discolouration at the cervical area of tooth 21. The composite wire splint was removed after four weeks. Root canal treatment continued, and the canal was obturated with gutta-percha as there was no sign of resorption post-6-month injury. Non-vital single-visit internal bleaching was done, and during the subsequent visit, loss of lamina dura and signs of EIRR were noted, further progressing from the middle 1/3rd of distal root extended to apically. However, the tooth was asymptomatic and not mobile. CASE DISCUSSION: The literature review suggested that a corticosteroid-antibiotic (CS-AB) intracanal medicament is particularly useful in the management of EIRR. Interceptive protocol for 15 months of intracanal medication has been suggested to induce a hard tissue barrier. CS-AB medicament for 6 weeks, followed by a 50:50 mixture of CS-AB and calcium hydroxide after another 6 weeks if the EIRR has not progressed. Subsequently, it is replaced with calcium hydroxide every 3 months up to 1 year until hard tissue repair of the resorptive lesion is evident. CONCLUSION: Calcium hydroxide should not be used as an immediate medicament because of its irritant properties, but it is valuable as a subsequent medication. KEYWORDS: avulsion, external inflammatory root resorption, extraoral time, extraoral dry time Fakulti Pergigian Faculty of Dentistry
39 Abstract 12 IN THE AFTERMATH: A TALE OF TWO TEETH’S UNIQUE DESTINY Rajendran K1 , Kamarudin A1 , Baharin F1 , Mahmood Z1 1Paediatric Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia INTRODUCTION: Traumatic dental injuries (TDIs) are prevalent in the permanent teeth of children and young adults, particularly affecting the maxillary central incisors. Treating such cases, particularly involving young immature teeth is challenging due to thin walls, and complex anatomy which increases the reinfection risk and root fracture. CASE PRESENTATION: A healthy 9-year-old girl was referred for the management of caries. Incidentally, it was found that her tooth 21 had a sinus tract. Further history revealed a dental trauma two years ago, which led to fractures in teeth 11 and 21 with increased mobility. She received restorations for the fractured teeth but defaulted subsequent follow-ups. Intraorally, teeth 11 and 21 had no mobility, discoloration, or tenderness. However, both teeth did not respond to pulp sensibility testing. Radiographically, tooth 21 displayed a periapical radiolucency with an immature root tooth, while 11 showed complete pulpal canal obliteration (PCO). The roots of both teeth were stunted. Regenerative endodontic procedures (REPs), incorporating triple antibiotic paste, were performed on tooth 21, accompanied by the unique approach of using a sterile pink 20-gauge branula to induce bleeding. Tooth 11 was conservatively monitored. Positive outcomes were seen on tooth 21 at the 3rd and 6th-month recalls, with no pain, response to cold test, resolution of the sinus tract, and periapical radiolucency. CASE DISCUSSION: This case is notable for showcasing the contrasting reactions of two seemingly identical teeth, the maxillary right and left permanent central incisors, to the dental injury. Notably, the case introduces the innovative use of a branula for apical induction, a method not commonly observed in conventional regenerative endodontic procedures. Additionally, the case emphasizes the positive outcome of using REPs in managing delayed trauma presentations. CONCLUSION: The clinician should be able to delineate appropriate treatment to manage the adverse sequelae following dental trauma, ensuring the preservation of aesthetics, tooth function, and longevity. KEYWORDS: Maxillary central incisors; Pulpal Canal Obliteration; Regenerative Endodontic Procedures; Traumatic Dental Injuries Fakulti Pergigian Faculty of Dentistry
40 Abstract 13 CUSTOMIZING THE PREFABRICATED POST IN A STRUCTURALLY COMPROMISED ENDODONTICALLY TREATED CENTRAL INCISOR: AN INNOVATIVE APPROACH TO CONSERVE A TOOTH Ismail N1 , Ismail NH1 , Yuen CY2 , Mohd Fauzi RR2 1Paediatric Dental Specialist Clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan 2Restorative Specialist Clinic, Seremban, Negeri Sembilan INTRODUCTION: Managing traumatic dental injury following previously endodontic-treated teeth can be challenging as the tooth was already compromised and brittle. CASE PRESENTATION: A healthy 13-year-old Malay female came with a complaint of mobile crown Tooth 21 after allegedly being hit by a basketball 2 weeks prior. Last 2 years, the same tooth was diagnosed with a complicated crown fracture and has been treated with gutta-percha (GP) obturation followed by pin-retained composite core as the final restoration. Currently, the affected Tooth 21 has sustained a crown-root fracture at the cervical area. Hence, surgical decoronation was decided to preserve the alveolar bone height and width as the patient is still in the growing phase followed by an upper removal denture as interim restoration. Upon GP removal, an intraoral periapical radiograph (IOPA) revealed that apical 1/3 obturation material could not be removed after several attempts, and consultation with the restorative unit was done to assist with the removal of the remaining obturation material under a microscope examination. Microscope exploration confirmed that the apical 1/3 of the root was originally treated with MTA, with a perforation noted on the lingual surface. Therefore, the afflicted tooth was restored by making modifications to the prefabricated post and core and the root perforation was repaired using MTA. The smile on the adolescent was brought back after tooth 21 was restored with composite buildup. CASE DISCUSSION: This case highlights an innovative approach to conserve a structurally compromised endodontic-treated central incisor with cervical root fracture. Ultimately, endodontics and prosthodontics aim to preserve a tooth for as long as possible for the growing patient. CONCLUSION: A multidisciplinary approach is advisable when it comes to outweighing the realistic concerns regarding structurally compromised endodontic-treated teeth versus the patient’s wish to retain the so-called “non-restorable” tooth which had multiple episodes of dental trauma. KEYWORDS: Endodontics, Post-Core Technique, Tooth Injuries Fakulti Pergigian Faculty of Dentistry
41 Abstract 14 MANAGEMENT OF TRAUMATIZED IMMATURE PERMANENT INCISORS USING BIODENTINE Muhd Noor N1 , Zuhir O1 , Abdul Rahman MS2 , Marsom A1 1Department of Paediatric Dentistry, Hospital Selayang 2Department of Paediatric Dentistry, Hospital Melaka INTRODUCTION: Managing dental trauma in immature permanent teeth is challenging due to the complexity of complications and treatment needs. Common complications are extensive loss of tooth structure, necrotic pulp, inflammatory or replacement resorption with incomplete root development. The conventional approach often consumes multiple treatment visits and gives uncertain results. Using the newest bioactive material containing calcium silicate in such cases may improve the prognosis of traumatized teeth in young children. CASE PRESENTATION: Three cases were presented with different types of injuries and their sequelae. All teeth affected are the upper permanent incisors with immature roots and necrotic pulp. The first case is a severely intruded tooth that was surgically repositioned and managed with total obturation with Biodentine. The second case was a subgingival crown-root fracture managed with rapid orthodontic extrusion, gingivectomy, Biodentine apical plug, and post and core. The third case is a reimplanted avulsed tooth that developed external root resorption. The resorption was treated and arrested with corticosteroid-antibiotic paste followed by total obturation with Biodentine. DISCUSSION: Management of immature roots using Biodentine is a possible alternative therapy that could provide equally satisfying clinical results when regenerative endodontic treatment is not viable, particularly in dental trauma cases with a risk of root resorption or extensive loss of crown structure, which requires post and core placement into the canal system. Calcium silicate-based cement adheres to root dentine and initiates calcium and silicate uptake by the dentine. Its high alkalinity may help to arrest osteoclastic action in root resorption. These superior physical properties may eventually enhance fracture resistance and compressive strength, promote periapical healing and arrest the progression of root resorption. CONCLUSION: The use of Biodentine in a wide range of injuries in immature teeth offers a paradigm shift, thus resulting in immediate completion of treatment, less dental visits and successful outcomes. KEYWORDS: Biodentine; immature tooth; root resorption; trauma Fakulti Pergigian Faculty of Dentistry
42 Abstract 15 PULP PROLIFERATION IN TRAUMATIZED PRIMARY TOOTH: AN UNUSUAL PRESENTATION Wan Rossly WNS1 , Selvaraj N2 , Mamat N2 1Dental Clinic, Hospital USM, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia 2Paediatric Dentistry Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan Malaysia INTRODUCTION: The occurrence of pulp proliferation or hyperplastic pulpitis following traumatic injury in primary teeth is uncommon and more prevalent in children under 2 years of age. If the fracture of the crown exposes the pulp to oral environment, early treatment is crucial to minimize bacterial invasion and promote healing of pulp. CASE PRESENTATION: A healthy 1 year 7 months old girl presented to the Paediatric Dental Clinic, Hospital Universiti Sains Malaysia with complaint of pain and overgrowth of tissue from the upper anterior teeth. A detailed history revealed that the child had alleged fall at home and sustained a dental trauma 10 days prior. Mother did not seek for any treatment at that time. Clinical and radiographical examination were performed and revealed a complicated crown-root fracture of tooth 51 and 61 with pulp polyp protrusion from the fracture line on the labial surface. In view of the fracture line extended subgingivally, presence of occlusal disturbances and patient’s uncooperativeness, extraction of tooth 51 and 61 was done. DISCUSSION: Pulp polyp occurrence is associated with pulp’s reactivity and resistance towards bacterial invasion. Thus, it suggest the absence of necrosis. Many clinicians are unaware of treatment alternatives for traumatized primary tooth with pulp polyp and often opt for extraction. However, studies have shown that endodontic treatment in these cases may prevent early primary tooth loss. CONCLUSION: It is important for dentist to know factors that should be taken into consideration in managing traumatic tooth with pulp polyp and endodontic treatment should be one of the treatment options. In this case, the presence of crown-root fracture increases the need for tooth extraction because it may complicate endodontic and restorative treatments. Hence, to achieve a successful outcome, dentist needs to weigh the risks and benefits of the treatment to avoid unfavorable sequelae. KEYWORDS: Crown fracture; primary tooth; pulp polyp Fakulti Pergigian Faculty of Dentistry
43 Abstract 16 COMPLEXITY OF DENTAL REHABILITATION POST-TRAUMA Nik Norfathiah binti Nik Muhammad Nasir 1 , Mohd Asmawardi bin Abdullah1 , 1 Department of Oral Maxillofacial Surgery, Hospital Kuala Lipis, Pahang INTRODUCTION: Traumatic dental injury (TDI) is considered a challenging public health, concerning with a great impact on a person’s quality of life since it could be a potentially lifechanging event. Among commonest cause of TDI are motor vehicle accidents, fall and sport injuries. CASE PRESENTATION: A 32-year-old Malay male alleged motorbike skidded and was managed at Emergency Department of Hospital Kuala Lipis. This patient sustained comminuted fracture on upper and lower anterior alveolus, extrusive luxation of tooth 12, avulsions of teeth 11 and 21(missing at scene), subluxations of teeth 42 and 22. On initial examination, teeth 42 and 22 presented with mobility grade I. Extraction of tooth 12 was done due to mobility grade III hence poor prognosis. An eyelet wiring was placed at the comminuted dentoalveolar segment from teeth 32 to 41. Upon follow up review of 4 weeks, eyelet wiring was removed. Intraoral periapical (IOPA) x-rays for teeth 22, 32 to 41 were taken, and pulp sensibility test was done. Teeth 32 and 31 showed non-vital and pulp extirpation of teeth 32 and 31 were done. After 5 month of multiple review visits, extraction of teeth 22, 32-42 had to be done due to persistent symptoms and grade III mobility. Computed tomography (CT) scan showed bone insufficiencies for both arches. Anterior maxilla and mandible ridge augmentations with bone grafting from iliac crest was done under general anesthesia followed by a successfully placement of eight implants under general anaesthesia. After osseointegration, he is planned for construction of crowns and bridges prosthesis. CONCLUSION: Severe trauma on dentoalveolar region is not only damaging to dentition, but also possess challenges on rehabilitation requires high clinical skill and patient commitment physically and financially. Concomitant dentoalveolar fractures and dental trauma will greatly reduce prognosis of the associated teeth. Fakulti Pergigian Faculty of Dentistry
44 Abstract 17 ENCROACHING THE FORBIDDEN TOOTH GERM TERITTORY- A PECULIAR CLINICAL QUANDARY M Madawana ASHWINI1 , Kamarudin AIMI1 and Zahari NURUL AINIZA2 1Paediatric Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia INTRODUCTION: Intrusive luxation injuries are not uncommon in young children and primary dentition. The management of these injuries is challenging due to the sequalae of injury and difficulty to obtain compliance from a very young child. This paper aimed to report a case of a severe type of intrusive luxation in primary tooth and its management while discussing alternative approaches. CASE PRESENTATION: This case reports a management of a peculiar intrusion injury of a single deciduous tooth in a 4-year-old girl presented to the Emergency Department after having alleged a fall from the motorbike. An intraoral periapical radiograph (IOPA) revealed the root of maxillary left lateral incisor was in close proximity with the permanent tooth germ. The tooth was conservatively managed by leaving in situ in view of patient’s age, level of cooperation and parents’ preference. At 6 months review, the tooth showed signs of eruption and was slightly rotated. However, radiograph showed the injured tooth had signs of internal resorption at the cervical region and the permanent tooth germ was symmetrical to the developing contralateral tooth germ. No other signs and symptoms were elicited by the patient. CASE DISCUSSION: According to the latest IADT guidelines, the tooth should be allowed to spontaneously reposition itself, irrespective of the direction of displacement. Clinicians should anticipate spontaneous improvement in the position of the intruded tooth which usually occurs within 6 months up to 1 year. Follow up is mandatory to observe any signs of pathosis or unfavourable outcome that is suggestive for active management such as extraction. However, in this peculiar case, is it then necessary to extract the tooth when it presented with internal resorption? In our case, keeping in mind the age of the patient, extraction would be traumatizing considering the difficulity in obtaining cooperation to take an intraoral radiograph. In addition, the tooth is asymptomatic and showing signs of eruption. Therefore , we opted on an approach that is non- invasive and to continue monitoring until the eruption time of permanent tooth. CONCLUSION: It is necessary to perform regular monitoring based on the guideline for intrusive luxation on primary teeth. A non-invasive approach should be opted for managing intrusive luxation in primary teeth unless there is clear justifications such as pulp necrosis or disturbance to permanent tooth germs. KEYWORDS: deciduous, injury, intrusion, trauma, resorption Fakulti Pergigian Faculty of Dentistry
45 Abstract 18 SHINING PAST THE GOLDEN HOUR?: A DELAYED TOOTH REPLANTATION Subramanian SHALINI1 , Harun NOR ASILAH2 1Dental officer, Dental and Maxillofacial Surgery Unit, Sultan Ahmad Shah Medical Centre @IIUM, Jalan Sultan Ahmad Shah, 25200, Kuantan, Pahang, Malaysia. 2Specialist, Department of Pediatric Dentistry, Kulliyyah of Dentistry, IIUM Kuantan Campus, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200, Kuantan, Pahang, Malaysia. INTRODUCTION: Tooth avulsion is the complete displacement of a tooth out of its socket and the preferred treatment is immediate replantation. The long term prognosis of replantation depends on the storage media used and the extraoral dry time of the avulsed tooth. This case report highlights the management of an avulsed maxillary central incisor by replantation after the extraoral dry time of eight hours. CASE PRESENTATION: A 10-year-old male presented with a dental injury to the anterior maxillary region sustained from a fall. Clinical examination revealed multiple abrasion wounds on the face and an avulsed immature tooth 21. The tooth had been wrapped in tissue for 8 hours and kept in saliva for another 2 hours. Tooth 21 was replanted according to existing guidelines and stabilized in place with composite splinting followed by endodontic treatment. After 10 months, root resorption was noted over the mesial surface of root 21. CASE DISCUSSION: Avulsion causes damage to the gingiva, periodontium and pulp. In literature, teeth replanted within 60 minutes had good prognosis. Ideally, an avulsed tooth should be replanted immediately or stored in a suitable medium to prevent dehydration of the periodontium tissues. Several studies have shown that extended extraoral dry time will lead to root resorption. Nevertheless, replantation of an avulsed tooth for a child is still indicated even if the prognosis is poor. CONCLUSION: In cases of avulsed permanent teeth with extended dry time, replantation may be performed if the patient and parents agree and understand the benefits and complications that may occur. This case will require long-term follow-up and prosthodontic management may be indicated later. KEYWORDS: Dental trauma; Immature tooth; Tooth avulsion; Tooth replantation Fakulti Pergigian Faculty of Dentistry
46 Abstract 19 INTEGRATIVE APPROACH OF AESTHETIC REHABILITATION IN A DELAYED POST-TRAUMATIC COMPLICATIONS CASE Rahimi SN1 , Mohd Hafiizh AM1 , Yacob N1 , Sabarudin MA1 1Faculty of Dentistry, Universiti Sains Islam Malaysia, Jalan Pandan Utama, 55100, Kuala Lumpur, Malaysia INTRODUCTION: Delayed complications following traumatic dental injury (TDI), particularly those involving missing anterior teeth, can lead to significant social embarrassment and impact an individual's self-esteem and quality of life. CASE PRESENTATION: This case report discusses multidisciplinary management of a 33-yearold healthy Malay lady presented with social embarrassment due to a missing anterior tooth and discoloration of an anterior crown, negatively impacting her smile. She had history of motor vehicle accident (MVA) in 2016 and sustained a direct impact dental trauma affecting teeth 12 to 22. Patient reported that her teeth were splinted for one month, and tooth 12 underwent root canal treatment (RCT) followed by a porcelain fused to metal (PFM) crown. Subsequently six years later, 22 became mobile and was extracted, revealing a severe buccal bone defect. During examination, she presented with discoloured 12, median diastema, and missing 22 with 5mm horizontal buccal bone defect. She was diagnosed with generalized periodontitis, discoloured 12, pulp necrosis with chronic apical abscess of 11, and missing 22 with a significant buccal bone defect. Multidisciplinary interventions were implemented for the patient, including periodontitis management, endodontic treatment, guided bone regeneration (GBR) surgery and prosthodontics rehabilitation. Definitive restorations planned for patient included multiple fixed prostheses: redo crown on 12 with full ceramic, full ceramic crown on 11, and a distal cantilever resin bonded bridge on 21 to 22 with a specially designed incisal-labial overlap veneer on tooth 21, to address both missing tooth and median diastema. CONCLUSION: As a conclusion, the multidisciplinary approach significantly improves the aesthetic appearance and the patient's psychological well-being, effectively addressing the patient’s social embarrassment. The innovative veneer-bridge design planned for this patient will preserve more natural tooth structure, respecting the principles of minimally invasive dentistry. KEYWORDS: aesthetics; bone deficiencies; discolouration; tooth vitality Fakulti Pergigian Faculty of Dentistry
47 Abstract 20 SURGICAL MANAGEMENT OF FACIAL NEGLECTED FRACTURE: A CASE REPORT Mahardika R1 , and Julia V1 , Hariar A R2 1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Indonesia 2Department of Oral and Maxillofacial Surgery Persahabatan Central General Hospital INTRODUCTION: Neglected fractures of the maxillofacial region require a comprehensive evaluation and complex surgical intervention. Delayed management and surgical intervention in patients with facial fractures make these cases more challenging and complicated. This case report aims to explain the surgical management of neglected fractures of the mandible and zygomaticomaxillary (ZMC) complex. CASE PRESENTATION: A 21-years-old patient with a neglected fracture involving the mandibular parasymphysis, mandibular corpus, and comminuted ZMC came to Persahabatan Central General Hospital with a history of a road traffic accident in the previous 3 months. Clinical examination revealed facial asymmetry with steps along the left parasymphysis, infraorbital, and left zygoma region. The patient was diagnosed with a neglected oblique fracture of the left parasymphysis and left ZMC. Radiographic examinations, including 3D CT scans of the head and face and 3D model printing by Stereolithography (SLA), were used to assist the preoperative pre-bending process of the plate and mesh in obtaining adequate bone adaptation. Surgical intervention with open reduction and internal fixation (ORIF) technique with miniplate and mesh was used. Postoperative care and follow-up aimed to achieve normal occlusion and restore oral function. CASE DISCUSSION: Neglected fractures demand a meticulous and individualized approach. Early diagnosis and intervention remain crucial for optimal outcomes in facial fractures. In this case, surgical interventions included ORIF with miniplate and mesh construction. The use of surgical planning and 3D model printing facilitated precise anatomical reconstruction. CONCLUSION: This case emphasizes the importance of early treatment of facial fractures to achieve optimal outcomes, prevent higher morbidity, and long-term patient rehabilitation. KEYWORDS: neglected fracture; open reduction and internal fixation; parasymphysis fracture; stereolithography; ZMC complex fracture Fakulti Pergigian Faculty of Dentistry
48 Abstract 21 NOVEL APPROACH TO MANAGING DENTAL TRAUMA IN A CHILD WITH AUTISM Raja Mohan DHANIYA RANI1 , Sinnumu Naidu BAVANI1 Vijayakumar THAARANI1 1Department Of Paediatric Dentistry, Kajang Hospital, Selangor INTRODUCTION: Paediatric dentistry is a specialized field focused on providing comprehensive preventive and therapeutic oral healthcare for individuals under the age of 16, including those with special health needs. Studies have shown an increased risk of dental trauma among children with autism spectrum disorder (ASD), ranging from 30–39%. This can be attributed to their predisposition to aggression which may lead to self-injuries. Furthermore, children with ASD have the tendency to present with class II malocclusion with incisor flaring increasing risk of trauma to the upper incisors. CASE PRESENTATION: A 11-year old male with ASD allegedly had a fall and sustained mild extrusion of 11. Tooth 11 was repositioned and splinted from 12 to 22 under local anaesthesia. Standard follow up protocol was carried out to assess the tooth sensibility in accordance to IADT guidelines however, sensibility tests proved to be unreliable due to sensory issues, prompting reliance on clinical and radiographic parameters to assess tooth condition. Patient underwent a multidisciplinary discussion session, and consensus was reached to initiate a twin-block appliance once tooth 11 had stabilized. Subsequent periodic clinical and radiographic assessments indicated the tooth remained vital. However, given the impending commencement of orthodontic treatment, it is imperative to schedule regular recalls for this child and clinicians are required to closely and carefully monitor signs of compromised vitality of tooth 11, allowing timely intervention if needed. CONCLUSION: Managing dental trauma of patients with ASD presents unique challenges for clinicians, primarily attributed to the handling of sensory issues. Existing trauma guides recommend periodic monitoring of pulp status. However it can be exceptionally challenging to interpret nonverbal cues with regards to the perception of pain and sensory response of standard vitality tests. It is crucial for clinicians to be aware of these unique challenges and tailor their therapeutic approaches accordingly taking into account the special child’s distinctive characteristics and potential vulnerabilities Keywords: ASD, Dental trauma, Tooth extrusion, Pediatric dentistry Fakulti Pergigian Faculty of Dentistry
49 Abstract 22 SUBCILIARY AND VESTIBULAR APPROACH FOR REDUCTION AND FIXATION OF LE FORT I AND PARASYMPHYSIS MANDIBLE FRACTURE : A CASE REPORT Suhandi H.U.1 , Latief M.A.1 , Haria A.R.2 1Resident, Department of Oral & Maxillofacial Surgery, Faculty Dentistry, University of Indonesia, Jakarta, Indonesia INTRODUCTION: Fractures of the maxillofacial bones can impact the physiologic and aesthetic aspects of the patient’s face. It is not uncommon that the management of complex facial fractures remains a challenge for oral and maxillofacial surgeons. Here we present multiple facial fractures reduced and fixed using vestibular and subciliary approaches. CASE DESCRIPTION: A 20 year-old male brought to ED after getting in a traffic accident 6 hours before admission. He was riding a bike around 50 km/h until he hit a car in front of him. He was still conscious after the accident and was brought to the nearest clinic, then referred to hospital. Physical examinations showed raccoon eyes, tenderness and crepitations in infraorbital, zygoma and right mandibular parasymphysis. Malocclusion, anterior and posterior open bite, floating maxilla, and Guerin sign were noted. Further examinations showed unremarkable laboratory with normal chest and cervical x-ray. From the skull CT showed Le Fort 1 fracture, right mandibular parasymphysis fracture, and palatal fracture type 2. The patient was planned for ORIF using combined subciliary and vestibular approach. The reduction and fixation of the fractures were done using mash and plates. DISCUSSION AND CONCLUSION: In this case, we did the ORIF of the fracture of the mandibular parasymphysis through the vestibular approach to minimize the scar. ORIF of the Le Fort 1 fracture in this patient was done through combined superior vestibular incision and subcilliary incision to maximize the access and visualization of the maxillary fracture yet minimize the scar impact. Although subciliary incision can cause complications, there is no technique more superior than others, thus decision of the technique used should be considered by case KEYWORDS: Le Fort fracture, Mandibular parasymphysis fracture, ORIF Fakulti Pergigian Faculty of Dentistry
50 Abstract 23 MANDIBULAR FRACTURES IN CHILDREN: A COMPREHENSIVE CASE SERIES ON MANAGEMENT AND OUTCOMES Mohd Zulfadli Harun1 , Sumathy Perumal1 , Suhailiza Saharudin1 1Department of Paediatric Dentistry, Hospital Raja Permaisuri Bainun Ipoh, Perak, Malaysia INTRODUCTION: The dynamic nature of facial and dental development poses significant challenges in the management of paediatric mandible fractures. Management of such fractures differs from that in adults, where open reduction and internal fixation commonly preferred in older patients. There are other various treatment modalities available for managing mandibular fractures in children. This case series highlights the importance of non-invasive therapies for the best results in managing mandibular fractures in paediatric patients. CASE PRESENTATION: Three cases of paediatric mandibular fractures are presented in this case series, each demonstrating the effectiveness of our management approach. The first case involved a 4-year-old with a left parasymphysis mandible fracture and bilateral condyle fractures. The second case featured an 8-year-old with left ramus and right parasymphysis fractures; while the third case focused on a 14-year-old patient diagnosed with a right parasymphysis mandible fracture. CASE DISCUSSION: Our approach focused on the appropriate use of cap splints and lingual splints to accommodate the unique needs of developing dentition and growing mandibles. The concomitant fixation of these splints using circummandibular wires ensured stability during the healing process. These comprehensive and conservative approaches allowed preservation of occlusion and, continued growth and development of mandible in children. The utilization of ageappropriate techniques demonstrated individualized care and the unique anatomical considerations inherent in managing paediatric mandibular fractures. CONCLUSION: This case series contributes valuable insights into the nuanced field of paediatric mandibular fracture management. Our approaches demonstrated the effectiveness of non-invasive interventions by comprehending the dynamic facial and dental growth in young children. These conventional yet effective techniques ensured optimal outcomes and the sustained well-being of young patients. KEYWORDS: Paediatric mandible fractures; conservative management; splints; circummandibular wiring Fakulti Pergigian Faculty of Dentistry