- Email: [email protected]
Maxillofacial trauma trends
Periodontology (18 articles), followed by the Journal of Dental Research (16 articles). Discussion.—Among the most cited articles, the majority were clinical studies, especially case series and narrative reviews and/or expert opinions. The fields of periodontology and implantology were most often the topic of these studies. Most of the articles were published in dental journals considered to have a high impact factor.
Clinical Significance.—Although there are limitations in this review, it points out important information about some of the assumptions regarding what constitutes a ‘‘classic reference’’ in the field of dentistry. Traditionally, any reference cited at least 100 times is considered classic and usually represents an historical reference point in the development of an area. The least number of times a reference on this list was cited was 326, so many articles that would be considered classic are missing. The fact that some articles with a high number of citations may have been excluded because the journal is no longer included in the category searched may also affect the outcome. In addition, there is no way to eliminate self-citations or to identify if a ‘‘snowball effect’’ of citing references because they have received numerous citations in the past is at work. It has also been assumed that the true impact of a study cannot be assessed sufficiently until at least 20 years after
publication. This might explain the high number of articles that came from the decades of the 1980s and 1990s. Older articles are usually cited more frequently, with more recent articles frequently undervalued. In this review, only nine articles since 2000 are included. The emphasis on clinical content is also seen in other disciplines such as general surgery, anesthesia, and orthopedic surgery. Disappointingly, most articles presented evidence at the levels of 4 and 5, and the list included only two randomized clinical trials and two systematic reviews/meta-analyses. Thus the level of evidence does not necessarily correlate with the number of citations—as has been noted in other medical fields. Many articles came from journals that have a high impact factor ranking. The impact factor of a journal is not determined just by the number of citations of the most relevant articles, but by the total number of citations in a given year by all of the articles published in the previous 2 years. Other factors may include an increase in the relevance of some journals or a decrease in the relevance of others.
Feijoo JF, Limeres J, Fernandez-Varela M, et al: The 100 most cited articles in dentistry. Clin Oral Invest 18:699-706, 2014 Reprints available from P Diz, School of Medicine and Dentistry, Special Needs Unit, c/Entrerrıos sn, 15782 Santiago de Compostela ~a, Spain; e-mail: [email protected] A Corun
Dental Trauma Maxillofacial trauma trends Background.—Various factors appear to influence the incidence and etiology of maxillofacial fractures. Among these are geographic area, whether the population is urban or rural, population density, and socioeconomic status. Motor vehicle collisions (MVCs) are a significant cause of these fractures, along with assaults, sports injuries, occupational pursuits, domestic violence, and falls. Soft tissue injuries, neurologic trauma, and orthopedic injuries often accompany and are correlated significantly with maxillofacial fractures. Some concomitant injuries can be life-threatening, including cerebral trauma, hemorrhagic shock, hemopneumothorax, and airway compromise. More than 6% of patients who suffer maxillofacial fractures
require a life-saving emergency intervention. The incidence and etiology of maxillofacial fractures seen in a single trauma center were evaluated over the period between 1984 and 1990 (1990 study) and the period between 2004 and 2010 (2010 study) to determine if differences exist. Methods.—The records of patients with maxillofacial fractures were retrospectively studied over the two time periods at the authors’ institution. Number of fractures, mechanism of injury, patient age, and mortality were compared. Results.—In the 1990 study, 152 midface and 306 mandibular fractures occurred, for a total of 458
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age 21 to 40 years and 14.5% in those at least age 66 years. Ninety-nine patients died from their injuries in the 2010 study, with 27.3% from an MVC, 26.3% of a fall, 15.2% of an MCC, 8.1% of a pedestrian strike, 8.1% of penetrating trauma, 2% of a sports injury, and 3% of other causes. Analyzing specifically patients whose mechanism of injury was a fall showed a significant relationship between increased age and mortality, with those at least age 66 years accounting for 44.1% of all falls and 3.9% of those dying. Fig 1.—Comparison of main mechanisms of injury. Abbreviations: MCC, Motorcycle collision; MVC, motor vehicle collision. (Courtesy of Martinez AY, Como JJ, Vacca M, et al: Trends in maxillofacial trauma: A comparison of two cohorts of patients at a single institution 20 years apart. J Oral Maxillofac Surg 72:750-754, 2014.)
maxillofacial fractures. Assault was the mechanism of injury for 48.8% of patients, MVCs for 39.1%, motorcycle collisions (MCCs) for 4%, sports injuries for 3.8%, falls for 3.6%, and occupational pursuits for 0.7%. In the 2010 study, 1313 midface and 418 mandibular fractures occurred, for a total of 1731 maxillofacial fractures. Some of the causative classes were merged for comparison purposes, specifically, MVCs included pedestrian strikes and ATV crashes, MCCs included moped injuries, and assaults included abuse and penetrating injury. Assault was the mechanism of injury for 29.7% of patients, MVCs for 29.6%, falls for 22.1%, MCCs for 8.5%, sports injuries for 3.7%, and other for 6.4% (Fig 1). An analysis of prevalence in the 1990 study found a peak in patients age 21 to 40 years (61.7%), with 18.6% in those age 16 to 20 years and 13.1% in those age 41 to 65 years. Prevalence analysis in the 2010 study identified the population as older. A peak prevalence was noted in patients age 41 to 65 years (35.4%), with 35.3% in those
Discussion.—The incidence of maxillofacial fractures increased significantly between the 1990 and 2010 studies. In addition, the population involved was older in the later study and was more likely to be injured in a fall.
Clinical Significance.—Maxillofacial fractures are less likely to be caused by assault and to occur in younger patients and more likely to be caused by falls in elderly patients in the authors’ institution. These findings indicate that it is important to have preventive programs and appropriately trained maxillofacial surgery teams to address these injuries in an older population today.
Martinez AY, Como JJ, Vacca M, et al: Trends in maxillofacial trauma: A comparison of two cohorts of patients at a single institution 20 years apart. J Oral Maxillofac Surg 72:750-754, 2014 Reprints available from AY Martinez, Div of Oral and Maxillofacial Surgery, Dept of Otolaryngology, Lenox Hill Hosp, New York, NY 10065; e-mail: [email protected]
Endodontics Irrigation Background.—Irrigation provides important mechanical, chemical, and microbiological functions in root canal treatment. It allows cleansing of root canal areas and the removal of tissue remnants and biofilms that cannot be accomplished with mechanical instrumentation. A report on the current state of knowledge about irrigation and recommendations regarding specific solutions, concentrations, irrigant sequencing, and methods of delivery was prepared.
274
Dental Abstracts
Irrigation Principles.—Irrigation is especially valuable for eradicating root canal microbes. The solutions used for irrigation during and after instrumentation facilitate the killing and removal of microorganisms, necrotic and inflamed tissue, and debris. Irrigating solutions also reduce the friction between instruments and dentin, improve cutting effectiveness, dissolve tissues, and cool the file and the tooth, especially when ultrasonic tools are used. It may also prevent packing hard and soft tissue into apical
Clinical Significance.—Although there are limitations in this review, it points out important information about some of the assumptions regarding what constitutes a ‘‘classic reference’’ in the field of dentistry. Traditionally, any reference cited at least 100 times is considered classic and usually represents an historical reference point in the development of an area. The least number of times a reference on this list was cited was 326, so many articles that would be considered classic are missing. The fact that some articles with a high number of citations may have been excluded because the journal is no longer included in the category searched may also affect the outcome. In addition, there is no way to eliminate self-citations or to identify if a ‘‘snowball effect’’ of citing references because they have received numerous citations in the past is at work. It has also been assumed that the true impact of a study cannot be assessed sufficiently until at least 20 years after
publication. This might explain the high number of articles that came from the decades of the 1980s and 1990s. Older articles are usually cited more frequently, with more recent articles frequently undervalued. In this review, only nine articles since 2000 are included. The emphasis on clinical content is also seen in other disciplines such as general surgery, anesthesia, and orthopedic surgery. Disappointingly, most articles presented evidence at the levels of 4 and 5, and the list included only two randomized clinical trials and two systematic reviews/meta-analyses. Thus the level of evidence does not necessarily correlate with the number of citations—as has been noted in other medical fields. Many articles came from journals that have a high impact factor ranking. The impact factor of a journal is not determined just by the number of citations of the most relevant articles, but by the total number of citations in a given year by all of the articles published in the previous 2 years. Other factors may include an increase in the relevance of some journals or a decrease in the relevance of others.
Feijoo JF, Limeres J, Fernandez-Varela M, et al: The 100 most cited articles in dentistry. Clin Oral Invest 18:699-706, 2014 Reprints available from P Diz, School of Medicine and Dentistry, Special Needs Unit, c/Entrerrıos sn, 15782 Santiago de Compostela ~a, Spain; e-mail: [email protected] A Corun
Dental Trauma Maxillofacial trauma trends Background.—Various factors appear to influence the incidence and etiology of maxillofacial fractures. Among these are geographic area, whether the population is urban or rural, population density, and socioeconomic status. Motor vehicle collisions (MVCs) are a significant cause of these fractures, along with assaults, sports injuries, occupational pursuits, domestic violence, and falls. Soft tissue injuries, neurologic trauma, and orthopedic injuries often accompany and are correlated significantly with maxillofacial fractures. Some concomitant injuries can be life-threatening, including cerebral trauma, hemorrhagic shock, hemopneumothorax, and airway compromise. More than 6% of patients who suffer maxillofacial fractures
require a life-saving emergency intervention. The incidence and etiology of maxillofacial fractures seen in a single trauma center were evaluated over the period between 1984 and 1990 (1990 study) and the period between 2004 and 2010 (2010 study) to determine if differences exist. Methods.—The records of patients with maxillofacial fractures were retrospectively studied over the two time periods at the authors’ institution. Number of fractures, mechanism of injury, patient age, and mortality were compared. Results.—In the 1990 study, 152 midface and 306 mandibular fractures occurred, for a total of 458
Volume 59
Issue 5
2014
273
age 21 to 40 years and 14.5% in those at least age 66 years. Ninety-nine patients died from their injuries in the 2010 study, with 27.3% from an MVC, 26.3% of a fall, 15.2% of an MCC, 8.1% of a pedestrian strike, 8.1% of penetrating trauma, 2% of a sports injury, and 3% of other causes. Analyzing specifically patients whose mechanism of injury was a fall showed a significant relationship between increased age and mortality, with those at least age 66 years accounting for 44.1% of all falls and 3.9% of those dying. Fig 1.—Comparison of main mechanisms of injury. Abbreviations: MCC, Motorcycle collision; MVC, motor vehicle collision. (Courtesy of Martinez AY, Como JJ, Vacca M, et al: Trends in maxillofacial trauma: A comparison of two cohorts of patients at a single institution 20 years apart. J Oral Maxillofac Surg 72:750-754, 2014.)
maxillofacial fractures. Assault was the mechanism of injury for 48.8% of patients, MVCs for 39.1%, motorcycle collisions (MCCs) for 4%, sports injuries for 3.8%, falls for 3.6%, and occupational pursuits for 0.7%. In the 2010 study, 1313 midface and 418 mandibular fractures occurred, for a total of 1731 maxillofacial fractures. Some of the causative classes were merged for comparison purposes, specifically, MVCs included pedestrian strikes and ATV crashes, MCCs included moped injuries, and assaults included abuse and penetrating injury. Assault was the mechanism of injury for 29.7% of patients, MVCs for 29.6%, falls for 22.1%, MCCs for 8.5%, sports injuries for 3.7%, and other for 6.4% (Fig 1). An analysis of prevalence in the 1990 study found a peak in patients age 21 to 40 years (61.7%), with 18.6% in those age 16 to 20 years and 13.1% in those age 41 to 65 years. Prevalence analysis in the 2010 study identified the population as older. A peak prevalence was noted in patients age 41 to 65 years (35.4%), with 35.3% in those
Discussion.—The incidence of maxillofacial fractures increased significantly between the 1990 and 2010 studies. In addition, the population involved was older in the later study and was more likely to be injured in a fall.
Clinical Significance.—Maxillofacial fractures are less likely to be caused by assault and to occur in younger patients and more likely to be caused by falls in elderly patients in the authors’ institution. These findings indicate that it is important to have preventive programs and appropriately trained maxillofacial surgery teams to address these injuries in an older population today.
Martinez AY, Como JJ, Vacca M, et al: Trends in maxillofacial trauma: A comparison of two cohorts of patients at a single institution 20 years apart. J Oral Maxillofac Surg 72:750-754, 2014 Reprints available from AY Martinez, Div of Oral and Maxillofacial Surgery, Dept of Otolaryngology, Lenox Hill Hosp, New York, NY 10065; e-mail: [email protected]
Endodontics Irrigation Background.—Irrigation provides important mechanical, chemical, and microbiological functions in root canal treatment. It allows cleansing of root canal areas and the removal of tissue remnants and biofilms that cannot be accomplished with mechanical instrumentation. A report on the current state of knowledge about irrigation and recommendations regarding specific solutions, concentrations, irrigant sequencing, and methods of delivery was prepared.
274
Dental Abstracts
Irrigation Principles.—Irrigation is especially valuable for eradicating root canal microbes. The solutions used for irrigation during and after instrumentation facilitate the killing and removal of microorganisms, necrotic and inflamed tissue, and debris. Irrigating solutions also reduce the friction between instruments and dentin, improve cutting effectiveness, dissolve tissues, and cool the file and the tooth, especially when ultrasonic tools are used. It may also prevent packing hard and soft tissue into apical