Born 1949, Herzeliya, Israel
Education
§ 1976 – DMD degree, The Hebrew University Hadassah School of Dental Medicine
§ 1983 – Specialist in Pediatric Dentistry
§ 1982 – Instructor,
§ 1991 – Clinical Lecturer
§ 1992 – Lecturer
§ 1996 – Senior Lecturer.
§ 2008 - Clinical Associate Professor
Research Interests
Traumatic injuries to the primary dentition
Abstracts of Current Research:
Traumatic injuries to primary teeth
My main focus during the past years has been on “Traumatic injuries to primary teeth”. Three main reasons motivated investigation in this field:
§ The fact that the majority of publications related to this subject are text book chapters and/or review articles with relatively few research studies;
§ Currently the descriptions of outcomes of injuries to primary teeth are based mainly on opinions and beliefs rather than evidence, with the result that an attempt to trace the source of the information often leads to a dead end;
§ Currently, the main treatment guidelines have been formulated by dentists who do not treat children on a regular basis and who may be lacking the management skills to cope with young children's uncooperative behavior. Extraction is often the treatment of choice within these guidelines.
One of the main controversies found in the literature regarding injuries to primary teeth, is the disputed condition of the pulp in dark, discolored primary incisors . This has been investigated and published in an article showing that the pulp in almost 100% of these teeth is partially or completely necrotic.
This raised several questions:
§ How is it possible that dark discolored teeth that containing a necrotic pulp, remain clinically and radiographically asymptomatic?
§ Why do some teeth remain asymptomatic until their natural exfoliation, whereas others develop sinus tracts or swelling and inflammatory root resorption after years of being asymptomatic?
§ How often does it happen?
§ Should asymptomatic teeth with dark coronal discoloration be treated endodontically or left untreated?
These questions were investigated, discussed and resolved in several publications.
There are still some questions regarding dark coronal discoloration that have received only slight attention in the literature and need clearing up. For example, why some teeth retain the dark shade, whereas the color fades in others? What is the meaning of different dark shades (gray, black, brown and a variety of intermediate shades)? Can red blood cells really invade the dentin tubules as some authors suggest or is the dark shade the result of degradation of hemoglobin as other claim?
These are some of the topics that I am currently investigating, and plan to research in the future.
Intrusive luxation is one of the most complicated injuries to primary teeth. Although numerous studies are available on the effect of intrusion of primary teeth on their permanent successors, only a few articles deal with theses effects on primary teeth. One of my dtudies reports on the long-term outcomes of intrusion to the primary incisors. The survival rate of such teeth beyond 36 months, the reasons for loss of teeth throughout the years, the radiographic appearance with the unique finding of tube-like mineralization in the pulp canal, have never been reported before. This study reports other aspects as well.
Another study in which the diagnostic value of a lateral extraoral radiograph was found to be of limited, challenged the recommendation to take this radiograph in-order to diagnose the spatial relation between the intruded primary incisor and the permanent successor.
A case report describes the development of a dentin bridge following partial pulpotomy (the Cvek technique) in a primary incisor with crown fracture and pulp exposure in a very young child.
Data on other cases of partial pulpotomy in injured primary incisors is currently being collected and will be published when sufficient information has been gathered. Meanwhile a review has been published on various options for treating primary incisors with traumatic exposure of the pulp.
Another report describes a successful conservative treatment of severely luxated primary incisors with follow-up until natural exfoliation of the primary teeth and eruption of their permanent successors.
These reports intended to show that extraction is not the only treatment option for primary teeth with severe traumatic injuries.
The association, usually overlooked, between injuries to the chin and fractures of primary molars has been investigated in a survey. A case report of an unusual effect of trauma to the chin on the attachment apparatus of primary molars has been published.
The consequences of early loss of primary incisors are mentioned in the literature. However, only few statements are supported by controlled studies. I am now investigating several aspects of early loss of primary incisors as a result of traumatic injuries. For example, is there loss of space in the case of extracting of a primary incisor before eruption of the primary canines? Does early loss of primary incisors affect the child's self-esteem and parents' esthetic demands? In a future study, I intend to investigate how the loss of primary incisors affects speech and the development of oral habits.
The traditional rejection of replantation of avulsed primary incisors is based on many arguments, most of which are irrelevant. A critical review article dealing with the controversy of this practice has been presented on several occasions and will be sent for publication in the near future. The risk of aspiration following avulsion of primary incisors has been demonstrated.
The results of the research studies on traumatic injuries to the primary teeth and the experience gained over years of practice are summarized in chapters in two books of which I am a co-author.
List of Recent Publications : (last 4 years)
Articles
Holan, G. (2004) Development of clinical and radiographic signs associated with dark discolored primary incisors following traumatic injuries. A prospective controlled study. Dental Traumatology. 20:276-287.
Shapira, J. Kupietzky, A Fuks, AB. Kedari, A. and Holan, G. (2004) Comparison of oral midazolam with and without hydroxyzine in the sedation of pediatric dental patients. Pediatric Dentistry. 26:492-496.
Moskovitch M. Samara E. and Holan G. (2005) Success rate of root canal treatment in primary molars. Journal of Dentistry. 33:41-47.
Holan, G. Peretz, B . Efrat, J . and Shapira, Y . (2005) Traumatic injuries to the teeth in young individuals with cerebral palsy. Dental Traumatology. 21:65-69
Holan, G. Eidelman, E and Fuks , AB . (2005) Long-term evaluation of pulpotomy in primary molars using Mineral Trioxide Aggregate or formocresol as dressing materials. Pediatric Dentistry. 27:129-136. The abstract of this article has been published in the journal: Evidence Based Dentistry. 7:35-36, 2006.
Holan, G. (2006) Long term effect of different treatment modalities for traumatized primary incisors presenting dark coronal discoloration with no other signs of injury. Dental Traumatology. 22:14-17.
Holan G. Cohenca N . Brin I and Sgan-Cohen H . (2006) An oral health promotion program for the prevention of complications following avulsion: the effect on knowledge of physical education teachers. Dental Traumatology. 22:323-327.
Chapters in Books
Holan, G. McTigue, D.J. (2005) Chapter 15: Traumatic injuries to the primary dentition. In: Pediatric Dentistry: Infancy through adolescent. Pinkham, JR. ed. 4 th ed. W.B.Sounders Company.
Flores, MT. Holan , G. Borum, M. and Andreasen, JO ( 2006 in press) Injuries to the Primary Dentition. In: Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4 th ed. Blackwell Munkgaard.
Case reports
Katz-Sagi, H. PI Moskovitz, M. C Moshonov, J. C and Holan, G. C (2004) Pulp canal obliteration in an unerupted permanent incisor following trauma to its primary predecessor. A case report. Dental Traumatology. 20:181-183.
Moskovitz, M. and Holan, G. (2004) Pre-eruptive intra-coronal radiolucent defect: A case of a non-progressive lesion. ASDC Journal of Dentistry for Children. 71:175-178.