{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:41:47Z","timestamp":1792644107500,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Dental Traumatology"],"abstract":"ABSTRACT<\/jats:title>\n \n Background\/Aims<\/jats:title>\n Inconsistent terminology in dental traumatology limits comparability between clinical, epidemiological, and prognostic studies. This is particularly relevant for traumatic dental injuries in which two or more distinct injuries affect a single permanent tooth during the same traumatic episode. Such injury patterns have been described using several overlapping terms, resulting in conceptual and reporting heterogeneity. This study aimed to establish a standardized term and corresponding definition for multiple traumatic dental injuries affecting a single permanent tooth in one traumatic episode using a mixed\u2010methods consensus approach.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A sequential mixed\u2010methods design was used. First, terminology identified in a previous systematic review was analyzed to identify conceptual patterns. These findings informed the development of candidate terms and definitions. Subsequently, a modified Delphi consensus process was conducted with international experts in dental traumatology, following CREDES and ACCORD guidance. Experts rated the suitability of proposed terms and definitions on a 10\u2010point Likert scale. Items rated >\u20097 by more than 70% respondents were considered to have reached consensus. A subsequent feedback exercise among practicing dentists and postgraduate students assessed broader acceptability of the proposed terminology.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Twenty\u2010six terms describing multiple injuries affecting a single permanent tooth were identified in the literature and grouped into four conceptual categories: general terminology for multiple injuries, specific pairings of trauma types, tissue\u2010level classifications, and expanded descriptive phrases. Following two Delphi rounds, the term \u201ccombination injury\u201d reached the highest level of expert agreement (76.9%). The feedback exercise showed acceptability by 70.5% among a broader group of dentists and highlighted the need for further dissemination and clarification before widespread implementation.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The term \u201ccombination injury,\u201d supported by a refined clinically relevant definition, achieved expert consensus. Adoption of this terminology may improve consistency in clinical documentation, research reporting, and future prognostic studies. Further studies should evaluate its usability in clinical records and epidemiological datasets.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/edt.70150","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:22:46Z","timestamp":1792642966000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Standardization of Terminology for Multiple Traumatic Dental Injuries Affecting a Permanent Tooth in a Single Episode: A Mixed\u2010Methods Delphi Consensus Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6747-5110","authenticated-orcid":false,"given":"Nitesh","family":"Tewari","sequence":"first","affiliation":[{"name":"Division of Pediatric Dentistry, Department of Dental Medicine Karolinska Institutet Huddinge Sweden"},{"name":"Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8281-9241","authenticated-orcid":false,"given":"Alina","family":"Wikstrom","sequence":"additional","affiliation":[{"name":"Center of Pediatric Oral Health Research Stockholm Sweden"},{"name":"Department of Endodontics Public Dental Health Services, Eastmaninstitutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0859-7262","authenticated-orcid":false,"given":"Eva","family":"Lauridsen","sequence":"additional","affiliation":[{"name":"Dental Trauma Guide Teamet K\u00e6bekirurgisk Afdeling Rigshospitalet Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2710-1894","authenticated-orcid":false,"given":"Vijay Prakash","family":"Mathur","sequence":"additional","affiliation":[{"name":"Division of Pediatric and Preventive Dentistry, Centre for Dental Education and Research All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4563-3675","authenticated-orcid":false,"given":"Partha","family":"Haldar","sequence":"additional","affiliation":[{"name":"Centre of Community Medicine All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1035-2539","authenticated-orcid":false,"given":"Lars","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department of Oral & Maxillofacial Surgery Malmo University Malmo Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zafer","family":"\u00c7ehreli","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry Istanbul Health and Technology University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5361-5840","authenticated-orcid":false,"given":"Georgios","family":"Tsilingaridis","sequence":"additional","affiliation":[{"name":"Division of Pediatric Dentistry, Department of Dental Medicine Karolinska Institutet Huddinge Sweden"},{"name":"Center of Pediatric Oral Health Research Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Health Data Standards and Terminology: What Are Terminology Standards?","author":"National Library of Medicine","year":"2026"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijmedinf.2021.104431","article-title":"Use of Standardized Terminologies in Clinical Practice: A Scoping Review","volume":"149","author":"Fennelly O.","year":"2021","journal-title":"International Journal of Medical Informatics"},{"issue":"12","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.apjon.2025.100659","article-title":"Enhancing Research Quality Through Defined and Consistent Terminology","volume":"27","author":"Dorri N.","year":"2025","journal-title":"Asia\u2010Pacific Journal of Oncology Nursing"},{"issue":"4","key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1111\/j.1600-9657.2011.00992.x","article-title":"Important Considerations for Designing and Reporting Epidemiologic and Clinical Studies in Dental Traumatology","volume":"27","author":"Andersson L.","year":"2011","journal-title":"Dental Traumatology"},{"key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/j.1600-9657.2006.00342.x","article-title":"A Systematic Review of the Diagnostic Classifications of Traumatic Dental Injuries","volume":"22","author":"Feliciano K. M.","year":"2006","journal-title":"Dental Traumatology"},{"issue":"3","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1111\/edt.12753","article-title":"NA0D\u2014The New Traumatic Dental Injury Classification of the World Health Organization","volume":"38","author":"Petti S.","year":"2022","journal-title":"Dental Traumatology"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/edt.70076"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/edt.70090"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12911\u2010021\u201001534\u20106"},{"issue":"1","key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/edt.12993","article-title":"Appropriate Terminology for the Time Elapsed From Avulsion of a Permanent Tooth to Replantation: A Scoping Review and Delphi Consensus","volume":"41","author":"Tewari N.","year":"2025","journal-title":"Dental Traumatology"},{"issue":"8","key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1177\/0269216317690685","article-title":"Guidance on Conducting and Reporting Delphi Studies (CREDES) in Palliative Care","volume":"31","author":"J\u00fcnger S.","year":"2017","journal-title":"Palliative Medicine"},{"issue":"6","key":"e_1_2_12_13_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0020476","article-title":"Using and Reporting the Delphi Method for Selecting Healthcare Quality Indicators: A Systematic Review","volume":"6","author":"Boulkedid R.","year":"2011","journal-title":"PLoS One"},{"issue":"1","key":"e_1_2_12_14_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1004326","article-title":"ACCORD (ACcurate COnsensus Reporting Document): A Reporting Guideline for Consensus Methods in Biomedicine Developed via a Modified Delphi","volume":"21","author":"Gattrell W. 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An International Approach to the Development of a Core Outcome Set","volume":"34","author":"Kenny K. P.","year":"2018","journal-title":"Dental Traumatology"},{"issue":"6","key":"e_1_2_12_21_1","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1111\/edt.12713","article-title":"Extension of a Novel Diagnostic Index to Include Soft Tissue Injuries: Modified Eden Baysal Dental Trauma Index","volume":"37","author":"Eden E.","year":"2021","journal-title":"Dental Traumatology"},{"issue":"1","key":"e_1_2_12_22_1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/edt.12216","article-title":"Prevalence of Soft Tissue Injuries in Pediatric Patients and Its Relationship With the Quest for Treatment","volume":"32","author":"Soares T. 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