The 100 most cited articles about orofacial trauma in children and adolescents: bibliometric analysis

Abstract This bibliometric study aimed to identify and analyze the 100 most cited articles about orofacial trauma in children and adolescents. The search was conducted in the Web of Science Core Collection (WoS-CC) using a combined search strategy. Two researchers collected the following data from each article: year of publication, country, journal, number and density of citations, author, institutions, study design, type of trauma, and keywords. The VOSviewer and SPSS version 22.0 softwares were used for data analyses. The articles were published from 1968 to 2012 and the number of citations ranged from 49 to 176. Europe was the continent with most articles (40 articles; 3,408 citations). Brazil was the country that made the largest contribution (20 articles; 1,741 citations) and the Universidade do Sul de Santa Catarina (Brazil) was the institution with most articles (5 articles; 492 citations). Marcenes W was the most productive author (8 articles; 968 citations). The cross-sectional study design was the most common (50 articles; 3,978 citations). The most frequent field was epidemiology (73 articles; 5,971 citations). The most widely used criteria for trauma diagnosis were the Andreasen (18 articles; 1,505 citations) and Le Fort (3 articles; 260 citations). Strong positive correlations were found in the number of citations between WoS-CC and Google Scholar (r = 0.929; p < 0.001), WoS-CC and Scopus (r = 0.976; p < 0.001), and Google Scholar and Scopus (r = 0.903; p < 0.001). The 100 most cited articles about orofacial trauma in children and adolescents were mainly cross-sectional studies published by Brazilian authors in epidemiology using Andreasen criteria. Dental Traumatology was the journal with the largest contribution.


Introduction
][4] Individuals who suffer orofacial trauma may need less invasive treatment, such as monitoring, incisal adjustments or the use of a retainer, Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript.
or more invasive treatment, such as prosthetic restorations, endodontic treatment or surgical procedures with or without general anesthesia. 5,6here is also evidence that trauma can exert a physical impact and can influence the quality of life of affected individuals both directly and indirectly by generating economic impact. 7,8ibliometric analyses are scientific methods that enable the identification of articles with greater impact in both the research and clinical community, using metrics such as the number of citations that these studies receive over time. 9,10The quantitative analysis of these articles can be used to follow the development of particular fields of research. 11ibliometric studies enable clinicians to identify the main studies on a given topic.Moreover, bibliometrics can reveal research trends, main authors, and journals and countries with the most publication activity, as well as emerging and promising fields of research, 9 thereby inspiring the development of new studies. 12lthough bibliometric studies on orofacial trauma have been published in the literature, [13][14][15][16] no studies have addressed the subject with a focus on children and adolescents, despite the high prevalence of orofacial trauma in this age group.
The aim of the present bibliometric study was to identify and analyze the 100 most cited articles about orofacial trauma in children and adolescents and help inform researchers and clinicians with regards to current and future research trends.

Methods
A bibliometric study was conducted on May 20 th , 2021 to identify and analyze the most cited articles about orofacial trauma in children and adolescents.The search was performed in the "Dentistry, Oral Surgery and Medicine" category of the Web of Science Core Collection (WoS-CC) database using a combination of MeSH terms and keywords (Box ).
A list of articles was organized by the number of citations in decreasing order.On the same day, two researchers simultaneously examined the title and abstract of all articles identified based on the eligibility criteria.The inclusion criteria were: articles involving any aspect of orofacial trauma in children and adolescents.The exclusion criteria were: editorials, conference papers, guidelines, studies including adults in the sample, studies in which the age of the participants was not informed, and studies that addressed conditions other than orofacial trauma, such as dental caries.The selection stopped at the hundredth most cited article and the full texts were obtained for analysis.Those articles in which a clear decision about inclusion/exclusion was not possible from the title/abstract evaluation also underwent full-text analysis.Disagreements about the inclusion/ exclusion of articles were resolved by consensus with a third researcher, who was also present at the time of data collection.
The position of the articles on the list was based on the number of citations in WoS-CC.On the same day, a cross-match was performed with the number of citations in Scopus and Google Scholar for citation comparison.If there was a tie in the number of citations, the position of the articles on the list was determined by the citation density (number of citations per year) according to WoS-CC, followed by the number of citations in Scopus.
An electronic spreadsheet (Microsoft Excel ® , Windows 10 version) was exported from the WoS-CC containing automatically data extracted from each article, such as number of citations, authors' names, corresponding author's address, The articles were classified as review (systematic or non-systematic), observational studies (cross-sectional, case-control, cohort, or ecological), interventional (clinical studies), and case reports/case series based on the Cochrane glossary. 17The fields were subdivided into epidemiology, prevention, treatment, and prognosis.Studies with 100 or more citations were considered highly cited. 18,19he VOSviewer software (Centre for Science and Technology Studies, Leiden University) was used to create the bibliometric networks. 20Collaborative density maps were created for co-authorship and keywords and items were linked considering the number of articles with joint authorship.Each point on the density map has a color corresponding to the density of the items on that point.The greater the number of items close to a point and the greater the weight of these items, the closer the color is to red, whereas the fewer number of items close to a point and the lower the weight of the neighboring items, the closer to color is to blue.
Data analysis was performed using the Statistical Package for the Social Sciences (SPSS, version 24.0 for Windows; IBM Corp).The Kolmogorov-Smirnov was used to assess the normality of data distribution.As a non-normal distribution was revealed, Spearman's correlation test was used.The significance level was set at 5% (p < 0.05).

Results
The search in WoS-CC retrieved 3,223 articles.After the organization of the articles in decreasing order number of citations, 144 articles were excluded for not addressing the topic of interest and 53 others were excluded mainly for the following reasons: including adults in the sample, not reporting the age of the participants, addressing conditions other than orofacial trauma such as dental caries, editorials, conference articles, and guidelines.The list of the 100 most cited articles about orofacial trauma in children and adolescents is displayed in Table 1.
The 100 most cited articles were cited 7,932 times in WoS-CC, ranging from 49 to 176 citations.Twenty articles had at least 100 citations and were considered highly cited.Self-citations accounted for 4.76% of the total number of citations and were considered in the study.Citations were higher in Google Scholar (n = 17,901 citations) and Scopus (n = 8,894 citations).Strong positive correlations were found in the number of citations between WoS-CC and Google Scholar (r = 0.929; p < 0.001), between WoS-CC and Scopus (r = 0.976; p < 0.001), and between Google Scholar and Scopus (r = 0.903; p < 0.001).The most cited article was "Pediatric facial fractures -evolving patterns of treatment", which was a cohort study by Posnick, Wells and Pron (1993) published in Journal of Oral and Maxillofacial Surgery, with a total of 176 citations in WoS-CC (Table 1).
The year of publication ranged from 1968 to 2012 (Figure 1).The year 2001 had the largest number of published articles (n = 14).The oldest article was an integrative review by Rowe NL which was published in 1968 and cited 81 times in WoS-CC.The most recent article was a cross-sectional study by Miller EK et al. (2012), which was cited 59 times in WoS-CC (Table1).
The analysis of the types of orofacial trauma revealed that traumatic dental injury was the most addressed subject amongst the 100 most cited articles about orofacial trauma (n = 83; 6,616 citations).The age of the participants ranged from 0 to 19 years; 53 studies included preschoolers, schoolchildren, and/or adolescents combined.Most of the studies on traumatic dental injury addressed exclusively permanent dentition (50 articles; 4,029 citations).
The continents with the largest number of articles were Europe (n = 40 articles; 3,408 citations), Latin America (n = 22 articles; 1,917 citations), and North America (n = 15 articles; 1,108 citations) (Figure 2).The country with the largest contribution was Brazil (20 articles; 1,741 citations), followed by the United States of America (9 articles; 587 citations), and England (7 articles; 689 citations) (Figure 2).The institution with the most articles on the top 100     1968-1973 1974-1979 1980-1985 1986-1991 1992-1998 1999-2004 2005-2010    presents an overlay map showing the most frequent terms by decade.In the 1990s, the most frequent terms were "tooth avulsion", "tooth reimplantation", "pulp necrosis", "dental luxation", and "children's dentistry".Beginning in the year 2006, the most frequent terms were "avulsion", "traumatic dental injuries", and "facial fractures".The most commonly used criteria for traumatic dental injury diagnosis were the criteria proposed by Andreasen [21][22][23][24][25][26][27] (18 articles; 1,505 citations), whereas the most commonly used criteria for orofacial trauma diagnosis were the criteria proposed by Le Fort 28 (3 articles; 260 citations).Twenty-two articles did not report the index used for the evaluation of orofacial trauma.Among these articles, 19 of them addressed traumatic dental injuries and three addressed facial trauma.The most frequent field was epidemiology (73 articles; 5,791 citations).Dental Traumatology was the journal with the largest contribution (Table 3).

Discussion
The present study identified the 100 most cited articles in the field of orofacial trauma in children and adolescents and performed qualitative-quantitative analyses of these articles.][31] In the literature, an article is considered highly cited when the number of citations is greater than 400. 18,32For specific topics, however, such as oral traumatology, 100 citations is sufficient for an article to be considered highly cited in the field. 13,33,34Among the articles included in this study, 20 had at least 100 citations, demonstrating considerable influence in clinical practice and guiding other studies. 18,33he WoS was chosen as the reference database for the present study because it allows retrieving publications as far back as 1945.This database includes peer-reviewed articles published in periodicals throughout the world. 31,35In contrast, the Scopus database has the limitation of containing only articles published since 1996, which can lead to bias when selecting the most cited articles. 11,34,35he large number of citations in the Google Scholar database was due to the fact that, unlike WoS and Scopus, this database contains documents that have not been peer reviewed and whose scientific value can therefore not be guaranteed.Despite the difference in the number of citations, strong positive correlations were found between the different databases.Thus, as the number of citations of the articles in the WoS database increased, this also tended to be the case in Google Scholar and Scopus. 34he highly cited articles in this bibliometric analysis were published from 1974 to 2005.The most cited study addressed maxillofacial trauma and was written by Posnick, Wells and Pron (Table 1).The wide scope of the data reported in this retrospective cohort study may explain the greater number of citations.The other highly cited studies addressed important topics, such as epidemiology, incidence, prevalence, and associated factors of orofacial trauma.The most recent highly cited article was  1).The follow-up time greater than one year and the innovation of a promising method for the treatment of complex traumatic dental injuries may explain the number of citations of this study.The article by Miller EK et al. was the most recent among the 100 most cited articles (Table1).In 2012, pulp revascularization was the main focus of studies.Miller EK et al., after finding satisfactory results, suggested a new treatment protocol for these cases.This shows that, although articles accumulate citations over time, theoretically favoring older articles, novel information can also contribute to an increase in citation density of more recent studies. 36,37urope, South America, and North America were the continents with the most articles on the list of the 100 most cited.Prior to the 2000s, the major focus of studies, especially in the field of pediatric dentistry, was cariology.][40][41] Brazil was the country with the highest number of articles, which may be explained by the fact that the prevalence of traumatic dental injury is high in the country. 39,42The United States of America were the second country with the most articles, which may be due to the fact that the largest research centers in the world are located in the country. 42Moreover, due to investments in the funding of research and infrastructure, developed countries have more consolidated health research centers, [43][44][45] which is in agreement with data from other bibliometric studies in denstistry. 13,19,37ive authors were the most cited among the articles included in this bibliometric analysis: Marcenes, Sheiham, Traebert, Andreasen and Kenny (Table 1).These authors worked mainly on five topics: etiology, prevalence, diagnosis, prevention, and treatment, demonstrating their important contributions to the study, understanding, and management of orofacial trauma.In the bibliometric study by Kramer et al., 14 etiology and treatment were also among the most discussed topics.Traebert developed a set of pioneering studies related to trauma in the permanent dentition beginning in the year 2000 (Table 1).In co-authorship with Marcenes W, the researcher developed pioneering crosssectional studies on prevalence, treatment needs, and factors associated with trauma in permanent dentition.These studies were subsequently cited by most studies on the subject.Kenny published several literature reviews and guidelines on the treatment of traumatic dental injuries (Table 1).Andreasen JO may be considered the major scholar on the subject. 34is first publication available in PubMed dates back to 1967.In partnership with Andreasen FM, the researcher developed important histological studies that provided the basis for treatment protocols and guidelines for primary and permanent dentitions.Previous studies have identified Andreassen as the most productive author in the field of oral traumatology. 13,33He was also one of those who took the initiative to found the IADT, which has promoted 21 conferences on dental traumatology throughout the world and serves as a guide for the management of orofacial trauma. 34Moreover, national and international collaborations are found among the authors of the articles.The existence of these working groups focused on particular subjects, consequently increases the frequency of self-citations, especially considering the fact that the topic is more restricted. 18he cross-sectional design was the most frequently used among the studies, as well as in the bibliometric study by Kramer et al. 14 This design may have been the most frequent because such studies are efficient, fast and inexpensive, making this design more common in dental studies to evaluate prevalence in large populations and raise etiological hypotheses. 46,47nly one systematic review was among the 100 most cited articles.Clinical practice in orofacial trauma has not been based on high-quality clinical evidence. 45Well-designed clinical trials are needed for the application of better scientific evidence in the treatment of orofacial trauma.
The Andreassen and Le Fort criteria were the most used and are considered classic criteria for the evaluation of traumatic dental injuries and maxillofacial trauma, respectively.Among the studies that evaluated the occurrence of orofacial trauma, 22 failed to report the index used for diagnosis.This hinders comparisons among studies and can also have repercussions regarding the level of agreement in diagnosis among evaluators, putting into question the validity of studies.
Most studies addressed the preschool, school or adolescent age groups combined.By studying a wider age range, studies are able to present the characteristics of orofacial trauma at different ages.However, future studies focusing on each age group are needed to enable more assertive prevention and treatment guidelines for orofacial trauma.One limitation of the current study is that the research was conducted in 2021, and the results have since been updated; therefore, we encourage further studies.

Conclusion
This quantitative and qualitative bibliometric analysis can be useful for clinicians, researchers, and public policy development.The 100 most cited articles were mainly cross-sectional epidemiology studies and that used Andreasen criteria and were published by Brazilian authors.The findings demonstrated the need for studies focused on improving the treatment of orofacial trauma.

Figure 1 .
Figure 1.Number of citations and publications over time.

Figure 2 .
Figure 2. Worldwide distribution of the 100 most cited articles about orofacial trauma in children and adolescents.
Box. Search strategy used in the Web of Science Core Collection.TS=(child OR children OR childhood OR child, preschool OR "preschool child" OR "preschool children" OR infant OR infants OR toddler OR toddlers OR preschool OR preschoolers OR schoolchild OR "school child" OR schoolchildren OR "school children" OR kid OR kids OR newborn OR newborns OR youth OR youths OR pediatric OR pediatrics OR paediatric OR paediatrics OR pedodontic OR pedodontics OR adolescent OR adolescents OR adolescence OR teen OR teens OR teenager OR teenagers OR offspring OR student OR students) AND TS=(tooth OR teeth OR dent* OR odont* OR mouth OR oral OR facial OR maxill* OR mandib* OR alveol* OR periodont* OR root*) AND TS=(trauma* OR injur* OR intrud* OR extrusi* OR extrud* OR avuls* OR ex$articulation* OR luxat* OR fractur* OR fragment* OR lacerat* OR subluxat* OR concus* OR re$plant* OR re$implant* OR crack* OR mobil*) NOT TS=(adult OR adults OR elderly)

Table 3 .
Journal of publication of the 100 most cited articles on oral traumatology in children and adolescents.