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The dental practitioner who has to examine a child who has suffered dental trauma also has to manage the parents, who are often as upset as the patient. This paper, the first in a short series of management of various types of dental trauma, presents the steps necessary to formulate a treatment plan for such patients in a logical, step-by-step sequence.
Generalized idiopathic apical root resorption is an unusual finding, especially in adolescents. This report describes a case in which the root resorption was an incidental finding in a patient referred for orthodontic treatment after suffering trauma to a central incisor. It emphasizes the need for adequate clinical and radiological examination before undertaking active orthodontic treatment.
Traumatic injuries of permanent teeth in children present complex challenges. Growth and development influences, orthodontic considerations, and unknown endodontic and periodontal sequelae preclude immediate intervention with long-term restorations. "Interim" solutions are required to return the patient to the normal appearance, function, and health of the dental/alveolar complex until maturation of the patient allows long-term treatment planning. This report outlines diagnosis and treatment of multiple injuries, sustained by the maxillary anterior teeth. Step-by-step clinical procedures and their rationale are described. The learning objective of this case report is to outline the principles for management of traumatic injuries of permanent anterior teeth in young patients and to demonstrate clinical techniques for splinting displaced teeth, bonding fractured teeth, providing endodontic therapy, and fabricating adhesively bonded resin composite restorations for interim full coverage of severely damaged permanent incisors in a child.
Although root fractures are among the less common oral injuries (6 percent), a careful diagnostic evaluation of such injuries is required to arrive at an appropriate treatment plan. The position of the fracture in the root will determine the proper management. The problem of luxation due to trauma often involves the use of dental splints, which, if not properly designed, may cause root resorption, loss of alveolar bone, pulpal necrosis and pulp canal obliteration. The guidelines for the type of splint to use and conditions under which it should be placed are presented.
Traumatic injuries in children and adolescents are a common problem, and the prevalence of such injuries has increased over the last 10-20 years. The purpose of the present investigation was to evaluate long-term results following uncomplicated crown fractures and luxations involving subsequent pulp canal obliteration. A total of 198 patients with 488 injured permanent teeth were available for clinical examination (15 year follow-up), of which 102 also answered a questionnaire and were interviewed before oral examination. Further, 82 permanent incisors presenting with pulp canal obliteration (PCO) were followed for a period of 7 to 22 yr. (mean 16 yr.). The histological evaluation of luxation injuries was performed on 123 primary teeth from 98 patients. In the experimental study (crown fractures), 64 monkey permanent maxillary and mandibular central incisors and canines were subjected to different treatment alternatives at the time of fracture. The findings in the follow-up study showed very little pulpal response to crown fracture and subsequent restorative procedures as long as there was no concomitant periodontal injury. Approximately every fourth resin composite restoration was rated unacceptable at the clinical examination. The interview showed that half of the individuals were dissatisfied with the color and/or anatomic form of the composite restoration. PCO was found in all luxation categories, and according to the survival curve, the 20-year pulp survival rate diagnosed with X-ray was 84%. Although the risk for pulp necrosis (PN) increased with time, routine endodontic intervention of teeth with ongoing PCO of the root canal did not seem justified. The histological study showed that changes in dentin were represented by occlusion of the dentinal tubules and deposition of tertiary dentin. The tertiary dentin were classified as either dentin-like, bone-like or fibrotic. In the experimental study, few changes were observed in the pulp 3 months after crown fractures, irrespective of treatment alternative.
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Infection of the root canal system following dental trauma induces pulp and periapical disease and prevents healing of previously healthy pulp. A clinical goal in treating trauma is the maintenance of pulp vitality, and clinicians should be aware of factors that influence pulp healing. The learning objective of this article is to review the factors and techniques that influence pulp vitality and examine the influence pulp has on the healing of adjacent tissues. The potential routes for bacterial infection of the root canal system are discussed, with the clinical crown as the primary portal of entry. Uncomplicated and complicated crown fractures, as well as the crown-root and root fractures, are reviewed. Complications in pulp healing include canal obliteration, disturbed root development, apexogenesis, apexification, and the various forms of resorption.
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The consequences of traumatic tooth injuries (dental trauma) are time-consuming and costly treatment and follow-ups, of which our knowledge is scarce. Consequently the aim of the present study was to measure the total time of treatment of uncomplicated and complicated traumas to primary and permanent teeth. The study was performed in three steps based on a randomly selected sample of Danish children and adolescents living in the municipality of Copenhagen, Denmark: (I) A descriptive analysis of traumas affecting 106 children and adolescents all born in 1970 and randomly chosen among the total number of patients treated. Treatments took place between 1972 and 1988. (II) A study of the time and frequency of different types of emergency and planned treatment estimated by 14 dentists employed by the municipal dental service. (III) Calculation of the total treatment time on the basis of the results from (I) and (II). The most common traumas were luxations of primary teeth and fractures of permanent teeth. The most frequent treatments dealt with were uncomplicated crown fractures and luxations followed by other different diagnoses of complicated traumas. The treatment time for primary teeth for uncomplicated traumas were used mostly for information, while the time for complicated traumas was used for follow-ups. The treatment time for traumas to permanent teeth was dominated by follow-ups, irrespective of the complication status. Only 3% of uncomplicated traumas of permanent teeth resulted in endodontic treatment, compared to 67% with complicated traumas. Uncomplicated traumas to primary teeth required a total of 2.5 visits and 0.8 hrs treatment time, while 4.3 visits and 1.6 hrs per individual were used for complicated traumas. For permanent teeth with uncomplicated traumas 9.2 visits and 3.2 hrs were required, and for complicated traumas 16.4 visits and 8.5 hrs per individual. The respective treatment times for complicated traumas for primary and permanent teeth were 2.0 and 2.7 times higher, compared to the corresponding uncomplicated traumas. There were no gender differences in type of injury and number of visits for injuries to primary and permanent teeth.
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The prevalence of dental injuries in Spanish children living in an urban area was studied in 4000 schoolchildren ages six to twelve years. A total of 227 children experienced dental injuries. Simple enamel fracture was the predominant injury (46.2 percent). Boys showed a higher prevalence than girls In the majority of cases (74.9 percent), the trauma affected one tooth only. The maxillary central incisor was the most frequently affected tooth (87.9 percent). The most common fracture site was the mesioincisal angle (40.6 percent) followed by distoincisal angle (27.3 percent). Twenty-four percent of the children with dental injuries had an overjet of more than 3 mm.
Thorough evaluation and correct treatment of traumatized teeth improve their chances for survival. This article provides an overview clinical evaluation and how best to treat the tooth that has been traumatized. The rationale and techniques for tooth stabilization of the traumatized tooth will also be presented.
Anterior teeth that are completely avulsed from traumatic injury should be replanted as soon as possible. Care should be exercised to prevent dehydration of the tooth. The avulsed tooth should be stabilized until the patient can be seen by the dentist. The long-term prognosis favors the benefit of retaining a natural tooth, even though some resorption of the root surface occurs with almost all replantations. Immature permanent teeth offer the best prognosis for healing.