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This report presents a case of replantation of a traumatically avulsed central incisor in a 32-year-old woman. The tooth was replanted after a 30-min extra-alveolar period. Emergency unconventional immobilization was performed, using 2-0 chromic gut, and a restorative composite made Gunning-type splint. The tooth is still in place 27 years after replantation (1976 to date) without marked resorption.
Based on an analysis of the literature concerning parameters influencing the prognosis of traumatic dental injuries, few studies were found to have examined possible relationships between treatment delay and pulpal and periodontal ligament healing complications. It has been commonly accepted that all injuries should be treated on an emergency basis, for the comfort of the patient and also to reduce wound healing complications. For practical and especially economic reasons, various approaches can be selected to fulfill such a demand, such as acute treatment (i.e. within a few hours), subacute (i.e. within the first 24 h), and delayed (i.e. after the first 24 h). In this survey the consequences of treatment delay on pulpal and periodontal healing have been analyzed for the various dental trauma groups. Applying such a treatment approach to the various types of injuries, the following treatment guidelines can be recommended, based on our present rather limited knowledge of the effect of treatment delay upon wound healing. Crown and crown/root fractures: Subacute or delayed approach. Root fractures: Acute or subacute approach. Alveolar fractures: Acute approach (evidence however questionable). Concussion and subluxation: Subacute approach. Extrusion and lateral luxation: Acute or subacute approach (evidence however questionable). Intrusion: Subacute approach (evidence however questionable). Avulsion: If the tooth is not replanted at the time of injury, acute approach; otherwise subacute. Primary tooth injury: Subacute approach, unless the primary tooth is displaced into the follicle of the permanent tooth or occlusal problems are present; in the latter instances, an acute approach should be chosen. These treatment guidelines are based on very limited evidence from the literature and should be revised as soon as more evidence about the effect of treatment delay becomes available.
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Combined trauma involving intrusive luxation of one tooth and avulsion of another is rare. A case is presented involving the endodontic management of two traumatised maxillary central incisors, one of which was intrusively luxated and the other avulsed. Spontaneous re-eruption of the intruded tooth occurred, thereby avoiding the need to further traumatise the periodontal ligament with either orthodontic or surgical repositioning, and allowing endodontic therapy to be carried out uneventfully. Endodontic therapy of the avulsed tooth was completed and its prognosis is considered good.
The management and immediate treatment of an avulsed permanent tooth will determine the long-term survival of the tooth. The aim of this study was to evaluate the knowledge of oral health professionals on the new guidelines for emergency treatment of avulsed teeth. A 12-item questionnaire was distributed among general dentists, specialists, dental hygienists and dental assistants attending Continuing Education courses at the School of Dentistry, University of Southern California, between 2003 and 2004. This study reports only on the general practitioners who comprised 83% of the participants. The results revealed an uneven pattern of knowledge among them regarding the emergency management of an avulsed tooth. Statistically significant associations were related to the participants' previous dental trauma education and their age. In conclusion, there is a need to improve the knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth.
Dental trauma is the largest single reason for successful malpractice claims against anaesthetists. The purpose of this article is to familiarize the anaesthetist with basic tooth anatomy and pathology and to provide an update on the different types of dental treatment and appliances which one may encounter in anaesthetic practice. Traumatic fractures to teeth are classified into six categories; Class I - fracture into the enamel layer, Class II - fracture into the dentinal layer, Class III - fracture into the pulp of a tooth, Class IV - fracture of the root of a tooth, Class V - subluxation of a tooth, and Class VI - avulsion of a tooth. Treatment for each class of fracture is described as well as certain preventative ideas. Some of the more recent developments in dental therapy such as the butterfly bridge, titanium implants and porcelain laminate veneers are described. Such developments in their turn have led to new and different problems. Care must be taken when using the laryngoscope as these teeth may be more easily fractured or dislodged. Several investigations into malpractice claims found that the oral airway was responsible for up to 55 per cent of dental complications. Prevention of dental trauma begins with an understanding of basic tooth anatomy and pathology and a recognition of the different dental treatments and appliances at the preoperative visit. The value of an appropriate preoperative dental consultation must not be underestimated.
Avulsion of a tooth is a not uncommon childhood injury, with up to 16% of dental injuries involving the loss of a tooth. Although this is an apparently 'minor' injury, for a child there may be long-term psychological and treatment problems. Correct advice in the early stages of this injury, and the recognition that prompt treatment may allow a tooth to be successfully reimplanted are vital in the management of these injuries. Often, nursing staff in the accident and emergency or paediatric department may be asked for advice either professionally or informally, and can influence the long-term dental health for these patients. This paper looks at the knowledge of parents and healthcare professionals in the management of these injuries.
Odontogenic infections and orofacial trauma are the most common types of pediatric dental emergencies. The avulsion of a child's permanent tooth or spread of an odontogenic infection through facial planes present serious medical problems requiring expedited care to achieve a favorable prognosis.
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The alveolus of a (usually maxillary) canine tooth in a dog may fracture during fighting or in a car accident. The trauma loosens the tooth with resultant avulsion. Ten patients are reviewed, nine with maxillary and one with mandibular canine tooth avulsion, and a method for fixation and replantation is described.
Occasionally, an orthodontic patient will accidentally traumatize a maxillary anterior tooth before or during orthodontic treatment. In some situations, the trauma will be substantial and avulse the tooth. In other accidents, the tooth may not avulse, but the pulp becomes nonvital. If the pulp is devitalized, and the root has not fully formed, the apex of the root canal may be wide. In this situation, the endodontist may recommend apexification procedures to help close the apex before conventional obturation of the root canal. If the patient is currently undergoing orthodontic movement of the traumatized incisor, what effect will the tooth movement have on the success of the apexification? If the tooth were avulsed, replanted, and then ankylosed, should it be extracted? If so, when should the ankylosed incisor be removed? What effect will further facial growth have on the ankylosed tooth and the potential to achieve a successful esthetic restoration? The answers to these questions are important during the interdisciplinary treatment planning of the patient with traumatized teeth. This article will elucidate the endodontic-orthodontic considerations for patients with traumatized anterior teeth.
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Studies in Jordan indicated that delay in seeking emergency management of dental trauma leads to unfavorable outcome of even mild forms of trauma. The purpose of this cross-sectional study was to assess, by means of a structured questionnaire, the level of general knowledge of mothers in Jordan with regards to the immediate emergency management of dental trauma, and its relation to socioeconomic variables. The questionnaire surveyed mothers' demographic data, basic knowledge of immediate management of tooth fracture, avulsion, and loss of consciousness. It also investigated the participants self assessed knowledge, attitude to public education, and knowledge of availability and priority of emergency services for trauma in Jordan. The sample consisted of 2215 mothers who attended mother and child care centers in the capital Amman, and in Irbid (the second largest city in Jordan) over a period of 3 months (July to September, 2003). Overall the participants' basic knowledge with regards to the emergency management of the trauma cases presented in the questionnaire was deficient regardless of age, level of education, socioeconomic class, or number of previous encounters with dental trauma. Generally, the attitude to public education on the topic was positive and chi-square test indicated that the level of education of mothers positively affected their knowledge of 'during working hour' emergency services and the importance of immediate management of dental trauma. Educational programs that can be added to the mother and child care advice protocols may help improve the knowledge and awareness of mothers and therefore improve the outcomes of dental trauma.