Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research*

Abstract

Almost all treatment procedures used for dental traumas are still today not evidence-based, a fact, which makes it difficult to analyse the long-term outcome of healing and its relationship to treatment. Crown fractures with extensive dentin exposure represent a dominant injury in the permanent dentition. Accepted treatment philosophy is dentin coverage (dental liner and/or dentin bonded restoration) to prevent bacteria penetration into the pulp. Today there is, apart from deep proximal fractures, no evidence that this treatment is necessary to protect the pulp. In case of luxation injuries, the accepted treatment principles appear to be anatomically correct repositioning, stabilization with a splint and sometimes antibiotic coverage. In clinical studies, these principles could not be proven to optimize either periodontal or pulpal healing, the explanation possibly being that both reposition and application of splints in certain cases add extra damage to the pulp and periodontal ligament. In case of root fractures with dislocation, fast and optimal repositioning and rigid long-term splinting (i.e. 3 months) have been considered the principle of treatment. However, a recent clinical study has shown that short-term splinting with a semi-rigid splint appears to optimize fracture healing. In tooth avulsion with subsequent replantation, cleansing of the root surface for contamination and systemic antibiotics has been considered essential for pulp and periodontal healing. These treatment concepts have been derived from experimental studies in animals. However, their importance could not be verified in large clinical studies. Ideally, randomized clinical studies are needed in the future for selected trauma types. The influences of repositioning, splinting and the role of infection and antibiotics should be further investigated. However, for ethical reasons, it will be difficult to perform randomized studies on trauma victims and we will be forced in the future to rely on experimental animal studies supported by clinical observational studies.

Effects of Alendronate on Osteoclast Formation and Activity In Vitro

“…Approximately 16% of these injuries in permanent teeth result in dental avulsion (1). The poor prognosis in such cases is related to an inflammatory response leading to root resorption, whose extent is correlated to the initial damage (2).…”

Long-term Effects of Traumatic Injuries to Incisors and Periodontal Tissues during Childhood

“…Guidelines on the treatment of incisor injury should be observed [9] but they are not a panacea. Such injuries can be prevented by wearing a gum shield during sports [20], in sich bei Erhalt des traumatisierten Zahnes − trotz optimaler Kronenform und Zahnstellung − in einer solchen Farbveränderung des betroffenen Zahnes finden.…”

“…Richtlinien zur Therapie einer Frontzahnverletzung sind zu beachten [9], stellen jedoch kein Patentrezept dar. Präventionen in Form eines Mundschutzes bei sportlichen Aktivitäten [20] entsprechend der DGZMK-Stellungnahme [39] oder durch die Korrektur einer großen sagittalen Stufe [13,34,47,48] sind notwendig.…”

Endodontic applications of cone beam computed tomography: case series and literature review

“…120 The treatment outcome for fractured teeth may be influenced by several factors, such as the degree of dislocation, stage of root formation, location of the fracture, interval between trauma and treatment, and type of dental trauma (displacement of the coronal fragment compared with no displacement of the coronal fragment). 121 One problem is that the fracture line will only be detected if the X-ray beam passes directly through it.…”