Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth

Abstract

Crown fractures and luxations occur most frequently of all dental injuries. An appropriate treatment plan after an injury is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence, based on literature research and professional opinion. In this first article of three, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Knowledge on dental trauma and orthodontic tooth movement held by a group of orthodontists

“…When a root fracture is detected, Flores et al 22 (2007) recommend a semi-rigid immobilization for 4 weeks and radiographic control for up to 5 years. In these cases, repair may occur through the fusion of the fractured segment, in which case the tooth preserves its original size, or through the interposition of conjunctive tissue between the fragments.…”

“…1 Some of the sequelae of dental trauma are: ankylosis, external root resorption, pulp necrosis, 10-12 pulp obliteration, marginal bone loss, 12 alveolar fracture, 1,22 crown fracture, root fracture, concussion, subluxation, luxation, and avulsion. 19,22,23 In the present study, 40.25% of the respondents chose the wrong answers to the questions about orthodontic movement of traumatized teeth. This result indicates that these professionals could take improper procedures when faced with this condition, resulting in undesirable consequences for their patients.…”

Incisor reduction: a provisional aesthetic technique for traumatised teeth

“…1,2,3 Delays in seeking treatment, poor cooperation and severity of the traumatic injuries can result in incomplete repositioning of teeth at the time of injury. 4 Once emergency care has been provided, decisions must be made with regard to the medium-and long-term treatment of the patient, including planning for pre-existing skeletal and dento-alveolar discrepancies.…”

Root fracture in patient in the pre-liver transplantation phase

“…Endodontic treatment was proposed because there was decreased response when subjected to thermal and electrical testing, and the radiographic examination revealed presence of a radiolucent lesion near the fracture line 12 . The decision to treat only the coronal portion of the fragment was taken because in most cases the apical portion remains vital 5 , and in this case there was no periapical involvement.…”

“…There is no precise method to evaluate this process, however, pulp or apical periodontal ligament cell invasion is believed to occur 5 . If the pulp becomes necrotic, inflamed and infected, radical endodontic treatment of the coronal portion is necessary 12 , otherwise the infection may spread to the underlying tissues, consequently leading to tissue destruction, tooth mobility, pain and even tooth loss 13 . The patient reported having suffered a trauma in adolescence, when playing with a friend nearly 30 years ago; he had received no treatment at the time.…”