Guidelines for the orthodontic management of the traumatised tooth

Abstract

Dental trauma is common in the UK, with more than one in ten children having experienced some form of dental trauma. In addition, one in ten patients have been reported to have experienced dental trauma before orthodontic treatment. A recent survey of orthodontists’ knowledge and experience of orthodontic management of traumatised teeth has highlighted large inconsistencies in management of traumatised teeth among UK orthodontists, highlighting the need for further information or training on orthodontic management of traumatised teeth. Therefore, the following guidelines have been developed in order to provide an evidence-based approach to treat this cohort of patients. The following guidance is based on the available literature, expert opinion and UK orthodontists’ consensus drawn from a recent survey.

Updated Guidelines for the Orthodontic Management of Traumatized and Endodontically Treated Teeth: A Review Study

“…It has also been reported that maxillary incisors with severe previous TDIs have a higher risk of pulp vitality loss with orthodontic extrusion [8]. In summary, it is not possible to say whether orthodontic movement of teeth with TDIs will increase the risk of vitality loss above that of uninjured teeth; however, all orthodontists must be aware of these risks and the possible need to undertake pulp vitality tests whenever necessary [5,3]. 1 1…”

“…Evidence was found to be insufficient and controversial regarding the development of pulp necrosis following orthodontic movement of teeth with previous TDIs [ 5 , 6 ]. One retrospective study has found a higher prevalence of pulp vitality loss in teeth with previous TDIs undergoing orthodontic treatment.…”

“…It is essential to take a comprehensive dental history for all new orthodontic patients, with special attention to the history of dental trauma incidence and the treatment provided, as well as the history and the initial diagnosis of endodontically treated teeth. Even in the absence of history of a TDI, it is essential to perform comprehensive clinical and radiographic assessment as patients may not always recall a trauma incident [ 3 , 5 , 15 ].…”

“…A high prevalence of 10.8% has been reported for orthodontic candidates with previous TDIs before the onset of orthodontic treatment [ 3 ]. Orthodontic treatment of such teeth might be associated with an increased risk of further pulpal and periodontal consequences, especially in teeth with a previous onset of root resorption following the trauma [ 5 ]. Orthodontic treatment planning can also be challenging for previously endodontically treated teeth, and hence, clinicians should have knowledge of the techniques and the appropriate time to proceed with orthodontic tooth movement of traumatized and endodontically treated teeth, whether it was secondary to deep carious lesions or TDIs, and about the risks involved [ 5 , 6 ].…”

“…Orthodontic treatment of such teeth might be associated with an increased risk of further pulpal and periodontal consequences, especially in teeth with a previous onset of root resorption following the trauma [ 5 ]. Orthodontic treatment planning can also be challenging for previously endodontically treated teeth, and hence, clinicians should have knowledge of the techniques and the appropriate time to proceed with orthodontic tooth movement of traumatized and endodontically treated teeth, whether it was secondary to deep carious lesions or TDIs, and about the risks involved [ 5 , 6 ]. This review was developed to provide an evidence-based approach regarding the orthodontic management of traumatized and root canal-treated teeth and the current recommendations for orthodontic tooth movement of such teeth.…”