Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries –a review article.

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 9/04/2009
Article title: Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries –a review article.
Author(s): Andreasen JO, Andreasen FM, Skeie A, et al.
Journal: Dental Traumatol. 2002
Volume (number): 18: 116-128
Major topic: Dental Trauma Treatment timing
Type of Article: Review of Literature
Main Purpose: The purpose of this article was to evaluate clinical and experimental studies when a treatment delay factor was analyzed. These treatment timing factors were divided into acute (<3>24 hrs). The studies were selected from a Medline search.
Materials and Methods: The studies were evaluated according to the following types of injuries: Enamel/Dentin fractures, Complicated crown fractures including pulp exposures, Crown root fractures, Alveolar fractures, Concussion and subluxation, Extrusion and lateral luxation, Intrusion, Avulsions, and Primary tooth trauma.
Findings: Enamel/Dentin fractures: There are few symptoms reported, and aside from the occurrence of luxation complications, there is very low risk of pulp complications. Pulp complications occur in 1-3% of cases on average regardless of timing of treatment. Complicated crown fractures which include pulp exposures: It is common to have stimulated pain such as during mastication and temperature changes. If pulp caps or partial pulpotomy is the treatment of choice than no time relationship was show between treatment and pulpal healing. However, if cervical pulpotomy is planned then a subacute approach has a better prognosis for pulp healing. Crown/root fracture: In these cases, the coronal fragment should be removed and the pulp should be extirpated in its entirety especially if the root development is mature. Treatment has no relation to timing. Root fractures: Pain is usually related to tooth displacement. Studies indicate no proof of treatment timing as it relates to prognosis. Alveolar fractures: Pain is present during coclusion on displaced tooth bone segment. The two studies evaluated indicate healing of bone is good, but the PDL and pulp often develop complications. A strong relationship exists between treatment time and risk of pulpal necrosis was reported, but the studies were biased. Acute treatment timing is indicated. Concussion and subluxation: Pain to occlusion and mastication but not spontaneous. Mobility may be related. No conclusions could be drawn between this injury type and timing of treatment. Extrusion and lateral luxation: Although no study yielded a significant relationship between treatment timine and periodontal ligament healing, it was suggested that to reduce clinical symptoms. An acute or subacute treatment time is indicated. Root development seems to have more relevance in time of healing of pulpal or PDL tissue. Intrusion: This type of injury has the most severe pulpal and periodontal injury prognosis regardless of treatment timing. Treatment considerations include immedicate extrusion or delated extrusion Avulsions: Prognosis is reated to storage medium and length of extra-alveolar timing. Acute timing for reimplantation is essential, but splinting may occur in a subacute time frame. Primary tooth trauma: most injuries are lateral locations and intrusions. The extent of the injury determines the prognosis of the permanent tooth more so than the timing of treatment. An acute treatment approach is more appropriate for injuries affecting occlusion. Otherwise subacute treatment is warranted.
Key points/Summary : Few acute treatment indications are supported by the literature as it relates to dental trauma. Repositioning and splinting of teeth has a questionable prognosis when treatment timing is considered. However the immediacy of antibiotics to prevent dental infection appear to be appropriate.
Assessment of article: Lots of data to support the conclusion that we do not as dentists need to rush to the office to treat dental truama