Resident: Cho
Author(s): Kenny et al.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2001. 23. 464-468.
Major topic: Dental trauma
Minor topic: Avulsion, intrusion, root fracture
Type of Article: Review Article
Main Purpose: The main purpose was to provide an update of how to treat dental trauma for pediatric dentists.
Overview of method of research: Systematic review
Key points/Summary:
Prevention: sports dentistry
- Children with overjets greater than 3mm twice as likely to sustain incisor injuries.
- Children with extreme overjets should be considered for early orthodontic intervention, especially if they have seizures, motor disturbances or are active participants in sports.
Avulsion: primary teeth
- There are no guidelines to replant primary teeth.
Possible sequelae of replanting primary teeth include dental abscesses, root resorption, ankylosis, deflection of permanent incisors and hypoplastic and morphological changes to permanent incisor crowns.
Avulsion: permanent teeth
- In vitro studies of avulsed permanent teeth have shown that by 15 minutes the progenitor cells on the root-side PDL are unable to differentiate into fibroblasts and by 30 minutes of dessication most or all PDL cells are dead. In vitro studies have also shown that storing an avulsed tooth in Balanced Salt Solution was equivalent to storing it in milk. Cool milk will maintain cell function twice as long as warm milk.
- Pre-replantation treatment of the avulsed tooth with fluoride is directed toward elimination of inflammatory root resorption and increasing resistance of the root to ankylosis.
- If the window of opportunity for periodontal regeneration has lapsed beyond 5-10 minutes, the clinician must plan for the inevitable outcomes of root resorption, ankylosis and tooth loss.
- Ankylosis may cause alveolar and gingival architecture to become distorted for growing children in the area of the ankylosed tooth. This may cause the need for bone grafting in conjunction with single tooth implant and crown.
- Replanted avulsed permanent incisors will be lost prematurely (prognosis for open apex is worse than closed apex).
Intrusion: permanent teeth
- The prognosis of incisors with severe (>6mm) intrusions are hopeless.
- Clinicians who apply traction or wait for re-eruption for teeth intruded more than 5-6mm must ensure that they can obtain endodontic access within 1-2 weeks in order to remove the dental pulp and prevent inflammatory root resorption.
Root Fractures: permanent teeth
- Splinting is a controversial topic: whether to splint, whether to splint rigid or flexible, and how long to splint
Bioactive substances
- Enamel matrix derivative, Emdogain, may facilitate PDL regeneration and thus inhibit the development of replacement and inflammatory root resorption. However, more research needs to be conducted in this field.
Autotransplantation
- Definition: extraction of a tooth in one location and replantation in another location.
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Assessment of Article: This article provided a good and basic overview of how to manage dental traumas.
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