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Comprehensive treatment of traumatic fracture and luxation injuries in the anterior permanent dentition.

The increased incidence of traumatic injuries in anterior teeth is a consequence of modern leisure activities. The key factors to successful functional and aesthetic rehabilitation of such injuries are proper diagnosis and adequate primary and subsequent treatment. In severe cases, sequential multidisciplinary treatment is required. All-ceramic crown and post-and-core systems allow for superior aesthetics without compromising function. This article addresses fractures and luxation injuries in the anterior permanent dentition and discusses updated treatment options. The multidisciplinary rehabilitation of a clinical case for optimal function and aesthetics is presented.

Adult↗

Pulpal healing following acute dental trauma: clinical and radiographic review.

Successful treatment of tooth luxations, crown fractures, and root fractures is often compromised by the emergency nature of the injury. Precise radiographic and clinical evaluation is required to facilitate healing and treatment selection. While traditional treatment protocols indicate that dental injuries implying pulpal ischemia require immediate endodontic therapy to avoid healing complications, the clinical investigations discussed herein suggest that a variety of etiologies for pulp survival/pulp necrosis exist. This article discusses the long-term prognosis of pulp necrosis following traumatic dental injuries, and clinical and radiographic criteria for its diagnosis.

Clinical Protocols↗

Treatment of traumatic injuries in the front teeth: restorative aspects in crown fractures.

Crown fractures are the most common form of traumatic dental injuries encountered in permanent dentition. Restorative treatment modalities incorporate adhesive materials to effectively maintain function and aesthetics. While uncomplicated injuries of the enamel and/or dentin can be treated solely with adhesive procedures, complicated trauma that involves pulp exposure requires the incorporation of a multidisciplinary treatment approach. Fragment reattachment is facilitated by the utilization of bonding agents that enhance retention and aesthetics. This article discusses the application of provisional and permanent restorative options for the treatment of complications following traumatic injuries.

Adhesives↗

Treatment of luxation traumatic injuries: definition and classification in the literature.

Luxation traumatic injuries affect the hard tissues and may involve periodontal tissues in severe cases. Periodontal healing must be considered during treatment of traumatic injuries that result in total luxation of the teeth. Pulpal healing is essential for the endodontic prognosis of a reimplanted tooth, as well as for its periodontal healing. Luxation injuries can be further classified as intrusive, extrusive, and/or lateral; this categorization further facilitates the mode of splinting and repositioning utilized during treatment. This article reviews various types of dentoalveolar traumatic injuries and discusses commonly incorporated treatment modalities.

Alveolar Process↗

Laser Doppler flowmetry for monitoring traumatized teeth.

Laser Doppler Flowmetry (LDF) has been shown to be valuable in monitoring revascularization of immature incisors following severe dental trauma. Several investigators have demonstrated the ability of LDF to record blood flow signals from vital tooth pulps. In this case report, LDF was used for a 7-year-old child patient following a severe luxation of tooth #9. During follow-up examinations the traumatized tooth was unresponsive to traditional vitality testing during the first 6 months; however, LDF indicated that revascularization had occurred much sooner. Until recently, CO2 ice has been the most effective method for sensitivity testing in trauma cases such as presented here. In this case, LDF gave us the assurance that we could defer invasive care during a critical time period when root canal therapy might have been initiated for this child patient.

Child↗

Dental management of traumatic injuries to the primary dentition.

There is considerable information on traumatic injury management of permanent teeth. However, there are no conclusive guidelines for treating traumatized primary teeth. This article will summarize a number of issues relative to primary dentition trauma and provide a system for treatment.

Age Factors↗

Luxation injuries and external root resorption--etiology, treatment, and prognosis.

When a tooth sustains a luxation injury, attachment damage of varying degrees will occur. In addition, necrosis of the pulp might result, thereby making the pulp space susceptible to infection. These circumstances can lead to root resorption. Treatment for root resorption includes preventing it by avoiding causes of root surface injury, minimizing initial inflammation, and reversing resorption.

Anti-Bacterial Agents↗

[Dento-alveolar injuries].

Most dento-alveolar traumas can be managed by the dentist-general practitioner. Still, there are some specific injuries which should be treated by dental specialists. Some specific guidelines are given for the combined surgical-orthodontic treatment of fracture of the coronal part of the root, intrusive luxation, abnormal position of the permanent tooth due to traumatic displacement of the deciduous tooth, ankylosis and tooth loss.

Child↗

Use of self-etching adhesive system and compomer for splinting traumatized incisors.

Traumatized teeth that are displaced from their normal alveolar positions need to be repositioned and stabilized so that healing can occur. Orthodontic ligature wire bonded into place with resin-based composite works well for splinting teeth. Using a self-etching adhesive bonding system and compomer material facilitates both the resin bonding and its removal. This clinical report describes a simplified resin/wire splinting procedure.

Adolescent↗

Treatment and prevention of alveolar fractures and related injuries.

Dentoalveolar trauma does not pose a significant morbid risk for the trauma patient. However, the long-term consequences of mismanagement can be devastating. Early, correct diagnosis, and appropriate referral of these injuries can affect the success of treatment. Failure to recognize or obtain appropriate consultation can result in premature tooth or alveolar bone loss, resulting in problematic prosthetic rehabilitation. The purpose of this article is to review the concepts of recognition, management, and prevention of dentoalveolar trauma. In situations where the possibility of trauma is likely, such as in athletics, dentoalveolar and related fractures can be prevented through the use of mouthguards fabricated by health care professionals.

Alveolar Process↗

Outcomes for root-fractured permanent incisors: a retrospective study.

PURPOSE: The objective of this study was to assess the outcomes for treated root-fractured permanent incisors with respect to pulp vitality, root tissue union, and tooth survival and to examine the effects of clinical and radiographic parameters and rigid splinting on the outcome. METHODS: Eighty-four teeth were identified and data extracted from case notes prior to transfer to an SPSS data base for analysis. The odds ratios for each factor were calculated and the significance of differences was determined. Tooth loss and relevant risk variables were examined using Cox's regression model and Kaplan-Meyer survival curves. RESULTS: Fourteen (17%) had fractures in the apical third, 47 (56%) in the middle third, and 23 (27%) in the coronal (gingival) third. Twenty-four (29%) also had crown fractures involving enamel and dentine. Crown fractures were identified as significant risk factors for pulp vitality. Loss of pulp vitality, horizontal displacement, and extrusive displacement of the coronal fragment were significant risk factors for hard root tissue union. Survival was poorest with gingival third fractures with 14 (61%) of these teeth being lost. Splinting rigidly had no significant effect on pulp vitality and type of root tissue healing. CONCLUSIONS: Loss of pulp vitality was significantly associated with enamel-dentine crown fracture. Hard root tissue union was significantly affected by pulp necrosis and luxation of the coronal fragment. Survival was poorest for root fractures within the gingival third of the root. Splinting with rigid fixation had no significant effect on pulp vitality and type of root tissue union.

Adolescent↗

Alveolar distraction osteogenesis: a case report involving ankylosed maxillary central incisors.

Restorative dentistry, for the optimal esthetic and functional result, at times requires innovation, exacting techniques, and employment of various treatment modalities. A case has been presented here involving a large esthetic defect in the maxillary anterior. Traditional methods of restoration may have been successful but alveolar distraction osteogenesis was determined to be the treatment of choice due to time, predictability, lack of invasiveness, and cost. It is a relatively new surgical procedure that has many applications to restore esthetic defects, ridge augmentation, and large craniofacial abnormalities. Movement of osseous sections can be made in a vertical, labial, or lingual direction. When treatment planning restorative dentistry with vertical hard and soft tissue deficiencies, alveolar distraction osteogenesis can be considered to achieve optimal esthetics and a more ideal crown-to-root ratio. Further information can be obtained from any oral surgeon, orthodontist, or from the Internet. Dr. Martin Chin, a maxillofacial surgeon from San Francisco, has done much of the clinical work regarding distraction procedures on humans and continues to be an innovator in craniofacial distraction osteogenesis. His work can be found on the Internet at www.distraction.net; other interesting Web sites include www.klsmartin.com/distract.dir/indexdistract.html and www.seattle-implants.com/articles/distost.htm.

Adolescent↗