| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Clinical Section |
Paediatric Dentistry, Leeds Dental Institute, University of Leeds, Leeds, UK
York Hospital, York, UK
Pinderfields Hospital, Wakefield, UK
Paediatric Dentistry, Leeds Dental Institute, University of Leeds, Leeds, UK
Address for correspondence: Mrs Susan Anne Kindelan, Specialist Registrar, Paediatric Dentistry, Leeds Dental Institute, University of Leeds, Clarendon Way, Leeds, LS2 9LU, UK. Email: susan{at}york360.wanadoo.co.uk
Received 10 May 2007; accepted 18 December 2007
 |
Abstract |
|---|
 Top Abstract IntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
Key words: Dental trauma, orthodontic tooth movement, endodontic treatment, root resorption
|
Introduction |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
revealed the proportion of children in the United Kingdom sustaining accidental damage to their permanent incisors increased with age from 5% at age 8 to 11% by age 12 with boys sustaining injuries more frequently than girls. Epidemiological data indicates that the majority of traumatized incisors remain untreated. Indeed previous studies have given cause for concern regarding the level of knowledge pertaining to the treatment of dentoalveolar trauma amongst dental professionals in the primary care sector.2–4
The high prevalence of previous dental trauma in an orthodontic patient population has recently been reported, with 10.8% of patients sustaining dental injuries before the onset of orthodontic treatment.5
|
Objectives |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
Excellent resources exist relating to the management of dental injuries7–10 and it is not the purpose of this paper to discuss treatment of specific injuries in detail but to give the reader a general overview of current thinking in the field of dental traumatology and its interface with orthodontic management. |
Risk factors associated with dental trauma |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
–13 In an epidemiological survey 45% of upper incisor teeth were reported to have sustained visible damage by the age of 12 years in children with an overjet greater than 9 mm (IOTN5a), compared with 23% of those with an overjet less than 9 mm.14 The orthodontic specialist should also note that children treated for dental injuries often sustain repeated episodes of trauma to teeth, particularly when the initial trauma occurs at an early age.15 |
Assessment and diagnosis of dental trauma |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
Continued root growth is the most convincing clinical sign of continued pulpal vitality in an immature tooth following trauma, therefore it is often very helpful if periapical radiographs of traumatized central incisors include both the injured tooth and its uninjured counterpart for direct comparison. The placement of the electrode should be as close to the incisal edge as possible. It is, however, recognized that the use of the EPT in developing teeth or an anxious child is unreliable with false negative and false positive responses occurring. Sensibility tests, therefore, should never be considered in isolation from other clinical and radiographic findings.
It must always be remembered that adjacent or opposing teeth may have been injured at the time of the dental trauma16 and thus clinical examination of these teeth is warranted.
Endodontic intervention is required when there are clinical and radiographic signs of pulpal necrosis and infection in the post-traumatized tooth. Failure of continued root formation, external inflammatory root resorption or sinus tract formation is indicative of root canal infection spreading periapically and requires referral for appropriate endodontic treatment.
In addition, it is important that the quality of any existing root canal filling is appraised prior to the commencement of orthodontic treatment. Consideration should be given to requesting re-root treating of a tooth if the existing obturation is unsatisfactory.
| In summary the status of the traumatized tooth is drawn from a detailed history and comprehensive clinical and radiographic examination. It is imperative that all patients be questioned about any previous dental trauma prior to commencing on a course of orthodontic treatment. This will allow the orthodontist to anticipate any potential complications which may occur and to carefully monitor the traumatized tooth during orthodontic tooth movement. Liaison with paediatric, dental or endodontic colleagues will help to determine the prognosis of the tooth and aid overall treatment planning.
|
|
Prevention of dental trauma |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
In an observational study Brin et al.13 concluded that prominent incisor position and inadequate lip coverage were the most consistent risk factors related to dental trauma and suggested that early interceptive treatment should be considered to reduce the risk of dental trauma.13
However Koroluk et al.18 compared the incidence of incisor trauma in children with an overjet greater than or equal to 7 mm who had early interceptive treatment with the incidence in those where treatment had been delayed until the permanent dentition, finding no significant difference.
| Early treatment of Class II patients with an increased overjet ensures an extended treatment time and often requires two distinct phases of orthodontic treatment. Patients need to be carefully chosen and excellent compliance, motivation, oral hygiene and dietary practices must be ensured for treatment to be successful. In particular it is important that young patients should not become despondent with treatment carried out over an extended time period. As a result of these disadvantages early interceptive treatment of the Class II malocclusion is not usually recommended in the United Kingdom.
The routine provision of mouthguards for use when playing contact sports is recommended although it should be appreciated that the greatest proportion of injuries to incisor teeth occurs as a result of other accidental damage. Techniques for the construction of custom-made mouthguards for patients undergoing orthodontic treatment are available in the literature.19
|
|
Effects of orthodontic tooth movement on traumatized teeth |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
Pulp vitality
One retrospective study20 has attempted to examine the influence of orthodontic movement per se, on previously traumatized teeth with respect to risk of loss of pulp vitality and replacement resorption. Although the authors found a higher prevalence of non-responsiveness to sensibility testing in previously traumatized teeth undergoing orthodontic treatment the study numbers are too small to be conclusive.
| In summary, with the evidence currently available it is not possible to say whether orthodontic tooth movement of traumatized teeth increases the risk of pulp necrosis above that of uninjured teeth undergoing tooth movement.
|
Root resorption
There are three main types of root resorption: surface resorption, inflammatory resorption and replacement resorption.21
For any type of resorption to occur there must first be damage to the protective cementum surrounding the root. Essentially, a race between cementoblasts adjacent to the area of damage and osteoblasts in the surrounding bone, ensues.21 A critical size defect of 4 mm2 has been reported above which osteoblastic healing will preferentially occur.22 A high metallic percussion note is detectable once 20% of the root surface is affected by replacement resorption23,24 and is usually the earliest clinical indication that replacement resorption is occurring. Ankylosis usually occurs initially on the buccal and palatal surfaces of the root surface and therefore, whilst the process is present at a cellular level it is not visible on conventional radiographs until much later (up to a year).25,26
In traumatized teeth with limited damage to the cementum, adjacent cementoblasts will repopulate the damaged area and surface or cemental healing occurs. This is the same type of healing as seen following resorption secondary to orthodontic tooth movement. Where there is extensive damage to cementum, osteoblasts infiltrate the area and osseous healing or replacement resorption occurs. This is ankylosis and although it has been reported as transitory in a few cases,24,26 in the vast majority it is permanent and the tooth is slowly replaced by bone. The speed of replacement resorption is related to the speed of bone turnover and whilst this is slow in an adult, in young children bone remodelling is rapid. When replacement resorption (ankylosis) occurs in a young child the ensuing lack of vertical growth in the anterior maxilla results in progressive infraocclusion.27
If a traumatic injury results in pulpal necrosis and subsequent bacterial infection, toxins within the pulp canal space have a pathway through the dentinal tubules directly to the area of root surface damage resulting in external inflammatory resorption of the root surface which will continue until the inflammatory stimulus has been removed (e.g. pulp extirpation and disinfection of the root canal space). During the post-traumatic healing phase further damage to the protective cemental layer is not advised as this will only increase the inflammatory stimulus and prolong the destructive phase, increasing the risk of osseous healing. A period of observation to allow for periodontal ligament healing, is therefore required prior to orthodontic tooth movement.
Periodontal injuries can be ordered in severity from those producing minor cemental damage to those inflicting more severe trauma: concussion, subluxation, extrusion, lateral luxation, avulsion and finally intrusion.21 Recommended observation periods prior to orthodontic tooth movement are dependent on the severity of the injury and a summary of current best practice is outlined in Table 1.
|
It has been recommended that radiographs are taken three months after the commencement of orthodontic treatment in teeth with blunt or pipette shaped apices.29
Studies investigating the influence of previous dental trauma on root resorption during orthodontic treatment are few in number and results have been conflicting. Malmgren et al.30 found that traumatized teeth did not have a greater tendency to root resorption than uninjured teeth however they suggested previously traumatized teeth which show signs of root resorption prior to orthodontic treatment may be more prone to root resorption during treatment. They suggested an initial observation period of four to five months be allowed prior to the institution of orthodontic forces for any injured teeth.30
One study has shown the average change in root length for traumatized teeth undergoing orthodontic tooth movement was 1.07 mm compared to 0.64 mm for uninjured teeth.31
Brin et al.20 looked carefully at the reaction of previously traumatized teeth to the application of orthodontic forces. Moderate root resorption was noted in 27.8% of previously injured teeth receiving orthodontic treatment compared to 7.8% in the orthodontic treatment only group and 6.7% in the trauma only group. An increased frequency of root resorption was noted in teeth that had experienced multiple episodes of trauma. The authors suggested previous trauma may be predictive of an increased risk of root resorption during orthodontic treatment, although they concede a small sample size and a heterogeneous collection of injuries may render findings inconclusive.
Radiographic monitoring of traumatized teeth or teeth with pre-treatment root resorption
Current recommendations for radiographic assessment of traumatized teeth or teeth showing signs of pre-treatment root resorption, during orthodontic treatment are baseline periapical radiographs or an upper standard occlusal radiograph with repeated views six to nine months into treatment. If minor root resorption is noted and a decision made to continue with orthodontic treatment, further radiographs should be taken after three months.32 In the case of severe root resorption a rest period of three months is recommended prior to recommencing orthodontic treatment.33
In a long term follow-up of maxillary incisors with severe apical root resorption a risk of permanent tooth mobility has been shown to occur if the total root length is less than or equal to 9 mm.34 This risk is reduced if more than 9 mm of tooth root remains in the presence of a healthy periodontium.34
| In summary, orthodontic tooth movement is known to cause root resorption in teeth; blunt or pipette-shaped roots, jiggling orthodontic forces and previous tooth trauma may increase the susceptibility to root resorption. Retrospective studies examining resorption in traumatized teeth are inconclusive, based on small patient numbers and a heterogeneous collection of injuries, orthodontic appliances and operators.20,30 The clinician should however acknowledge that traumatized teeth which display signs of root resorption before orthodontic tooth movement are at a high risk of increased root resorption as a result of orthodontic forces.28 Good clinical and radiographic assessment is thus essential and appropriate patient information and consent should be obtained prior to the commencement of orthodontic treatment. Reliable communication and teamwork between the orthodontist and paediatric dentist or general dental practitioner is necessary for an optimal outcome.35 Despite evidence of root resorption or continued uncertainty regarding the prognosis of a traumatized tooth it may still be in the best interest of the patient to proceed with orthodontic treatment. However, this is of course influenced by other factors too, e.g. severity of malocclusion, patient motivation, etc. If the prognosis of the traumatized anterior tooth is poor, it may be that orthodontic treatment is intended to align the arches and maintain space for a future premolar transplant, adhesive bridge or implant. The paramount issue is that the patient is given all the available information and warned that the prognosis of the tooth is guarded with or without orthodontic treatment.
|
|
Orthodontic tooth movement in root treated teeth |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
whilst others have reported equal37 or reduced risk.38,39 More recently a retrospective study has been carried out evaluating the radiographic findings in patients who concurrently had one endodontically treated maxillary incisor, with the adjacent incisor tooth available as a control. No statistically significant difference in the apical root resorption was seen in the root treated teeth compared to vital control teeth.40
In an animal model it has been shown that vital and non-vital teeth moved similar distances when subjected to the same forces.41 Histologically, root-filled teeth showed greater loss of cementum after orthodontic tooth movement than vital teeth, but there was no significant difference in radiographic root length.
| From the available evidence it can be concluded that there is no significant difference in the root resorption of endodontically treated teeth when compared to vital teeth subjected to the same orthodontic forces.
|
|
Orthodontic management of root filled teeth |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
stating that endodontic treatment can be considered successful one year postobturation when there is absence of pain or swelling, no sinus tract, no loss of function and radiographic evidence of a normal periodontal ligament space around the tooth.
Since previous guidance found in the literature6,32 controversy has remained regarding the use of calcium hydroxide as the root filling material of choice during orthodontic tooth movement. Both retention of a calcium hydroxide dressing in the root canal until orthodontic tooth movement is complete6,32 and obturation of the root canal with a definitive gutta-percha root canal filling prior to orthodontic tooth movement43 have been advocated. Whilst the former advice is based on clinical experience alone, the latter recommendation is based on findings from an animal model.44 No significant difference was found in resorption indices of teeth obturated with gutta-percha or those filled with an interim calcium hydroxide dressing. A definitively obturated and coronally sealed root treated tooth would appear to be at no greater risk of root resorption during tooth movement than one in which an interim dressing is maintained.
When there is established external inflammatory root resorption, long-term calcium hydroxide treatment (12 weeks) is significantly more effective than short-term treatment (1 week application prior to obturation) in promoting root surface healing with new cementum.45 There may, however, be detrimental effects in placing a calcium hydroxide dressing in non-vital teeth over the extended period of time orthodontic treatment requires, particularly in immature teeth. An increased risk of cervical root fracture in traumatized immature teeth treated with calcium hydroxide over prolonged periods of time during apexification has been reported.46 Several in vitro studies have shown the fracture resistance of teeth treated with calcium hydroxide over an extended period to be significantly decreased but unaffected by a dressing placed for up to 30 days.47–49 Rosenburg et al.49 compared the dentine fracture strength of teeth dressed with an intracanal calcium hydroxide paste and teeth obturated with gutta-percha, finding that the micro-tensile fracture strength of teeth reduced by 0.157 MPa per day, so that by day 84 the strength of dentine was reduced by 43.9%. This suggests that the clinical use of calcium hydroxide as an intra-canal medicament over a prolonged period of time should be re-evaluated.
These findings lend support to the earlier recommendations of completing definitive root canal therapy prior to a prolonged course of orthodontic tooth movement.43 A well-cleaned and obturated root filling with a good coronal seal50 allows for enhanced biological control over the tooth during tooth movement and thus obturation of non-vital traumatized teeth with gutta-percha and sealer should be recommended. The exceptions are when non-setting calcium hydroxide dressing is required for a longer period to allow disinfection of the root canal (e.g. in inflammatory resorption) or for apexification in an immature open apex incisor, although a single visit mineral trioxide appetite technique is becoming a popular alternative.51
| In conclusion it is recommended that definitive obturation of a non-vital tooth is completed at the earliest opportunity prior to orthodontic tooth movement, in most cases. Exceptions are noted above.
|
Observation periods following endodontic treatment prior to orthodontic tooth movement
Guidance is based on expert opinion.32,43 In cases where root canal treatment has been undertaken as a result of pulp necrosis due to caries, orthodontic tooth movement can commence immediately.
Where there has been extensive bone loss, tooth movement should be delayed until there are clinical and radiographic signs of some healing and an interval of at least six months has been suggested.43
Where endodontic therapy has been carried out following dental trauma an interval of one year is recommended prior to proceeding with orthodontic treatment to increase the likelihood of complete healing and the absence of ankylosis.32,43 At one year healing should be complete and the possibility of ankylosis subsequently developing is minimal, although even some years after a significant luxation injury the chance of a future diagnosis of ankylosis cannot be totally eliminated52 and patients should be warned that this could still occur. The orthodontist should have a high index of suspicion that this has occurred if a previously traumatised tooth fails to move as expected. Recommendations relating to time intervals to be observed prior to orthodontic tooth movement are based on clinical judgement and experience rather than being founded on evidence from well-designed studies. In a review Hamilton and Gutmann53 reported a lack of well-designed studies to provide definitive guidance relating to the best time to commence orthodontic treatment following root canal therapy in previously traumatized teeth.
An animal model has shown that, although orthodontic forces applied to root-filled teeth delays the periapical healing process in comparison to obturated contralateral incisors it does not prevent it, with a reduced periapical radiolucency visible in orthodontically moved teeth.54 This work suggests that tooth movement may be commenced prior to complete radiographic resolution of periapical pathosis.
A summary of observation periods recommended prior to the orthodontic movement of endodontically treated teeth is provided in Table 1 .
|
Force levels and mechanics for root-filled teeth
Normal force levels (net force of 50–100 g on a central incisor for bodily movement) using fixed appliances can be used for moving root-filled teeth, providing the periodontal ligament is healthy.39
Monitoring root treated teeth during orthodontic tooth movement
There has been no recent literature contradicting previous guidance32 which recommends initial radiographs prior to the commencement of orthodontic tooth movement followed by radiographic monitoring six months after the start of orthodontic treatment.
|
Teeth traumatized during treatment |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
Patients who have experienced dental trauma prior to orthodontic treatment can thus be warned, not only of the possible increased risk of root resorption as a result of orthodontic forces on the tooth, but equally of the risk of future episodes of trauma during treatment which may have an impact on the prognosis of the teeth and the length of time for orthodontic treatment to be completed. This is particularly true if tooth movement needs to be halted whilst endodontic treatment is carried out, a period of observation following trauma is required, or a rest period is necessary if root resorption becomes apparent during treatment. The reader is referred to Table 1 for a summary of current guidance regarding observation periods prior to commencing or restarting orthodontic tooth movement. |
Interdisciplinary management of root fractured and intruded teeth |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
Root fractured teeth
Root fractures account for 0.5–7% of dental traumatic injuries55 and may be horizontal, vertical, single or multiple and complete or incomplete. The aims of treatment are to preserve pulp vitality, facilitate periodontal healing and encourage fracture healing with a hard tissue callus rather than connective tissue, bone and connective tissue or granulation tissue (as the result of a necrotic coronal pulp). It should be remembered that the apical root fragment almost always remains vital even if the coronal part becomes non-vital.56 Diagnosis of root fractures can be problematic and requires radiographic exposure in two or more planes in order to identify or rule out this possible diagnosis. The established protocol for root fractured teeth for over 30 years has been rigid splinting for two to three months but recent guidance advocates physiological splinting for four weeks in the case of apical and mid-root fractures and splinting for four months in the case of cervical root fractures.9
If orthodontic movement of previously root fractured teeth is considered it is essential to determine that a hard tissue barrier of dental callus exists between the fragments. If the fracture has healed with connective tissue the coronal fragment alone will move when subjected to orthodontic forces and it should be considered as a tooth with a short root. This has profound implications if further orthodontic root resorption occurs to the coronal fragment thereby shortening the root further. As discussed previously, permanent mobility of the coronal fragment can be expected where the root length is less than 9 mm.34
When there are radiographic and clinical signs indicative of coronal pulp necrosis and granulation tissue is interposed between the fragments, appropriate endodontic therapy of the coronal pulp is required prior to orthodontic tooth movement. Following successful endodontic treatment of the coronal fragment only, the healing of the fracture site will be by connective tissue and the tooth should be considered to have a short root. Zachrisson and Jacobsen 57 recommended an observation period of two years prior to commencing orthodontic tooth movement of root fractured teeth, although it has been suggested this could be shortened in the absence of complications, which will usually have become evident by one year.32
| In the case of orthodontic movement of root fractured teeth it is recommended that light forces be used,31 treatment is expediently completed6,32,43 and teeth are appropriately monitored radiographically and clinically for continued signs of pulpal vitality.
|
Intrusion injuries
Intrusion injuries account for about 1.9% of all traumatic injuries.58 The crushing injury of intrusion causes severe damage to the tooth, periodontium and pulpal tissues. Although periodontal ligament regeneration may occur in mild intrusions healing outcomes for more severe intrusion injuries frequently include replacement resorption, marginal bone loss and pulp necrosis.
Guidelines exist for the management of intruded permanent incisor teeth in children.9,59
In essence, all severely intruded teeth and moderately intruded teeth with closed apices, should be repositioned rapidly in order to allow access for extirpation of a non-vital pulp to prevent inflammatory root surface resorption secondary to pulp necrosis. Active surgical or orthodontic repositioning is, however, a further traumatic event for the periodontal ligament and it has been suggested that spontaneous re-eruption should be allowed in mild to moderate injuries in patients up to the age of 17 years.9 Active repositioning should still be considered if there is no change in the position of the tooth after a two week interval. It should also be remembered that severe intrusion may lock a tooth in position in the alveolar bone and gentle luxation forces may be required before orthodontic extrusion.
| A significantly higher prevalence of root resorption and pulp necrosis has been observed in the most severely intruded and in closed-apex teeth.60,61 Treatment method (surgical repositioning, orthodontic traction or spontaneous re-eruption) have been shown by some authors60–62 to have no significant effect on the prevalence or rate of root resorption, although there is some agreement that spontaneous re-eruption should be encouraged where possible.9 Clinicians should warn patients that discrepancies in the incisal position of teeth and in gingival marginal contour may occur following intrusion injuries due to replacement resorption and resulting infra-occlusion. Root fractures, intrusion injuries and tooth avulsion all result in a severe insult to the periodontal ligament, cementum and pulp of the tooth. Negative consequences include both loss of pulp vitality and significant damage to the cementum and periodontal tissues, allowing ingress of osteoclasts and osteoblasts to the area of damage and consequent replacement resorption of the root.
|
It would be of great benefit if it were possible to prevent replacement resorption in the injured tooth. Mine et al.63 used a rat model to examine the role of mechanical stimuli in preventing ankylosis. Mine’s group suggested that occlusal stimuli promotes the regeneration of the periodontal ligament and prevents dentoalveolar ankylosis, although excessive initial force may cause severe root and bone resorption. They postulated that an orthodontic archwire may be used to distribute or deliver the appropriate force to a transplanted (and thus it may be inferred, a replanted) tooth to avoid root resorption and ankylosis, whilst stimulating periodontal ligament repair and improving the prognosis. Other authors64 have shown the beneficial effect of encouraging a hard diet, following dental trauma in a monkey model, and this may well be a simpler way of providing the physiological stimuli discussed previously.63
Neither method is able to regenerate cemental healing when very extensive damage has occurred to the periodontal tissues, with replacement resorption being inevitable.
Table 1 outlines the observation periods which would be recommended prior to orthodontic tooth movement given the evidence currently available.
|
Conclusions |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
|
References |
|---|
|
TopAbstractIntroductionObjectivesRisk factors associated with...Assessment and diagnosis of...Prevention of dental traumaEffects of orthodontic tooth...Orthodontic tooth movement in...Orthodontic management of root...Teeth traumatized during...Interdisciplinary management of...ConclusionsReferences |
|---|
2 Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 1: the prevalence and incidence of injuries and the extent and adequacy of treatment received. Br Dent J 1997; 182: 91–95.[Medline]
3 Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 2: dentists’ knowledge of management methods and their perceptions of barriers to providing care. Br Dent J 1997; 182: 129–33.[Medline]
4 Kostoupolou MN, Duggal MS. A study into dentist’s knowledge of the treatment of traumatic injuries to young permanent incisors. Int J Paediatr Dent 2005; 15: 10–19.[CrossRef][Medline]
5 Bauss O, Röhling J, Schwestka-Polly R. Prevalence of traumatic injuries to the permanent incisors in candidates for orthodontic treatment. Dent Traumatol 2004; 20: 61–66.[CrossRef][Medline]
6 Atack NE. The orthodontic implications of traumatized upper incisor teeth. Dent Update 1999; 26: 432–37.[Medline]
7 Andreasen JO, Andreasen FM, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth, 4th edn. Oxford: Blackwell Munksgaard, 2007.
8 Welbury RR, Gregg TA. Managing Dental Trauma. London: Quintessence, 2006.
9 Flores MT, Andersson L, Andreasen JO, et al. Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth. Dent Traumatol 2007; 23: 66–71.[CrossRef][Medline]
10 Bakland LK, Andreasen JO. Dental traumatology: essential diagnosis and treatment planning. Endod Topics 2004; 7: 14–34.[CrossRef]
11 Järvinen S. Traumatic injuries to upper permanent incisors related to age and incisal overjet. A retrospective study. Acta Odontol Scand 1979; 37: 335–38.[Medline]
12 Burden DJ. An investigation of the association between overjet size, lip coverage and traumatic injury to maxillary incisors. Eur J Orthod 1995; 17: 513–17.
13 Brin I, Ben-Bassat Y, Heling I, Brezniak N. Profile of an orthodontic patient at risk of dental trauma. Endod Dent Traumatol 2000; 16(3): 111–15.[CrossRef][Medline]
14 Todd JE, Dodd T. Children’s Dental Health in the United Kingdom 1983. London: Office of Population Censuses and Surveys, 1985.
15 Glendor U, Koucheki B, Halling A. Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth. Endod Dent Traumatol 2000; 16(5): 205–10.[CrossRef][Medline]
16 Majorana A, Pasini S, Bardellini E, Keller E. Clinical and epidemiological study of traumatic root fractures. Dent Traumatol 2002; 18: 77–80.[CrossRef][Medline]
17 Mohlin B. Early reduction of large overjets. In: Andreasen JO, Andreasen FM, Sjöström D, Eriksson B (Eds). Proceedings of the Second International Conference on Dental Trauma. Stockholm: Folksam, 1991, 88–95.
18 Koroluk LD, Tulloch JF, Phillips C. Incisor trauma and early treatment for Class II Division 1 malocclusion. Am J Orthod Dentofacial Orthop 2003; 123(2): 117–25.[CrossRef][Medline]
19 Newsome PR, Tran DC, Cooke MS. The role of the mouthguard in the prevention of sports-related dental injuries: a review. Int J Paediatr Dent 2001; 11: 396–404.[CrossRef][Medline]
20 Brin I, Ben-Bassat Y, Heling I, Engelberg A. The influence of orthodontic treatment on previously traumatized permanent incisors. Eur J Orthod 1991; 13: 372–77.
21 Trope M. Root resorption due to dental trauma. Endod Topics 2002; 1: 79–100.[CrossRef]
22 Andreasen JO, Kristerson L. The effect of limited drying or removal of the periodontal ligament. Periodontal healing after replantation of mature permanent incisors in monkeys. Acta Odontol Scand 1981; 39: 1–13.[Medline]
23 Andersson L, Blomlof L, Lindskog S, Feiglin B, Hammerstrom L. Tooth ankylosis. Int J Oral Maxillofac Surg 1981; 13: 423–31.
24 Andersson L. Dentoalveolar ankylosis and associated root resorption in replanted teeth. Experimental and clinical studies in monkeys and man. Swed Dent J Suppl 1988; 56: 1–75.[Medline]
25 Andreasen JO. Analysis of pathogenesis and topography of replacement root resorption (ankylosis) after replantation of mature permanent incisors in monkeys. Swed Dent J 1980; 4: 231–40.[Medline]
26 Andreasen JO. Periodontal healing after replantation of traumatically avulsed human teeth. Assessment by mobility testing and radiography. Acta Odontol Scand 1975; 33: 325–35.[CrossRef]
27 Malmgren B, Malmgren O. Rate of infraposition of reimplanted ankylosed incisors related to age and growth in children and adolescents. Dent Traumatol 2002; 18: 28–36.[CrossRef][Medline]
28 Levander E, Malmgren O. Evaluation of the risk of root resorption during orthodontic treatment: A study of upper incisors. Eur J Orthod 1988; 10: 30–38.
29 Levander E, Bajka R, Malmgren O. Early radiographic diagnosis of apical root resorption during orthodontic treatment: a study of maxillary incisors. Eur J Orthod 1998; 20: 57–63.
30 Malmgren O, Goldson L, Hill C, Orwin A, Petrini L, Lundberg M. Root resorption after orthodontic treatment of traumatized teeth. Am J Orthod 1982; 82: 487–91.[CrossRef][Medline]
31 Linge BO, Linge L. Apical root resorption in upper anterior teeth. Eur J Orthod 1983; 5: 173–83.
32 Malmgren O, Malmgren B and Goldson L. Orthodontic management of the traumatised dentition, In Andreasen JO, Andreasen FM, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth, 4th edn. Oxford: Blackwell Munksgaard, 2007, 669–715.
33 Levander E, Malmgren O, Eliasson S. Evaluation of root resorption in relation to two orthodontic treatment regimes. A clinical experimental study. Eur J Orthod 1994; 16: 223–28.
34 Levander E, Malmgren O. Long-term follow-up of maxillary incisors with severe apical root resorption. Eur J Orthod 2000; 22(1): 85–92.
35 Luther F, Dominguez-Gonzalez S, Fayle SA. Teamwork in orthodontics: Limiting the risks of root resorption. Br Dent J 2005; 198: 407–11.[CrossRef][Medline]
36 Wickwire NA, McNeil MH, Norton LA, Duell RC. The effects of tooth movement upon endodontically treated teeth. Angle Orthod 1974; 44: 235–42.[Medline]
37 Hunter ML, Hunter B, Kingdon A, Addy M, Dummer PM, Shaw WC. Traumatic injury to maxillary incisor teeth in a group of South Wales school children. Endod Dent Traumatol 1990; 6: 260–64.[CrossRef][Medline]
38 Remington DN, Joondeph DR, Årtun J, Riedel RA, Chapko MK. Long-term evaluation of root resorption occurring during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989; 96: 43–46.[CrossRef][Medline]
39 Spurrier SW, Hall SH, Joondeph DR, Shapiro PA, Reidel RA. A comparison of apical root resorption during orthodontic treatment in endodontically treated and vital teeth. Am J Orthod Dentofacial Orthop 1990: 97: 130–34.[CrossRef][Medline]
40 Esteves T, Ramos AL, Pereira CM, Hidalgo MM. Orthodontic root resorption of endodontically treated teeth. J Endod 2007; 33(2): 119–22.[CrossRef][Medline]
41 Mah R, Holland GR, Pehowich E. Periapical changes after orthodontic movement of root-filled ferret canines. J Endod 1996; 22(6): 298–303.[CrossRef][Medline]
42 European Society of Endodontics. Consensus report of the European Society of Endodontology on quality guidelines for endodontic treatment. Int Endod J 1994; 27: 115–24.[CrossRef][Medline]
43 Drysdale C, Gibbs SL, Ford TR. Orthodontic management of root-filled teeth. Br J Orthod 1996; 23(3): 255–60.[Abstract]
44 Dumsha T, Hovland EJ. Evaluation of long-term calcium hydroxide treatment in avulsed teeth—an in vivo study. Int Endod J 1995; 28(1): 7–11.[CrossRef][Medline]
45 Trope M, Moshonov J, Nissan R, Buxt P, Yesilsoy C. Short vs. long-term calcium hydroxide treatment of established inflammatory root resorption in replanted dog teeth. Endod Dent Traumatol 1995; 11: 124–28.[CrossRef][Medline]
46 Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol 1992; 8:45–55.[CrossRef][Medline]
47 Andreasen JO, Farik B, Munksgaard EC. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol 2002; 18(3): 134–37.[CrossRef][Medline]
48 Doyon GE, Dumsha T, von Fraunhofer JA. Fracture resistance of human root dentin exposed to intracanal calcium hydroxide. J Endod 2005; 31(12): 895–97.[CrossRef][Medline]
49 Rosenberg B, Murray PE, Namerow K. The effect of calcium hydroxide root filling on dentin fracture strength. Dent Traumatol 2007; 23(1): 26–29.[Medline]
50 Saunders WP, Saunders EM. Coronal leakage as a cause of failure in root-canal therapy: a review. Endod Dent Traumatol 1994; 10: 105–8.[CrossRef][Medline]
51 Rafter M. Apexification: a review. Dent Traumatol 2005; 21: 1–8.[CrossRef][Medline]
52 Andersen PK, Andreasen FM, Andreasen JO. Prognosis of Traumatic Dental Injuries: Statistical Considerations, In: Andreasen JO, Andreasen FM, Andersson L (Eds). Textbook and Color Atlas of Traumatic Injuries to the Teeth, 4th edn. Oxford: Blackwell Munksgaard, 2007, 835–41.
53 Hamilton RS, Gutman JL. Endodontic-orthodontic relationships: a review of integrated treatment planning challenges. Int Endod J 1999; 32: 343–60.[CrossRef][Medline]
54 De Souza RS, Gandini LG, Jr, de Souza V, Holland R, Dezan E, Jr. Influence of orthodontic dental movement on the healing process of teeth with periapical lesions. J Endod 2006; 32: 115–19.[CrossRef][Medline]
55 Andreasen FM, Andreasen JO. Root fractures. In: Andreasen JO, Andreasen FM, Andersson L (Eds). Textbook and Color Atlas of Traumatic Injuries to the Teeth, 4th edn. Oxford: Blackwell Munksgaard, 2007, 337–71.
56 Welbury R, Kinirons MJ, Day P, Humphreys K, Gregg TA. Outcomes for root-fractured permanent incisors: a retrospective study. Paediatr Dent 2002; 24(2): 98–102.
57 Zachrisson BU, Jacobsen I. Response to orthodontic movement of anterior teeth with root fractures. Trans Eur Orthod Soc 1974; 50: 207–14.[Medline]
58 Andreasen JO, Bakland LK, Matras RC. Andreasen FM. Traumatic intrusion of permanent teeth. Part 1: an epidemiological study of 216 intruded permanent teeth. Dent Traumatol 2006; 22: 8–89.
59 Kinirons MJ. UK National Clinical Guidelines in Paediatric Dentistry. Treatment of traumatically intruded permanent incisor teeth in children. Int J Paediatr Dent 1998; 8: 165–68.[CrossRef]
60 Al-Badri S, Kinirons M, Cole B, Welbury R. Factors affecting resorption in traumatically intruded permanent incisors in children. Dent Traumatol 2002; 18: 73–76.[CrossRef][Medline]
61 Humphrey JM, Kenny DJ, Barrett EJ. Clinical outcomes for permanent incisor luxations in a pediatric population. I. Intrusions. Dent Traumatol 2003; 19: 266–73.[CrossRef][Medline]
62 Chaushu S, Shapira J, Heling I, Becker A. Emergency orthodontic treatment after the traumatic intrusive luxation of maxillary incisors. Am J Orthod Dentofacial Orthop 2004; 126: 162–72.[CrossRef][Medline]
63 Mine K, Kanno Z, Muramoto T, Soma K. Occlusal forces promote periodontal healing of transplanted teeth and prevent dentoalveolar ankylosis: an experimental study in rats. Angle Orthod 2005; 75(4): 637–44.[Medline]
64 Andersson L, Lindskog S, Blomlof L, Hedstrom KG, Hammarstrom L. Effect of masticatory stimulation on dentoalveolar ankylosis after experimental tooth replantation. Endod Dent Traumatol 1985; 1: 13–16.[Medline]
65 Paulsen HU, Andreasen JO, Schwartz O. Pulp and periodontal healing, root development and root resorption subsequent to transplantation and orthodontic rotation: a long-term study of autotransplanted premolars. Am J Orthod Dentofacial Orthop 1995; 108: 630–40.[CrossRef][Medline]
66 Andreasen JO. A time-related study of periodontal healing and root resorption activity after replantation of mature permanent incisors in monkeys. Swed Dent J 1980; 4: 101–10.[Medline]
67 Tsukiboshi M. Sequence and treatment procedures. In Autotransplantation of Teeth, 2nd Edn. Chicago: Quintessence, 2001, 76–131.
This article has been cited by other articles:
|
|
 |
|
  P. F Day, S. A Kindelan, J. R Spencer, J. D Kindelan, and M. S Duggal Dental trauma: part 2. Managing poor prognosis anterior teeth - treatment options for the subsequent space in a growing patient J. Orthod., September 1, 2008; 35(3): 143 - 155. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
