The treatment of traumatic dental injuries

Asgeir Sigurdsson DDS, MS

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Article: The treatment of traumatic dental injuries

Authors: Asgeir Sigurdsson, DDS, MS

Learning Objectives:

  •  Discuss how to assess the patient and diagnose common dental and pulpal injuries.
  • Describe the recommended emergency treatment for common dental injuries.
  • Describe the recommended follow-up schedule for common dental injuries.

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For additional reading on the topic, please refer to:

1.            Diangelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol 2012;28:2-12.

2.            Andreasen JO, Ahrensburg SS, Tsilingaridis G. Root fractures: the influence of type of healing and location of fracture on tooth survival rates - an analysis of 492 cases. Dent Traumatol 2012;28:404-409.

3.            Bucher K, Neumann C, Thiering E, Hickel R, Kuhnisch J. Complications and survival rates of teeth after dental trauma over a 5-year period. Clin Oral Invest 2013;17:1311-1318.

4.            Hofman PA, Nelemans P, Kemerink GJ, Wilmink JT. Value of radiological diagnosis of skull fracture in the management of mild head injury: meta-analysis. J Neurol Neurosurg Psych 2000;68:416-422.

5.            McCrory P, Meeuwisse WH, Aubry M, Cantu RC, Dvorak J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport, Zurich, November 2012. J Athl Train 2013;48:554-575.

6.            Fuss Z, Trowbridge H, Bender IB, Rickoff B, Sorin S. Assessment of reliability of electrical and thermal pulp testing agents. J Endodon 1986;12:301-305.

7.            Skieller V. The prognosis for young teeth loosened after mechanical injuries. Acta Odonta Scand 1960;18:171-173.

8.            About I, Murray PE, Franquin JC, Remusat M, Smith AJ. The effect of cavity restoration variables on odontoblast cell numbers and dental repair. J Dent 2001;29:109-117.

9.            Murray PE, About I, Lumley PJ, Franquin JC, Windsor LJ, Smith AJ. Odontoblast morphology and dental repair. J Dent 2003;31:75-82.

10.          Capp CI, Roda MI, Tamaki R, Castanho GM, Camargo MA, de Cara AA. Reattachment of rehydrated dental fragment using two techniques. Dent Traumatol 2009;25:95-99.

11.          Cox CF, Bergenholtz G, Fitzgerald M, Heys DR, Heys RJ, Avery JK, et al. Capping of the dental pulp mechanically exposed to the oral microflora – a 5 week observation of wound healing in the monkey. J Oral Path1982;11:327-339.

12.          Cvek M, Lundberg M. Histological appearance of pulps after exposure by a crown fracture, partial pulpotomy, and clinical diagnosis of healing. J Endodon 1983;9:8-11.

13.          Cvek M. A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture. J Endodon 1978;4:232-237.

14.          Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endodon 1999;25:197-205.

15.          Andreasen FM, Noren JG, Andreasen JO, Engelhardtsen S, Lindh-Stromberg U. Long-term survival of fragment bonding in the treatment of fractured crowns: a multicenter clinical study. Quintessence Intern 1995;26:669-681.

16.          Robertson A, Andreasen FM, Andreasen JO, Noren JG. Long-term prognosis of crown-fractured permanent incisors. The effect of stage of root development and associated luxation injury. Int J Paedi Dent 2000;10:191-199.

17.          Zachrisson BU, Jacobsen I. Long-term prognosis of 66 permanent anterior teeth with root fracture. Scan J Dent Res 1975;83:345-354.

18.          Cvek M, Tsilingaridis G, Andreasen JO. Survival of 534 incisors after intra-alveolar root fracture in patients aged 7-17 years. Dent Traumatol 2008;24:379-387.

19.          Alkhalifa JD, Alazemi AA. Intrusive luxation of permanent teeth: a systematic review of factors important for treatment decision-making. Dent Traumatol 2014;30:169-175.

20.          Andreasen JO, Bakland LK, Andreasen FM. Traumatic intrusion of permanent teeth. Part 2. A clinical study of the effect of preinjury and injury factors, such as sex, age, stage of root development, tooth location, and extent of injury including number of intruded teeth on 140 intruded permanent teeth. Dent Traumatol 2006;22:90-98.

21.          Andreasen JO, Bakland LK, Andreasen FM. Traumatic intrusion of permanent teeth. Part 3. A clinical study of the effect of treatment variables such as treatment delay, method of repositioning, type of splint, length of splinting and antibiotics on 140 teeth. Dent Traumatol 2006;22:99-111.

22.          Kahler B, Heithersay GS. An evidence-based appraisal of splinting luxated, avulsed and root-fractured teeth. Dent Traumatol 2008;24:2-10.

23.          Andreasen JO, Andreasen FM, Mejare I, Cvek M. Healing of 400 intra-alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics. Dent Traumatol 2004;20:203-211.

24.          Huang GT. A paradigm shift in endodontic management of immature teeth: conservation of stem cells for regeneration. J Dent 2008;36:379-386.

25.          Trope M. Treatment of the immature tooth with a non-vital pulp and apical periodontitis. Dent Clin N Am 2010;54:313-324.

26.          Wang C, Qin M, Guan Y. Analysis of pulp prognosis in 603 permanent teeth with uncomplicated crown fracture with or without luxation. Dent Traumatol [Epub ahead of print]: 2014

27.          Blomlof L, Lindskog S, Hedstrom KG, Hammarstrom L. Vitality of periodontal ligament cells after storage of monkey teeth in milk or saliva. Scand J Dent Res 1980;88:441-445.

28.          de Souza BD, Bortoluzzi EA, da Silveira Teixeira C, Felippe WT, Simoes CM, Felippe MC. Effect of HBSS storage time on human periodontal ligament fibroblast viability. Dent Traumatol 2010;26:481-483.

29.          Hinckfuss SE, Messer LB. Splinting duration and periodontal outcomes for replanted avulsed teeth: a systematic review. Dent Traumatol 2009;25:150-157.

30.          Lindskog S, Blomlof L, Hammarstrom L. Cellular colonization of denuded root surfaces in vivo: cell morphology in dentin resorption and cementum repair. J Clin Perio 1987;14:390-395.

31.          Day P, Duggal M. Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted. The Cochrane database of systematic reviews 2010(1):CD006542.

Release date: 14 August 2015
Expiration date: 13 August 2018


Asgeir Sigurdsson DDS, MS

Asgeir Sigurdsson, DDS, MS, was born and raised in Reykjavik, Iceland. He received a dental degree from University of Iceland, Faculty of Dentistry, in 1988. After one year in private practice in Iceland, he moved to Chapel Hill, N.C. He graduated from University of North Carolina (UNC) at Chapel Hill in 1992 with a certificate in endodontics and a master of science with emphasis on neurobiology and pain perception. He was a full-time faculty member at UNC School of Dentistry from 1992 until 2004, first as an assistant professor and then associate professor with tenure beginning in 2000.  He was appointed as the graduate program director of endodontics (specialty training) in 1997 and served in that position until 2004. From 2004 to 2012 he was in a private endodontic practice in Reykjavik, Iceland, and London, England. In September 2012 he became the chairman of the department of endodontics at New York University College of Dentistry. Additionally, he holds the following academic positions: From 2004 adjunct associate professor at UNC; honorary clinical teacher in endodontology, UCL Eastman Dental Institute, London, from 2006; and from 2011 honorary clinical associate professor in the Faculty of Dentistry, the University of Hong Kong. He has lectured extensively around the world on dental trauma, endodontics, pain diagnosis and forensic dentistry. He is active in many professional organizations and is past president of the International Association for Dental Traumatology (IADT). He received the Edward M. Osetek Educator Award from the American Association of Endodontists in 1998.

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