Traumatic Dental Injuries: A Manual

102 Pages·2011·37.16 MB·English

by  Jens O. Andreasen

TRAUMATIC DENTAL INJURIES
– A Manual
Third Edition
J. O. ANDREASEN
L. K. BAKLAND
M. T. FLORES
F. M. ANDREASEN
L. ANDERSSON
1
This edition fi rst published 2011
© 1999 Munksgaard
© 2003 Blackwell Munksgaard
© 2011 J.O. Andreasen, L.K. Bakland, M.T. Flores, F.M. Andreasen and L. Andersson
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First edition published 1999
Second edition 2003
Third edition 2011
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Library of Congress Cataloging-in-Publication Data
Traumatic dental injuries : a manual / J.O. Andreasen ... [et al.]. – 3rd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4051-9061-9 (pbk. : alk. paper) 1. Teeth–Wounds and injuries–Handbooks, manuals, etc. 2. Dentistry, Operative–Handbooks, manuals,
etc. I. Andreasen, J. O.
[DNLM: 1. Tooth Injuries–diagnosis–Handbooks. 2. Tooth Injuries–therapy–Handbooks. WU 49]
RK501.5.T73 2011
617.6044–dc22
2010040958
A catalogue record for this book is available from the British Library.
Artwork by Henning Dalhoff Aps, Tue Frigaard Hansen from 360 Degree, Karina Nekes Suhr and Søren Ahrensburg Steno Christensen
Layout by Tue Frigaard Hansen from 360 Degree, Karina Nekes Suhr and Søren Ahrensburg Steno Christensen
1 2011
2
Preface to Third Edition
The third edition of T raumatic Dental Injuries – A Manual includes several new aspects of dental traumatology and an updating
of existing material. The new sections that have been included describe soft tissue injuries associated with dental trauma, show
how decoronation of ankylosed anterior teeth in adolescents can preserve the alveolar process for later implant placement or
prosthodontic restoration and identify predictors for pulpal and periodontal ligament healing complications as well as for tooth
loss. Furthermore the use of an internet- b ased interactive Dental Trauma Guide to predict healing complication for individual
trauma scenarios is introduced. An added bonus is an enclosed DVD that shows animated treatment procedures for all trauma
entities.
J. O. Andreasen, L. K. Bakland, M. T. Flores, F. M. Andreasen, L. Andersson
Copenhagen, January 2011
3
Preface to Second Edition
In this second edition, the epidemiological section on global trauma frequencies has been updated and all chapters have been
revised, especially with respect to the urgency of acute treatment. Furthermore, the chapter on prevention of oral injuries has
been expanded. New chapters include diagnosis of pulp and periodontal healing complications, long-term prognosis of the
various trauma entities, and information to the patient subsequent to emergency treatment. Finally, a chapter has been
included which deals with the principles of endodontic treatment of traumatized teeth.
J. O. Andreasen, F. M. Andreasen, L. K. Bakland, M. T. Flores
Copenhagen, January 2003
Preface to First Edition
In Traumatic Dental Injuries – A Manual , we present the highlights of dental traumatology in a format which will be a ready
reference for general practitioners and aid dental students in their studies. Each chapter is designed to describe the principles
in the diagnosis and treatment of the specifi c traumatic dental injury, including treatment objectives, treatment parameters
and long - term expectations based on existing long - term studies of various trauma entities. In order to standardize diagnostic
and treatment procedures, examination forms and follow - up protocol are provided in the appendices. As no type of dental
trauma is ‘ perfect ’ , a given injury type has been generated electronically by a medical artist, in order to enhance similarities and
diff erences between the various injury groups. Periodontal and pulpal healing for the given injuries are based on recent long -
term follow- u p studies.
F inally, information to the public is also presented. As the best treatment result follows prompt emergency care, informed
individuals at the scene of the injury can aid the dental practitioner in optimizing treatment and hopefully in preventing
injuries.
I t is the authors’ hope that T raumatic Dental Injuries – A Manual will fi ll the gap in dental education and give dental trauma its
full birthright.
J. O. Andreasen, F. M. Andreasen, L. K. Bakland, M. T. Flores
Copenhagen, January 1999
4
Contributors
JENS O. ANDREASEN, DDS, ODONT DR. HC, FRCS
Department of Oral and Maxillofacial Surgery
University Hospital (Rigshospitalet)
Copenhagen
Denmark
LEIF K. BAKLAND, DDS
Diplomate, American Board of Endodontics
Ronald E. Buell Professor of Endodontics
School of Dentistry, Loma Linda University
Loma Linda, California
USA
MARIA T. FLORES, DDS
Professor of Pediatric Dentistry
Faculty of Dentistry
University of Valparaiso
Valparaiso
Chile
FRANCES M. ANDREASEN, DDS, DR. ODONT
Research Associate
Department of Oral and Maxillofacial Surgery
University Hospital (Rigshospitalet)
Copenhagen
Denmark
LARS ANDERSSON, DDS, ODONT DR.
Professor of Oral and Maxillofacial Surgery
Faculty of Dentistry
Kuwait University
Kuwait City
Kuwait
5

Contents
Epidemiology of Traumatic Dental Injuries 8
Pathophysiology and Consequences of Dental Trauma 10
Classifi cation of Dental Injuries 16
Examination and Diagnosis 18
Diagnosis of Pulpal Healing Complications 22
Diagnosis of Periodontal Healing Complications 24
Treatment Priorities after Dental Trauma 26
Crown Fracture without Pulp Exposure 28
Crown Fracture with Pulp Exposure 30
Crown-Root Fracture 32
Root Fracture 34
Alveolar Process Fracture 36
Concussion 38
Subluxation 40
Extrusive Luxation 42
Lateral Luxation 44
Intrusive Luxation 46
Avulsion 48
Injuries to the Primary Dentition 54
Soft Tissue Injuries 58
Splinting 62
Endodontic Considerations in Dental Trauma 64
Decoronation of Ankylosed Teeth in Adolescents 68
Predictors for Healing Complications 70
Tooth Survival in the Permanent Dentition 74
Information for the Patient About Dental Trauma 76
Information for the Public About Dental Trauma 78
Prevention of Traumatic Dental Injuries 80
Appendices 84
References 88
Index 97
7
Epidemiology of Traumatic Dental Injuries
OBJECTIVES
1 Recognize trauma incidence and prevalence in the primary and permanent dentitions.
2 Recognize peak incidences of trauma in relation to age and sex.
3 Recognize typical causes of trauma.
TRAUMA PREVALENCE
T he prevalence (i.e. the number of injuries up to a given age) of traumatic dental injuries has been examined in many countries,
usually reporting very high fi gures. 1 It should, however, be noted that most of these studies represent prevalences in various
age groups, and therefore these prevalences cannot be compared. When prevalences are specifi ed for 5 - and 12 - year - olds, the
fi gures can be seen in the maps below. Please note that only countries where reliable fi gures were available have been included
and color - coded.
TRAUMA PREVALENCE IN 5 - YEAR - OLD CHILDREN
In 5 - year - old children, approximately one - third have suff ered a traumatic dental injury involving primary teeth, most often
tooth luxation; boys have a slightly higher frequency than girls.1 ,2
TRAUMA PREVALENCE IN 12 - YEAR - OLD CHILDREN
In 12 - year- old children, 20 – 30% of them have suff ered dental injuries, with boys ’ injuries occurring approximately one - third
more frequently than girls ’ . The typical injury is an uncomplicated crown fracture. 1 ,2
Traumatic Dental Injuries: A Manual, Third Edition © J.O. Andreasen, L.K. Bakland, M.T. Flores, F.M. Andreasen and L. Andersson
Published 2011 by Blackwell Publishing Ltd
8