Tuesday, May 15, 2018

Recent trends in the management of dentoalveolar traumatic injuries to primary and young permanent teeth

Resident’s Name: Brian Darling                                                                     Date: 4/16/2018
Article Title: Recent trends in the management of dentoalveolar traumatic injuries to primary and young permanent teeth
Author(s): Jihan Turkistani, Azzah Hanno
Journal: Dental Traumatology
Date: 2011; 27: 46-54
Major Topic: Dental trauma
Type of Article: Review Article
Main Purpose: This article aimed to examine recent trends in trauma management
Key Points:  Dental Trauma management is continually changing so practitioners should follow the current literature.
The article reviews a lot of the main points from the dental trauma guide website and AAPD guidelines so I just tried to review some of interesting/key points below, especially those that may be relevant to boards.
·      Trauma studies that are school-based may significantly increase the number of trauma cases as compared to hospital based studies because minor dental injuries are less likely to be reported at a hospital.
·      Boys are twice as likely to experience trauma as girls
·      Increased trauma risk: SHCN patients; ADHD; seizures; intellectual disability; muscle incoordination; abnormal protective reflexes
·      Most injuries are due to falls > traffic accidents > violence > sports
·      Damage to teeth is most common complaint against anesthesiologists due to intubation
·      Infraction injuries may be treated with an unfilled resin to prevent staining from getting into cracks
·      Calcium hydroxide
o   Questionable for use a liner over dentin because it disintegrates beneath restoration with time
o   Recommended as intracanal medicament because it is bactericidal, allows environment for hard tissue repair and bridge formation, minimizes risk of root resorption, dissolves necrotic tissue  
·      Want to restore crown fractures ASAP to prevent labial protrusion of fracture tooth and drifting or tilting of adjacent teeth into fracture site or supraeruption of opposing teeth
·      Emdogain has shown success for direct pulp capping
·      For periodontal injuries, consider splinting an extra 3-4 weeks if marginal bone breakdown is evident. This is one reason probing around injured tooth and following its development is important.
·      Tetracyclines for avulsions
o   Proven anti-resorptive properties can limit area of root surface damaged by inhibiting collagenase activity and osteoclast function to promote more favorable healing
o   Promote fibroblast and connective tissue attachment thereby enhancing regeneration of periodontal attachment
·      Corticosteroids have been used for avulsed teeth to reduce inflammatory responses and osteoclastic bone resorption
·      Soaking avulsed teeth in alendronate (a bisphosphonate) may cause less loss in root mass because of resorption
·      Emdogain can promote PDL proliferation on avulsed teeth
·      There’s a statistically significant association between extirpation within 14 days and an increased likelihood of successful periodontal healing and prevention of external inflammatory root resorption
·      Ledermix (corticosteroid-antibiotic intracanal paste) has been used as an intracnal medicament because anti-inflammatory and antibacterial properties may decrease root resorption by directly inhibiting resorptive cells
·      For avulsed teeth with >60 minutes of dry time, soaking in 2% NaF for 5-20 minutes decreases rate of osseous replacement resorption
·      For immature avulsed teeth, soaking tooth in doxycycline before replantation double chance of revascularization

Assessment of Article:  Level of Evidence/Comments:

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