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TRAUMATIC DENTAL INJURIES– A Manual
Third EditionJ. O. ANDREASEN
L. K. BAKLAND
M. T. FLORES
F. M. ANDREASEN
L. ANDERSSON
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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 1999Second edition 2003Third edition 2011
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Library of Congress Cataloging-in-Publication DataTraumatic 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
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The third edition of Traumatic 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 - based 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
Preface to Third Edition
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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 - up studies.
Finally, 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.
It is the authors ’ hope that Traumatic 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
Preface to First 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. FloresCopenhagen, January 2003
Preface to Second Edition
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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
Contributors
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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
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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.
Traumatic Dental Injuries: A Manual, Third Edition © J.O. Andreasen, L.K. Bakland, M.T. Flores, F.M. Andreasen and L. AnderssonPublished 2011 by Blackwell Publishing Ltd
TRAUMA PREVALENCE The 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
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TRAUMA PREVALENCE AND INCIDENCES IN THE PRIMARY DENTITION Annual trauma incidences (i.e. the number of new injuries occurring during a year) peak in the primary dentition at 2 – 3 years of age, when motor coordination is developing and the children start moving around on their own. 1,2
100
90
80
70
50
60
20
30
40
10
0
CAUSE OF TRAUMA RELATED TO SEX
Bicycles Violence Sports Falls Misc.
%
Boys
Girls
CAUSE OF TRAUMA RELATED TO SEX AND AGE
0-6 years 7-15 years 16-30 yearsFalls Push/ Hit Falls Push/ Hit Falls Push/ Hit
100
90
80
70
50
60
20
30
40
10
0
%
Boys
Girls
TRAUMA PREVALENCE AND INCIDENCES IN THE PERMANENT DENTITION In the permanent dentition, peak incidence for boys is found at 9 – 10 years, during which time vigorous playing and sports activities become more frequent. 1,2
Longitudinal studies during one year have shown incidences between 1.3 and 4% for school children and 0.4% for all ages in the population of a society. 1
ETIOLOGY OF TRAUMA The most common causes of injuries in the permanent denti-tion are falls, followed by traffi c injuries, acts of violence and sports accidents. 3
ETIOLOGY OF TRAUMA IN VARIOUS AGE GROUPS In preschool children (0 – 6 years) the injuries mainly result from falling and usually occur in the home environment during day time.
In school children (7 – 15 years) the injuries mainly result from being pushed and hit, and from falling; these occur mainly in school or sports areas during day time.
In adolescents and adults the injuries mainly result from push/hit injuries which predominantly occur during leisure hours. 4