CASE STUDY increases the risk of pulp necrosis as compared with extrusion of non-traumatized teeth.” 18 Kindelan added the following regarding teeth with root fractures: “In the case of orthodontic movement of root fractured teeth, it is recommended that light forces be used, treatment is expediently completed and teeth are appropriately monitored radiographically and clini-cally for continued signs of pulpal vitality.” 14 In their study of the literature, Hamilton and Gutman summarized the topic as follows: “A trauma-tized tooth can be moved orthodontically with mini-mal risk of resorption, provided the pulp has not been severely compromised (infected or necrotic). If there is evidence of pulpal demise, appropriate endodontic management is necessary prior to orthodontic treat-ment. If a previously traumatized tooth exhibits resorp-tion, there is a greater chance that orthodontic tooth movement will enhance the resorptive process.” 19 References 1. Glendor U. Epidemiology of traumatic dental injuries – a 12 year review of the literature. J. Dent. Trauma. 2008;24:603-611. 2. Blinkhorn F. The etiology of dento-alveolar injuries and factors influencing attendance for emergency care of adolescents in the northwest of England. Endod Dent Traumatol. 2000;16:162-3. 3. Todd JE, Dodd T. Children's dental health in the United Kingdom, 1983: A survey carried out by the Social Survey Division of OPCS, on behalf of the United Kingdom health departments, in collaboration with the Dental Schools of the Universities of Birmingham and Newcastle. London 1985. 4. Shulman J, Peterson J. The association between incisor trauma and occlusal characteristics in individuals 8-50 years of age. Dental Traumatology. 2004 Apr;20(2):67-74. 5. Bauss O, Rohling J, Schwestka-Polly R. Prevalence of traumatic injuries to the permanent incisors in candidates for orthodontic treatment. Dental Trauma-tology. 2004;20:61-66. 6. Caprioglio A, Caprioglio C, Mariani L, Caprioglio D. Foreward. Orthodontics and traumatic injuries to the teeth. Bologna: Officine Grafiche Zanini; 2014. 7. Andreasen JO, Andreasen FM, Andreasen L. Textbook and Color Atlas of Trau-matic Injuries to the Teeth 4th ed. Copenhagen, Denmark: Blackwell Publish-ing; 2007. 8. Proffit W, Fields H, Larson B, Sarver D. Contemporary Orthodontics, 6th Edition. Philadelphia, PA: Elsevier; 2019. 9. American Academy of Pediatric Dentistry. Assessment of Acute Traumatic Injuries 10. International Association of Dental Traumatology. Dental Trauma. 2012. Available at: www.iadt-dentaltrauma.org. 11. Lambert D. Splinting rationale and contemporary treatment options for luxated and avulsed permanent teeth. Acad. Gen. Dent. Traumatic Injuries & Emergencies. 2015(Nov/Dec):56-60. 12. Meshari W, Anderson L, Lucas P. Stiffness characteristics of splints for fixation of traumatized teeth. Dental Traumatology. 2015;32(2). 13. Hinckfuss S, Messer L. Splinting duration and periodontal outcomes for replanted avulsed teeth: a systematic review. Dental Traumatology. 2009;6(March):150-7. 14. Kindelan S, Day P, Kindelan J, Spencer J, Duggal M. Dental trauma: an overview of its influence on the management of orthdontic treatment. Part 1. Journal of Orthodontics. 2014;35(2):68-78. 15. Andreasen J. Healing of 400 intra-alveolar root fractures. Journal of Dental Traumatology. 2004;20:203-211. 16. Levander E, Malmgren O. Evaluation of the risk of root resorption during orthodontic treatment: A study of upper incisors. European Journal of Orthodontics. 1988;10(1):30-38. 17. Levander E, Malmgren O. Evaluation of root resorption in relation to two orthodontic treatment regimes. A clinical experimental study. European Jour-nal Orthodontics. 1994;16:223-8. 18. Bauss O, Schafer W, Sadat-Khonsari R, Knosel M. Influence of orthodontic extrusion on pulpal vitality of traumatizd maxillary incisors. Journal of Endodontics. 2010;36(2):203-7. 19. Hamilton R GJ. Endodontic orthodontic relationships: a review of integrated treatment planning challenges. Int Endo Journal. 2001;32(5):343-60. 20. Martins C, Batista B, Verri A, Verri F, Gomes Filho J, Panziarini S. Orthodontic approach in dental trauma: systematic review and meta-analysis. Arch Health Invest. 2016;5(6):336-41. 21. Marcello Tondelli P, Rogerio de Mendonca M, Aparecodo Cuoghi O, Pozzobon Pereira AL, Agner Busato MC. Knowledge on dental trauma and orthodontic tooth movment held by a group of orthodontists. Braz Oral Res. 2010;24(1):76-82. Recommendations A meta-analysis of the literature regarding the orthodontic approach in dental trauma concludes that, “there is no well-established protocol for these cases.” 20 Additionally, a study based on the answers of 105 ques-tionnaires completed by practicing orthodontists deter-mined that 40% of them were not acquainted with recommendations for orthodontic movement of trau-matized teeth. 21 Therefore, a lack of clarity and under-standing underscores the lack of distinction between treatment protocols and recommendations. The significance of the five cases described here is in the differences and overlap between splinting and orthodontic repositioning. For instance, splinting is typi-cally distinct from repositioning since the goal is to allow healing with physiologic mobility while reposi-tioning is more active movement. These five cases described instances of traumatized teeth splinted and repositioned with seamless transitions. The cases demon-strate favorable results despite significant trauma. Additionally, the cases illustrate the optimal value of using orthodontic appliances to provide treatment that may overlap the two methods, splinting and repositioning. Treatment may be rendered, using orthodontic appliances that fall in the overlap between the two methods. Studies are necessary to compare and contrast the methods in controlled manners with agreed upon measures of success. In conclusion, practitioners should understand treat-ment modalities for dental trauma including the use of orthodontic systems that can serve two important func-tions – stabilization by splinting and repositioning. These cases represent the overlap between splinting and repositioning and lead to the question of where splint-ing ends and repositioning begins. It is possible that the successful outcomes of these cases could have only been possible by employing orthodontic appliances and simultaneously using techniques of splinting and orthodontic repositioning. 16 Spring 2019 JAOS
Journal of the American Orthodontic Society Spring 2019: Page 16
