Abstract
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Dental Traumatology |
| Vol/bind | 26 |
| Udgave nummer | 1 |
| Sider (fra-til) | 16-22 |
| Antal sider | 7 |
| ISSN | 1600-4469 |
| DOI | |
| Status | Udgivet - 2010 |
Bibliografisk note
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I: Dental Traumatology, Bind 26, Nr. 1, 2010, s. 16-22.
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review
}
TY - JOUR
T1 - Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research
AU - Andreasen, Jens Ove
AU - Lauridsen, Eva Fejerskov
AU - Andreasen, Francis
N1 - Paper id:: 19811511
PY - 2010
Y1 - 2010
N2 - Almost all treatment procedures used for dental traumas are still today not evidence-based, a fact, which makes it difficult to analyse the long-term outcome of healing and its relationship to treatment. Crown fractures with extensive dentin exposure represent a dominant injury in the permanent dentition. Accepted treatment philosophy is dentin coverage (dental liner and/or dentin bonded restoration) to prevent bacteria penetration into the pulp. Today there is, apart from deep proximal fractures, no evidence that this treatment is necessary to protect the pulp. In case of luxation injuries, the accepted treatment principles appear to be anatomically correct repositioning, stabilization with a splint and sometimes antibiotic coverage. In clinical studies, these principles could not be proven to optimize either periodontal or pulpal healing, the explanation possibly being that both reposition and application of splints in certain cases add extra damage to the pulp and periodontal ligament. In case of root fractures with dislocation, fast and optimal repositioning and rigid long-term splinting (i.e. 3 months) have been considered the principle of treatment. However, a recent clinical study has shown that short-term splinting with a semi-rigid splint appears to optimize fracture healing. In tooth avulsion with subsequent replantation, cleansing of the root surface for contamination and systemic antibiotics has been considered essential for pulp and periodontal healing. These treatment concepts have been derived from experimental studies in animals. However, their importance could not be verified in large clinical studies. Ideally, randomized clinical studies are needed in the future for selected trauma types. The influences of repositioning, splinting and the role of infection and antibiotics should be further investigated. However, for ethical reasons, it will be difficult to perform randomized studies on trauma victims and we will be forced in the future to rely on experimental animal studies supported by clinical observational studies.
AB - Almost all treatment procedures used for dental traumas are still today not evidence-based, a fact, which makes it difficult to analyse the long-term outcome of healing and its relationship to treatment. Crown fractures with extensive dentin exposure represent a dominant injury in the permanent dentition. Accepted treatment philosophy is dentin coverage (dental liner and/or dentin bonded restoration) to prevent bacteria penetration into the pulp. Today there is, apart from deep proximal fractures, no evidence that this treatment is necessary to protect the pulp. In case of luxation injuries, the accepted treatment principles appear to be anatomically correct repositioning, stabilization with a splint and sometimes antibiotic coverage. In clinical studies, these principles could not be proven to optimize either periodontal or pulpal healing, the explanation possibly being that both reposition and application of splints in certain cases add extra damage to the pulp and periodontal ligament. In case of root fractures with dislocation, fast and optimal repositioning and rigid long-term splinting (i.e. 3 months) have been considered the principle of treatment. However, a recent clinical study has shown that short-term splinting with a semi-rigid splint appears to optimize fracture healing. In tooth avulsion with subsequent replantation, cleansing of the root surface for contamination and systemic antibiotics has been considered essential for pulp and periodontal healing. These treatment concepts have been derived from experimental studies in animals. However, their importance could not be verified in large clinical studies. Ideally, randomized clinical studies are needed in the future for selected trauma types. The influences of repositioning, splinting and the role of infection and antibiotics should be further investigated. However, for ethical reasons, it will be difficult to perform randomized studies on trauma victims and we will be forced in the future to rely on experimental animal studies supported by clinical observational studies.
U2 - 10.1111/j.1600-9657.2009.00818.x
DO - 10.1111/j.1600-9657.2009.00818.x
M3 - Journal article
SN - 1600-4469
VL - 26
SP - 16
EP - 22
JO - Dental Traumatology
JF - Dental Traumatology
IS - 1
ER -