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Orthodontic treatment for
traumatized teeth
Dr .shirazi
1
Prevalence:
A.Age
At age 8:average 5%
Age of 12 years average 16 %
•
B.Gender
Boys 16-30 % sustaining injuries more frequently than girls 4-19%
•
C.Lip coverage and OJ
45% with an overjet greater than 9 mm comared 23% when the oj is less than 9
mm
•
D.Others
Child physical abuse or non accidental injury as up to 50% of these children will
have orofacial injuries
•
Prevention of trauma
Interceptive treatment
functional appliance
3
Mouth guards
•
The risk of undertaking
orthodonthic treatment in cases
with previously traumatized
teeth
9
Factors in treatment
planning
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Primary dentition
Mixed dentition(cl II div 1 ,2)
Cl II div 1 space closure
Normal occlusion without crowding
Permanent dentition
permanent D
Observation periods prior
to orthodontic treatment
Crown and crown-root fractures
Without pulp
3mo
With pulp
partial pulpotomy ,hard tissue barrier
RG
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Root fractures
3mo
2y
Luxated teeth (necrose,RR,marginal)
Sub luxation
3 mo(RG healing) obliteration of canal
Intrusion,extrusion…….1 y
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Endodontically treated
teeth

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RR
Gutta perca
CAOH
Root surface
resorption
PDL injury
Surface
Inflammatory
3-6 week s after trauma
96%
1y
Replacement
2mo---1y
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Root anatomic
Cortical bone
Force

RG
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6-9 mo
2 mo
3mo
Factors affecting root resorption in
the orthodontic movement of
previously traumatized teeth
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Severity of trauma(More severe = higher chance or resorption during
ortho)
Intrusive luxation/avulsion have the highest chance or resorption
Diameter of apical foramen(Larger diameter = better chance of
healing = less chance of resorption
Presence or history of resorption(Teeth that have shown resorption or
are showing resorption may have increased levels of resorption if
orthoforces are initiated)
Orthodontic forces should not be placed on severely traumatized teeth
for at least one year when possible.
Teeth with healed fractures (horizontal fracture in the middle third)
may be moved orthodontically if the tooth is clinically and
radiographically asymptomatic for two years post trauma
Specific treatment principles
for various trauma type

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Crown,crown-root fractures
Pulp
3 mo follow
Pulp capping
Immature teeth
RG
6 mo
vitality
ortho
1y
2y
RG,test
Extrusion of crown-root and
cervical root fractures
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Attached gingiva
Rapid
Retention
3-4 w
Relapse
Non vital
3-5 mm
Ortho , surgery
3-4 w
Root fracture
• Calcified tissue(vitality test,movement)
• Connective tissue
• 1/3 apical
• 1/3 cervical
• 1/3 middle
Luxated teeth
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Root resorption
Prognosis
Inflammatory
Replacement
Avulsed teeth
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Primary
Permanent(os defect)
Auto transplant(mature or immature teeth)
¾ or complete with Open apex
Vitality,root formation,ortho movement
Space closure of lateral better than prosthodontics
treatment
Space closure of central
Space closure
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Mixed
Reshape +gingivectomy
Cl III
Open bite,deep bite,ant crossbite
Cl II lower jaw
Cl III upper jaw
Space maintenance
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Cl III
Cl II div 2
Spacing
Normal occlusion
Good alignment
Tooth shape
Lip coverage
Intruded teeth

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Immature teeth
Mature teeth
Severe
surgery
2w
2-3 w
3w
RCT
buccal cortical plate fracture
Ankylose
where the PDL fibers are conspicuously absent and therefore cannot serve as
an
 intermediary between the root structure and the alveolar bone.
 the primary cause of ankylosis is extrinsic localized trauma.
 preadolescents
Maintain the tooth in the mouth until the beginning of the adolescent growth
spurt if possible Good space maintainer, maximized alveolar bone height, best option
esthetically
Extract the tooth at the beginning of the adolescent growth spurt
Prevent s severe alveolar bone defect since the majority of facial growth occurs
during this period
 late adolecentperiod may have very little alveolar defect and normal restorative
procedures may be sufficient to align teeth esthetically. (follow 6 mo)
 Remove crown

trauma to a primary tooth
displaces the
permanent tooth bud
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First, if the trauma occurs while the crown of the permanent
tooth is forming, enamel formation will be disturbed and there
will be a defect in the crown of the permanent tooth.
Second, if the trauma occurs after the crown is complete,the
crown may be displaced relative to the root. Rootformation may
stop, leaving a permanently shortened root. More frequently,
root formation continues, but the remaining portion of the root
then forms at an angle to the traumatically displaced crown
dilaceration, which is defined as a distorted root form.it may be
necessary to extract a severely dilacerated tooth.

Immediately following a traumatic injury, teeth that have
not been irreparably damaged usually are repositioned with
finger pressure to a near normal position and out of occlusal
interference. They are then stabilized (with a light wire or
nylon filament) for 7 to 10 days. At this point, the teeth
usually exhibit physiologic mobility. If the alveolus has
beenfractured, then the teeth should be stabilized with a
heavy wire for approximately 6 weeks.
splint
Splinting guidelines for tooth/bone fractures and
luxated/avulsed teeth recommend flexible, non-rigid splinting
except in root fractures in the cervical third of the tooth and
alveolar fractures when rigid splinting is recommended.
Materials
 Non rigid (flexible) splint:
•
.017 X .025 stainless steel wire, composite
•
018 round stainless steel wire, composite
•
Monofilament nylon (20-30 lb test) with composite
 Rigid splint:
•
030 stainless steel wire, composite

Retention
prognosis
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Etiology of malocclusion
Occlusion
Reorganization of os and soft tissue
Space closure(root parallel,MD)
Subluxation
low force,short treatment period
prognose
Root fractures
good