Correction added after online publication 7 October, 2009. The title was originally published as “Cognitive dissonance in the treatment of traumatic dental injuries and ways to proceed in dental trauma research”.
Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research*
Article first published online: 7 OCT 2009
© 2009 John Wiley & Sons A/S
Volume 26, Issue 1, pages 16–22, February 2010
How to Cite
Andreasen, J. O., Lauridsen, E. and Andreasen, F. M. (2010), Contradictions in the treatment of traumatic dental injuries and ways to proceed in dental trauma research. Dental Traumatology, 26: 16–22. doi: 10.1111/j.1600-9657.2009.00818.x
- Issue published online: 7 JAN 2010
- Article first published online: 7 OCT 2009
- Accepted 21 March, 2009
Abstract – 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.