Orthodontic treatment for traumatized teeth 1 Dr.shirazi

A.Age At age 8:average 5% Age of 12 years average 16 % B.Gender Boys % 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 Mouth guards 3 Prevalence:

9 The risk of undertaking orthodonthic treatment in cases with previously traumatized teeth

 Primary dentition  Mixed dentition(cl II div 1,2)  Cl II div 1 space closure  Normal occlusion without crowding permanent D  Permanent dentition Factors in treatment planning

 Crown and crown-root fractures Without pulp 3mo With pulp partial pulpotomy,hard tissue barrier 3mo RG  Root fractures 2 y  Luxated teeth (necrose,RR,marginal) Sub luxation 3 mo(RG healing) obliteration of canal Intrusion,extrusion…….1 y Observation periods prior to orthodontic treatment

 RR  Gutta perca CAOH Endodontically treated teeth

 PDL injury Surface Inflammatory 3-6 week s after trauma 96% 1 y Replacement 2mo---1y  Root anatomic  Cortical bone  Force  RG 6-9 mo 2 mo 3mo Root surface resorption

 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 Factors affecting root resorption in the orthodontic movement of previously traumatized teeth

 Crown,crown-root fractures RG,test  Pulp 3 mo follow  Pulp capping vitality  Immature teeth ortho  RG 6 mo 1 y 2 y Specific treatment principles for various trauma type

 Attached gingiva  Rapid  Retention 3-4 w  Relapse  Non vital 3-5 mm 3-4 w  Ortho, surgery Extrusion of crown-root and cervical root fractures

Root fracture Calcified tissue(vitality test,movement) Connective tissue 1/3 apical 1/3 cervical 1/3 middle

 Root resorption  Prognosis  Inflammatory  Replacement Luxated teeth

 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 Avulsed teeth

 Mixed  Reshape +gingivectomy  Cl III  Open bite,deep bite,ant crossbite  Cl II lower jaw  Cl III upper jaw Space closure

 Cl III  Cl II div 2  Spacing  Normal occlusion  Good alignment  Tooth shape  Lip coverage Space maintenance

 Immature teeth 2w  Mature teeth 2-3 w 3 w RCT  Severe surgery buccal cortical plate fracture Intruded teeth

  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 Ankylose

 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.  trauma to a primary tooth displaces the permanent tooth bud

 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.

 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 splint

 Etiology of malocclusion  Occlusion  Reorganization of os and soft tissue  Space closure(root parallel,MD)  Subluxation low force,short treatment period good prognose  Root fractures Retention prognosis