International guidelines improve outcomes after dental trauma

By Sarah Guy, medwireNews Reporter

Adhering to the current International Association of Dental Traumatology (IADT) guidelines for emergency treatment and care of traumatized teeth results in significantly lower complication rates, report researchers in Clinical Oral Investigations.

Indeed, the majority of participants in the study were treated in accordance with the guidelines, they note.

The findings also highlight the importance of early follow-up visits; most patients with permanent teeth who experienced pulp necrosis or tooth loss did so within 6 months of the initial trauma.

"Although certain traumatic patterns have acute treatment requirements, others can be treated sub-acutely within the following days," say Katharina Bücher (Ludwig-Maximilians University, Munich, Germany) and co-investigators.

They add that little is known regarding treatment outcomes after the IADT recommendations were implemented.

To investigate, the researchers examined data on 216 patients treated for 361 traumatic dental injuries at their institution between 2004 and 2008, of whom 89.1% were treated according to IADT guidelines.

The team identified 84 complications in 55 teeth, and complication rates were significantly lower when the guidelines were followed compared with when they were not, at 12.4% versus 40.0%, respectively.

Complications occurred predominantly in permanent teeth (just 6% were in primary teeth), and the most common events were loss of restorations, pulp necrosis, abnormal mobility, and tooth loss.

For primary dentition, pulp necrosis occurred mostly within the first 24 months after trauma, with a tooth survival probability of 64.1%, while tooth loss was most frequent overall in the first 18 months, with intrusions and extrusions the most common related injuries.

After an average 22-month follow up of patients with permanent teeth, the survival rate for luxation injuries was approximately 86.8%, report Bücher et al. Both pulp necrosis and loss of pulp vitality occurred most frequently within the first 6-12 months of trauma; however, late instances of both were also recorded.

The lower survival rate of primary compared with permanent dentition illustrates one of the main treatment principles for primary teeth, remark the authors, "ie, either tooth observation or extraction, rather than endodontic preservation, is employed whenever necessary to avoid or minimise damage to the permanent teeth."

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