Endodontic Trauma: Pathogenesis and Treatment

Objectives and Goals

  • Name, describe and clinically identify the five possible results of trauma to the pulp and periodontal ligament.
  • Differentiate the types of external resorption and describe their etiologies.
  • Name, describe, diagnose and correctly treat all traumatic coronal injuries involving enamel, dentin, pulp exposure and apical maturation status.
  • Diagnose and properly treat horizontal root fractures.
  • Name, describe, diagnose and correctly treat luxation and avulsion injuries.
  • State the relative prognoses for pulp and tooth retention associated with each type of dental injury.

Trope M, Chivian N, Blanco L,  Sigurdsson A.  Traumatic Injuries. in Pathways of the Pulp, 9th edition, 2006.  pp 610-649.

Trope M.  Root resorption due to dental trauma.  Endodontic Topics 2002:79-100.

Andreasen JO, Hjorting-Hansen E.  Intraalveolar root fractures: radiographic and histologic study of 50 cases.  Oral Surg 25:414-426. 1967.

Andreasen JO.  Luxation of permanent teeth due to trauma.  Scand J Dent Res 78:273- 286. 1970.

Roed-Petersen B, Andreasen JO.  Prognosis of permanent teeth involved in jaw fractures.  Scand J Dent Res 78:343-352. 1970.

Degering CI. Radiography of dental fractures.  Oral Surg 30:213-219. 1970.

Andreasen JO, Ravn JJ. The effect of traumatic injuries to primary teeth on their permanent successors.  Scand J Dent Res 79:284-294. 1971.

Jacobsen I,  Zachrisson BU.  Repair characteristics of  root fractures in permanent anterior teeth.  Scand J Dent Res 83:355-364. 1975.

Andreasen JO.  Periodontal healing after replantation of traumatically avulsed human teeth.  Acta Odont Scand 33:325-335. 1975.

Jacobsen I, Kerkes K.  Long term prognosis of traumatized permanent anterior teeth showing calcifying processes in the pulp cavity.  Scand J Dent Res 85:210-217. 1977.

Andreasen JO.  A time related study of periodontal healing and root resorption activity after replantation of mature permanent incisors in monkeys.  Swed Dent J 4:101-110. 1980.

Andreasen JO, Kristerson L.  The effect of extra-alveolar root filling with calcium hydroxide on periodontal healing after replantation of permanent incisors in monkeys.  J Endodon 7:349-354. 1981.

Andreasen JO.  The effect of pulp extirpation or root canal treatment on periodontal healing after replantation of permanent incisors in monkeys.  J Endodon  7:245-252. 1981.

Ravn JJ.  Follow-up study of permanent incisors with enamel cracks as a result of acute trauma.  Scand J Dent Res 89:117-123. 1981.

Ravn JJ.  Follow-up study of permanent incisors with enamel fractures as a result of acute trauma.  Scand J Dent Res89:213-217. 1981.

Ravn JJ.  Follow-up study of permanent incisors with enamel-dentin fractures as a result of acute trauma.  Scand J Dent Res 89:355-365. 1981.

Tronstad L, Andreasen JO, Hasselgren G, Kristerson L.  pH chages in dental tissues after root canal filling with calcium hydroxide.  J Endodon 7:1;17-21.

Andreasen JO.  Relationship between cell damage in the periodontal ligament after replantation and subsequent development of root resorption.  Acta Odont Scand 39:15- 25. 1981.

Nasjleti C, Castelli W, Caffesse R.  The effects of different splinting times on replantation of teeth in monkeys.  Oral Surg 53:6;557-566.

Ravn JJ.  Follow-up study of permanent incisors with complicated crown fractures after acute trauma.  Scand J Dent Res 90:363-372. 1982.

Cvek M, Granath L, Lundberg M.  Failures and healing in endodontically treated non- vital anterior teeth with post-traumatically reduced pulpal lumen.  Acta Odont Scand 40:223-228. 1982.

Lindskog S, Blomlof L.  Influence of osmolality and composition of some storage media on human periodontal ligament cells.  Acta Odont Scand 40:435-441. 1982.

Kopel HM, Johnson R.  Examination and neurologic assessment of children with oro- facial trama.  Endod Dent Traumatol 1:155-159 1985.

Andreasen  JO.  Challenges in clinical dental traumatology.  Endod Dent Traumatol 1:45- 55.

Hammarstrom L, Blomlof, Feiglin B, Andersson L, Lindskog S.  Replantation of teeth and antibiotic treatment.  Endod Dent Traumatol 2:51-57.

Trope M, Friedman S.  Periodontal healing of  replanted dog teeth stored in Viaspan, milk and Hank’s balanced salt solution.  Endod Dent Traumatol 8:183-188.

OPTIONAL

Sweet, CA.  A classification and treatment for traumatized anterior teeth.  J Dent Child 22:144-149. 1955.

MacDonald, JB, et al.  The bacteriologic status of the pulp chambers in intact teeth found to be nonvital following trauma.  Oral Surg 10:318-322. 1957.

Lindahl B. Transverse intra-alveolar root fractures: reontgen diagnosis and prognosis.  Odont Revy 9:10-24. 1958.

Holcomb JB, Gregory WB.  Calcific metamorphosis of the pulp: its incidence and treatment.  Oral Surg 24:825-830. 1967.

Andreasen JO.  Etiology and pathogenesis of traumatic dental injuries.  Scand J Dent Res 78:329-342. 1970.

Andreasen, JO.  Treatment of fractured and avulsed teeth.  J Dent Child Jan/Feb:29-48. 1971.

Heiman, GR, et al.  Temporary splinting using an adhesive system.  Oral Surg 39:819-822. 1971.

Andreasen, JO and Ravn, JJ.  Enamel changes in permanent teeth after trauma to their primary predecessor.  Scand J Dent Res 81:203-209. 1973.     

Cvek, M, et al.  Treatment of non-vital permanent incisors with calcium hydroxide.  Odont Revy 25:43-56. 1974.

Barker, BCW.  Some unusual cases of apexification subsequent to trauma.  Oral Surg 39:144-150. 975.

Andreasen JO.  The effect of splinting upon periodontal healing after replantation of permanent incisors in monkeys.  Acta Odont Scand 33:313-323. 1975.

Jacobsen I.  Root fractures in permanent anterior teeth with incomplete root formation.  Scand J Dent Res 84:210-217. 1976.

Jacobsen I,  Sangnes G.  Traumatized primary anterior teeth. Acta Odont Scand 36:199-204. 1978.

Lundberg M, Cvek M.  A light microscopy study of pulps from traumatized permanent incisors with reduced pulpal lumen.  Acta Odont Scand 38:89-94. 1980.

Jacobsen I.  Criteria for diagnosis of pulp necrosis in traumatized permanent incisors.  Scand J Dent Res 88:306-312. 1980.

Andreasen JO.  The effect of removal of the coagulumin the alveolus before replantation upon periodontal and pulpal healing of mature permanent incisors in monkeys.  Int J Oral Surg 9:458-461. 1980.

Andreasen, JO.  Analysis of pathogenesis and topography of replacement root resorption after replantation of mature permanent incisors in monkeys.  Swed Dent J 4:231-240. 1980.

Oswald, RJ, et al.  A postreplantation evaluation of air dried and saliva stored avulsed teeth. J Endodon 6:546-551. 1980.

Van Hassel HJ, Oswald RJ, Harrington GW.  Replantation 2. the role of the periodontal ligament.  J Endodon 6:506-508. 1980.

Blomlof L, Lindskog S, Hammarstrom L.  Periodontal healing of exarticulated monkey teeth stored in milk or saliva.  Scand J Dent Res 89:251-259. 1981.

Blomlof L,  Andersson L, Lindskog S, Hedstrom KG, Hammarstrom L.  Periodontal healing of replanted monkey teeth prevented from drying.  Acta Odont Scand  41:117-123  1983.

Part II

Trope M, Yesilsoy C, Koren L, Moshonov J, Friedman S.  Effect of different endodontic treatment protocols on periodontal repair and root resorption of replanted dog teeth.  J Endodon 18:492-496. 1992.

Oikarinen K, Andreasen JO, AndreasenFM.  Rigidity of various fixation methods used as dental splints.  Endod Dent Traumatol;8:113-119.

Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM.  Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications.  Endod Dent Traumatol 11:51-58 1995.

Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM.  Replantation of 400 avulsed permanent incisors. 2. Factors relating to pulpal healing.  Endod Dent Traumatol 11:59- 68 1995.

Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM.  Replantation of 400 avulsed permanent incisors. 3. Factors related to root growth.  Endod Dent Traumatol 11:69-75 1995.

Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM.  Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing.  Endod Dent Traumatol 11:76-89 1995.

Dumsha T, Hovland EJ.  Evaluation of long term calcium hydroxide treatment in avulsed teeth - an invivo study.  Int Endodon J  28:7-11 1995.

Evans D, Reid J, Strang R, Stirrups D.  A comparison of laser Dopler flowmetry with other methods of assessing the vitality of traumatised anterior teeth.  Endod Dent Traumatol 1999;15:284-290.             2001 Cvek M, Andreasen JO, Borum MK.  Healing of 208 intraalveolar root fractures in patients aged 7-17 years.  Dent  Traumatol 17:53-62  2001.

von Arx, Filippi A, Lussi A.  Comparison of a new dental trauma splint devise (TTS) with three commonly used splinting techniques.  Dent Traumatol;17:266-274.

Malmgren B, Malmgren O.  Rate of  infraposition of reimplanted ankylosed incisors related to age and growth in children and adolescents.  Dent Traumatol 2002;18:28-36.

Trope M.  Clinical management of the avulsed tooth: present strategies and future directions.  Dent Traumatol 2002;18:1-11.

Bryson EC, Levin L, Banchs F, Abbott PV, Trope M.  Effect of immediate intracanal placement of Ledermix Paste on healing of replanted dog teeth after extended dry times.  Dent Traumatol 2002;18:316-321.

Cunha RF, Pavarini A, Percinoto C, Lima JEO.  Influence of surgical repositioning of mature permanent dog teeth following experimental intrusion: a histologic assessment.  Dent Traumatol 2002;18:304-308.

Bryson EC, Levin L, Banchs F, Trope M.  Effect of minocycline on healing of replanted dog teeth after extended dry times.  Dent Traumatil 2003;19:90-95.

Keum K, Oh-Taik K, Spangberg L, Kim C, Kim J, Cho M, Lee S.  Effect of dexamethasone on root resorption after delayed replantation of  rat tooth.  J Endod 2003;12:810-813.

American Association of Endodontics.  Guidelines for Treatment of Traumatic Dental Injuries. 2004.

Andreasen JO, Andreasen FM, Mejare I, Cvek M.  Healing of 400 intra-alveolar root fractures. 1.  Effect of pre-injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation.  Dent Traumatol:20:192-202.

Andreasen JO, Andreasen FM, Mejare I, Cvek M.  Healing of 400 intra-alveolar root fractures.  2.  Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics.  Dent Traumatol; 20;203-211.

Andreasen JO, Bakland LK, Andreasen FM.  Traumatic intrusion of permanent teeth. Part 2. A clinical study of the effect of preinjury and injury factors, such as sex, age, stage of root development, tooth location, and extent of injury including number of intruded teeth on 140 intruded permanent teeth.  Dent Traumatol 22:90-98.

Andreasen JO, Bakland LK, Andreasen FM.  Traumatic intrusion of permanent teeth.  Part 3.  A clinical study of the effect of treatment variables such as treatment delay, method of repositioning, type of splint, length of splinting and antibiotics on 140 teeth.  Dent Traumatol 22:99-111.

2008 Andreasen JO, Jensen L, Christensen S. Relationship between calcium hydroxide pH levels in the root canals and periodontal healing after replantation of avulsed teeth.  Endodon Topics: 93-101.

Andreasen JO, Jensen SS, Sae-Lim V.  The role of antibiotics in preventing healing complications after  traumatic dental injuries: a literature review.  Endodon Topics:80-92.

Andreasen JO, Malmgren B, Bakland L.  Tooth avulsion in children: to replant or not.  Endodon Topics:28-34

Flores M, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F, Bourguignon C, Diangelis A, Hicks L, Sigurdsson A, Trope M, Tsukiboshi M, von Arx T.  Guidelines for the management of traumatic dental injuries.  1.  Fractures and luxations of permanent teeth.  Endodon Topics:102-118.

OPTIONAL

Andreasen JO.  Analysis of topography of surface and inflammatory root resorption after replantation of mature permanent incisors in monkeys.  Swed Dent J 4:135-144. 1980.             Coccia, CT.  A clinical investigation of root resorption rates in reimplanted young permanent incisors: a five year study.  J Endodon 6:413-420. 1980.

Weinstein, FM, et al.  The effect on periodontal and pulpal tissues of various cleansing procedures prior to replantation of extracted teeth.  Acta Odont Scand 39:251-255. 1981.

Andreasen JO, Kristerson L.  The effect of limited drying or removal of     the periodontal ligament.  Acta Odont Scand 39:1-13. 1981.

Antrim DD, Ostrowski JS.  A functional splint for traumatized teeth.  J Endodon 8:328-331. 1982.

Dumsha, T and Hovland, EJ.  Pulpal prognosis following extrusive luxation injuries in permanent teeth with closed apexes.  J Endodon 8:410-412. 1982.

Heithersay, GS, et al.  Anterior subgingival fractures: a review of treatment alternatives.  Austral Dent J 27 (6). 1982.

Brand DA, Acampora D, Gottleib LD, Glancy KE, Frazier WH..  Adequacy of antitetanus prophylaxis in six hospital emergency rooms.  NEJM 309:636-640. 1983.

Blomlof,L, et al.  Storage of experimentally avulsed teeth in milk prior to replantation.  J Dent Res 62:912-916. 1983.

Turley, P, et al.  The effect of orthodontic extrusion on traumatically intruded teeth.  Amer J Orthod 85(1). 1984.

Andreasen, JO.  External root resorption: its implication in dental traumatology, pedodontics, periodontics, orthodontics and endodontics.  Int Endod J 18:109-118. 1985.

Matusow, RJ.  Clinical observations regarding the treatment of traumatically avulsed mature teeth: part 1.  Oral Surg 60:94-99. 1985.

Matusow, RJ.  Clinical observations regarding the treatment of traumatically avulsed mature teeth: part 2.  Oral Surg 60:428-435. 1985.

Andreasen, FM and Andreasen, JO.  Diagnosis of luxation injuries: the importance of standardized clinical, radiographic and photographic techniques in clinical investigations.  Endod Dent Traumatol 1:160-169. 1985.

Birch R, Rock WP. The incidence of complications following root fracture in permanent anterior teeth.  Brit Dent J 160:119-122. 1986.

Maxwell, EH, et al.  Incompletely fractured teeth: a survey of endodontists.  Oral Surg 61:113-117. 1986.

Oikarinen, K.  An atypical tooth fracture due to an indirect trauma mechanism. Endod Dent Traumatol 3:144-145. 1986.

Andreasen, FM.  Transcient apical breakdown and its relation to color and sensibility changes after luxation injuries to teeth.  Endod Dent Traumatol 2:9-19. 1986.

Kling M, Cvek M, Megare I.  Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors.  Endod Dent Traumatol 2:83-89  1986

Gazit E, Sarnat H, Lieberman M.  Timing of orthodontic tooth movement in a case with traumatized and avulsed anterior teeth.  J Dent Child July/Aug 304-307. 1988.

Andreasen FM.  Pulpal healing after luxation injuries and root fracture in the permanent dentition.  Endod Dent Traumatol 5:111-131. 1989.

Bjorvatn K, Selvig K, Klinge B.  Effect of tetracycline and Sn flouride on root resorption in replanted incisors in dogs.  Scand J Dent Res  97:477-482.  1989

Andersson L, Bodin I.  Avulsed human teeth replanted within 15 minutes-a long term clinical follow-up study.  Endod Dent Traumatol 6:37-42. 1990.

Crona-Larson G, Bjarnason S, Noren JG.  Effect of luxation injuries on permanent teeth.  Endod Dent Traumatol 7:199-206. 1991.

Cvek M.  Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta percha.  A retrospective clinical study.  Endod Dent Traumatol 8:45-55. 1992.

Al-Nazhan S, Andreasen JO, Al-Bawardi S, Al-Rouq S.  Evaluation of the effect of delayed management of traumatized permanent teeth.  J Endodon 21:391-393  1995.

Krasner P, Rankow HJ. New philosophy for the treatment of avulsed teeth.  Oral Surg  79:616-623 1995

Oulis C, Vadiakas G, Siskos G. Management of intrusive luxation injuries.  Endod Dent Traumatol 1996;  12:113-119

Mesaros SV, Trope M.  Revascularization of traumatized teeth assessed by laser Doppler flowmetry: case report.  Endod Dent Traumatol 13:24-30 1997

Barrett EJ, Kenny DJ.  Avulsed permanent teeth: a review of the literature and      treatment guidelines.  Endod Dent Traumatol 1997;13:153-163

Olson B, Mailhot J, Anderson R, Schuster G, Weller R.  Comparison of various transport media on human periodontal ligament cell viability.  J Endodon 11:676-79 1997.

Lekic P, Kenny D, Barrett E.  The influence of storage conditions on the clonogenic capacity of  periodontal ligament cells: implications for tooth replantation.  Int Endodon J 31:137-140 1998

Sae-Lim V, Wang CY, Trope M.  Effect of systemic tetracycline and amoxicillin on inflammatory root resorption of replanted dogs teeth.  Endod Dent Traumatol 1998;14:216-222

Sae-Lin V, Metzger Z, Trope M. Local dexamethasone improves periodontal healing of replanted dogs’ teeth.  Endod Dent Traumatol 1998;14:232-236

Levin L, Bryson EC, Caplan D, Trope M.  Effect of topical alendronate on   replanted dog teeth.  Dent Traumatol 17:120-126 2001

Thong YL, Messer HH, Siar CH, Saw LH.  Periodontal response to two intracanal medicaments in replanted monkey incisors.  Dent Traumatol 17:254-259  2001

Lee JY, Yanpiset K, Sigurdsson A, Vann Jr WF.  Laser doppler flowmetry for monitoring traumatized teeth.  Dent Traumatol 17:231-235  2001

Kehoe JC.  Splinting and replantation after traumatic avulsion.  JADA 112:224-230.  1986

Ashkendazi M, Marouni M, Saruat H.  Invitro viability, mitogenicity and clonogenic capacity of periodontal ligament fibroblasts after storage in four media supplemented with growth factors.  Dent Traumatol 17:27-35  2001

Hamamoto Y, Kawasaki N, Jarnbring F, Hammarstrom L.  Effects and distribution of the enamel matrix derivative Emdogain in the periodontal tissues of rat molars transplanted to the abdominal wall.  Dent Traumatol 2002;18:12-23

Kenny D, Barrett E, Casas M.  Avulsions and intrusions: The controversial displacement injuries.  2003;5:308-313

Andreasen JO, Baklund LK, Matras RC, Andreasen FM.  Traumatic intrusion of permanent teeth. Part 1.  An epidemiological study of 216 intruded permanent teeth.  Dent Traumatol;22(2):83-89

Sigalas E, Regan J, Kramer P, Witherspoon D, Opperman L. Survival of human periodontal ligament cells in media proposed for transport of avulsed teeth.  Dent Traumatol;20(1):21-28