Paeds/trauma – what I wish I’d known Susan Kindelan, Claire Rooney. BOC 2021. September 29th 2021. Episode 132

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Hosted by
Farooq Ahmed


Join me for Susan and Claire’s lecture looking at paediatric trauma and the orthodontic management




Prevalence of trauma

Prevalence 12% 12 year olds CDH 2013

10.3% orthodontic population have trauma


Ortho implication

·      Inform consent process

·      Previous trauma, likely 2nd traumatic episode



·      Generally weak – unable

·      Tooth SOS mobile app

·      International association of the dental traumatology

·      Guidelines for the orthodontic management of the traumatised tooth 2020 JO– Cara Sandler




·      Baseline periapical

·      Monitor injury dependent

·      CBCT


Management of traumatised teeth

·      Initial management

o   Repositioning

o   Splinting

·      Future orthodontic implications

o   Reducing forces – i.e. thermal NiTi wire

o   Space closure – use undersized archwire


Mild injury

·      Concussion

·      Subluxation – gingival fibre and bleeding at gingival level

o   3 month wait prior to orthodontic forces

Moderate injury

·      Intrusion – damage to vessel bundle

o   Immature – spontaneous eruption preferred as less RR

o   Mature – spontaneous / ortho up to 7mm, greater than 7mm surgical reposition – RCT 2-3 weeks after injury as will be non-vital from injury

o   When reposition, consider incisal positioning as likely ankylosed, therefore relative intrusion less evident as patient grows

·      Lateral luxation – displacement in a non-axial direction, frequent bony fracture

o   Digital reposition and light archwire placed for 6-9 months



·      Fixed appliances with passive archwire


Hard tissue injuries

·      Crown root fracture – crown, cement +/- pulp

·      Root fracture

o   Apical area treated as vital root

o   Cervical aspect treated non-vital

§  If orthodontic movement needed, likely loss of tooth


Rest periods prior to orthodontic active forces

·      Minor damage – 3 months

·      Moderate damage 6-12 months

·      Severe – root fractures -12 months



·      Endodontically treated teeth

·      No further RR during orthodontic treatment

o   Advise re-radiograph 6-9 months of orthodontic forces

·      Pulp canal obliteration

o   4-24% sequelae after trauma

o   Usually occurs up to 1 year after injury

o   Implies vitality of a tooth

o   HOWEVER – increased risk of loss of vitality during orthodontic treatment


·      Delayed presentation

o   Avulsed immature central incisor tooth

§  Can re-implant however plan for loss

§  Or temporary prosthesis

o   Safeguarding issues

o   Root end closure

§  MTA

§  Regenerative endodontics

·      Biologically increase root length and wall thickness

o   However unpredictable

§  No longer apexification with CaOH, risk of fracture and significant time


Traumatised teeth of poor prognosis management

·      Infection related resorption, ankylosed teeth

·      Ankylosed tooth

o   Decoronate – subgingival level

§  Maintains alveolar bone – prevents vertical bony defect

§  Temporary prosthesis

o   Autologous tooth transplantation

§  Usually premolar teeth – width, size and root morphology

§  Half formed root at time of transplantation

§  Bony inductive property = long term option

§  However restorative and clinical burden high

o   Space closure



o   10% of patients will have trauma – before or during orthodontic treatment

o   Informed consent – fluid process

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