Current Protocols in Management of Dental Trauma

 A reflection on current protocols in management of Dental Trauma in a growing child patient. Tradition versus a bright new Interdisciplinary future-2.30 hrs

In this course the speaker will outline his treatment philosophy for the management of young permanent teeth which have suffered trauma resulting in injury to the pulp and to the periodontal ligament.  The emphasis of this course is the lasting effect that trauma can have on the oral health of a growing child, and the use of the period of growth and development to ensure that the child has a good long term outcome.  An update on the current approaches for the management of the pulp and PDL that should be based on knowledge of cellular biology will be presented.  Any attempt to provide treatments without an understanding of the tissue responses to injury or treatment are doomed to failure.   Many practitioners will be called upon to manage acute dento-alveolar trauma that has resulted in injures to the PDL.  The management of injuries such as luxation, root fractures and avulsions are challenging especially in children where the anxiety and a traumatic episode are superimposed on the surgical problem.  In this lecture the latest recommendations for the management of such injuries will be explored and the new data on the outcomes will be presented.  The speaker will also use Video clips to familiarize the participants with the Traumaguide, which is a wonderful tool for all practitioners to use in their day to day practice. The speaker is one of the Board members that manage the Trauma guide.

Both orthodontists and Paediatric Dentists are in a privileged position of treating young patients who are in a period of growth and development.  Interdisciplinary and multidisciplinary team efforts for the treatment of young children and adolescents with developmental defects and who are unfortunate to suffer severe dento-alveolar trauma, will ensure good long term outcomes for the patients.  The management of much dental trauma in a growing child patient requires orthodontic input, in particular management of intrusion injuries that require orthodontic extrusion.   Also, there are implications for the orthodontic movement of teeth that have been traumatised in the past as many of these will remain prone to external root resorption during orthodontic movement.  In particular teeth that become ankylosed after trauma pose a serious management issues for clinicians with a very serious implications for the child.  What are the management options for such teeth?  What should clinicians do for teeth that are ankylosed and are getting infra-occluded?  Infra-occluding teeth can have disastrous consequences for the patient in the long term due to lack of alveolar bone growth in that region.  Bone management requires complex treatment planning but is crucial for a good prognosis for the child in the long term.  The speaker will present the methods for conserving bone in region of ankylosis, and the role of the interdisciplinary team working between orthodontists and Paediatric dentists to secure the best outcome for the child into adulthood.  We have developed a true interdisciplinary approach for the management of anterior teeth with poor prognosis as a result of dental trauma.  This involves bone management at the affected site followed by autotransplantation.  Since the inception of this programme we have placed over 230 transplants using the multidisciplinary team comprising of both paediatric dentistry and orthodontic expertise.  This talk will aim to provide an overview of the relationship between dental trauma and orthodontic practice and discuss the technique of transplantation, where teeth are lost as a result of trauma and the requirements for pre-transplant and post-transplant orthodontics.  The versatility of autotransplantation will be discussed as it can be used for numerous indications, including trauma, replacement of dilacerated teeth, developmental anomalies, replacing developmentally missing teeth etc.

Objectives to enable the participants

– to understand the impact of previous trauma

– to understand the impact of trauma during orthodontic treatment

– to understand the role of orthodontics in the treatment of traumatised teeth

– the role of orthodontics in treatment of traumatized teeth of poor prognosis -the role interdisciplinary care in dental Traumatology

– management of bone when loss of tooth is inevitable

– rationale and outcomes for tooth transplantation in children.