LITERATURE REVIEW

Aetiology of dental trauma

Accidents within and around the home have been reported as being the major source of injury
to the primary dentition, while accidents at home and school accounted for most injuries to
the permanent dentition. Table 3 indicates there is some variation between studies and
countries regarding the predominant causes of dental trauma, although accidents due to falls
appear to be the most common factor in both primary and permanent dentitions.
Accidents as a result of sport s , violence and road traffic accidents were also common causes
of dental trauma.

Injuries
The number, type and severity of dental injuries per patient differ according to the patient age
and the cause of the accident. Uncomplicated crown fracture without pulp exposure was the
most common injury to the permanent dentition in most studies (Table 3).However,
subluxations and complete luxations were the most frequently o c c u rring injuries in two
hospital studies, part icularly in the primary dentition.
Displacement (luxation) of teeth has occurred more frequently in the younger age groups
studied authors have indicat ed that the supporting structures (alveolar bone and periodontal
ligament) in the primary dentition are resilient, thereby favouring dislocations rather than
fractures. The maxillary central incisors were the most frequently injured teeth in all studies
for both the primary and secondary dentitions. The second most frequently injured teeth were
maxillary lateral incisors in all studies except that by Forsberg and Tedestam where
mandibular central incisors were the second most frequently injured teeth. The number of
injuries per patient has varied from between 1.1 and 2.0, but this variation could have been
influenced by the actual injuries being recorded, the classification used and the type of study
location. The two Australian studies by Liew and Daly and Martin et al.conducted in all age
groups from after hours dental clinics, reported more severe injuries to older patients and
involved more teeth per patient than had been found in the Australian pri vate practice study
by Davis and Knott.
The number of injured teeth per patient also varied between countries and sites of the studies.
The type of study centre also affected the frequency of multiple injuries per person. One tooth
was more frequently injured than multiple teeth in most p r o s p e c t i ve studies conducted
at school dental services and general clinics. Those studies conducted in hospital casualty
departments and after hours clinics have observed injuries to one and two teeth in equal
proportions or two teeth more frequently than one.9 This may be a function of


AVULSION
Traumatic injury to the oral cavity and surrounding the case is quite common among children
and adolescents , so mernbutuhkan and meticulous attention to both the care of a dentist .
Traumatic injury in children says nearly 30 percent of children have experienced trauma to
the teeth and face during play , exercise or other activity . Trauma involving the upper front
teeth remain common in the age of 8 to 12 years . The cause trauma to permanent teeth
among others, fell off the bike , fights , traffic accidents and sports .
Traumatized teeth should be examined whether the tooth is fractured , unsteadiness , change
position , injury to the periodontal ligament and alveolar bone , as well as trauma to the pulp
tissue . Check also the possibility of the involvement of the teeth are in the jaw of his
opponent .
The severity of trauma to the teeth can be classified into several pieces , which one of them is
the release of all parts of the tooth socket or what we call the avulsion . To handle this , the
dentist needs to take action to restore the tooth to its original socket , this action is called
replantasi teeth . Golden period to perform dental replantasi is 2 hours after the teeth apart .
When teeth direplantasi over 2 hours , it is likely to be non-vital teeth so the teeth need to be
fixed after endodontic treatment . If the avulsed tooth is not immediately treated , can lead to
significant negative impacts on children , namely impaired function , aesthetics , and
psychology .
The success of treatment of avulsed teeth depends on how long they lasted , the scene , what
action was taken the first time when the avulsed tooth and how the handling of the avulsed
tooth . The prognosis of dental trauma include influenced by three factors: the level of
damage or extent of the damage suffered , whether the damage suffered by another network
covering around the teeth , such as soft tissue and hard tissue such as the bone of the jaw , the
quality and immediacy of treatment performed after the trauma as well as the evaluation of
management during the healing period
All current evidence indicates that immediate replantation favors a successful outcome. If an
avulsed tooth must be transported or stored prior to replantation, specially developed storage
media can sustain the vitality of the PDL for several hours. Availability of such storage media
is a problem, but is has been demonstrated that milk can be a very suitable storage solution
for up to several hours . Keeping the tooth in saliva is also an option. Plain water or dry
storage will result in a quick death of the PDL and its cells.
With the exception of immature, incompletely developed teeth, root canal treatment is an
essential component of the treatment strategy . Failure to remove the necrotic pulp will result
in infection-related resorption . Failure to replant the avulsed tooth before PDL death will
likely lead to ankylosisrelated resorption.
Much attention has been given to the possibility that Emdogains may promote new
periodontal attachment to replanted, avulsed teeth with long dry time . The evidence is not
yet available to determine if this agent can reliably produce successful outcomes.




















CASE AND TREATMENT

CASE
A child comes to the dentist with complaints dislodged teeth as they fall from the ladder.
Patients carrying dislodged teeth that have been soaked in milk. What follow-up care that
dentists do?

TREATMENT

Emergency visit
The purpose of the emergency visit ( emergency measures ) is to mereplantasi teeth with
minimal cellular damage because it will cause inflammation and maximize the amount of
periodontal ligament cells that have the potential to regenerate and repair the damage to the
root surface ( Trope , 2002) .

Diagnosis and Treatment Planning

Examination of the avulsed tooth

A special media that can be used to store gear before direplantasi is Hank's Balanced Salt
Solution ( HBSS ) . This media is proven to maintain vialbilitas periodontal fibers in the long
term . Moreover, it can also use milk or normal saline ( Trope , 2002) .

Examination socket and Alveolar Bone
Examination socket done to ensure that the condition is still good and allows to do replantasi.
This check is done by pressing ( palpating ) the facial and palatal surfaces of the socket .
Furthermore , the socket is cleaned with saline solution and when a blood clot and debris that
is in it is clean , check whether there is an abscess wall socket or collapse . It is also important
examination of alveolar bone to determine whether there is a fracture or not ( Trope , 2002) .
Also recommended to perform radiographic examinations in the socket and surrounding area,
including soft tissue . Three vertical angulation required to diagnose a horizontal fracture at
the root of the tooth ( Trope , 2002).
The second stage is when the emergency care of patients already in the dentist 's office . At
this stage of things to note are :
When patients arrive at practice , dental placed in a beaker containing saline ( a little salt
added to the water will produce approximately 0.7 % salinity ) . Such procedures in general ,
needs to be done to know the health history history psien , check the area of the teeth and
dental x-rays done as quickly as possible . If the tooth has been restored to its socket , and the
place was appropriate , convenient , then the teeth stay in splinting alone ( Weine , 2004) .
If not direplantasi teeth , the dentist should not be mengkuretase sterilize the root portion of
the tooth or teeth or sockets . Teeth are held all the time on the crown only with the sponge
that had been given saline . Dispose of debris on the surface gently with a sponge wet roots .
Socket with saline irrigation and do not make access to the cavity , do not cut the roots and
not to place the apical penestrasi ( Weine , 2004) .
As quickly as possible , direplantasi avulsed tooth in the socket with a sponge . Check the
teeth with X-rays proficiency level . Perform a soft arch splinting with wire and with acid
etching . Patients are given information to consume soft foods first ( should not eat foods
such as apples , shell shrimp / crab , certain sandwich ) . The recommended foods such as ice
cream , ice milk , soft hamburger ( Weine , 2004 ) . Splinting techniques allow movement
during physiological tooth during healing and reduces the incidence of ankylosis .
Recommended splinting techniques are semi - rigid fixation for 7-10 days ( Trope 2002)
Avulsed tooth endodontic treatment needs to be done . The completion of the endodontic
treatment include :
One week after replantasi , prepare access cavities , perform root canal debridement and
preparation based on root length of x-rays that have been done before , and full to the brim
with tumpatan while like ZOE . At the apical tooth that has not fully closed , it was not done
because the extirpation of the pulp will have to continue the revitalization of apical
development . When the pulp is then become necrotic , the canal debridement and
apeksifikasi procedure can be done . To prevent ankylosis , take the splint at the end of
treatment .
Two weeks after replantasi , calcium hydroxide paste placed in the canal to prevent and
reduce external resorption . When calcium hydroxide paste placed too quickly , before
regenerating periodontal ligament , it can increase resorption .
After the periodontal ligament and musty look back on radiographs formed , in which it
usually takes 3-6 months , open the back teeth . Clean the back wall of the root canal with a
little preparation and with the gutta - percha content and sealer . Initial control in the first
month , then followed every three months . External resorption usually occurs in the first
year.

Replantasi after extraoral period
In some cases , it is sometimes difficult to put back rapidly avulsed teeth . Often teeth are not
discovered until a few hours or a few days later . The possibility of an accident that happened
to be away from the nearest dental practice . If the tooth can not be found within a few hours ,
then endodontic treatment can be performed before replantasi . However , there is also an
opinion that the sooner the tooth restored to its original place , it will be better . Pulp tissue
may be lost and this can be overcome by treatment as described at the beginning of phase 3 ,
ie by storing avulsed teeth on a medium .

Endodontic treatment on tooth avulsion
Teeth with open apex and Luat has been in the mouth for less than 2 hours
Replantasi done in an attempt to merevitaslisasi pulp
Control every 3-4 weeks to detect the presence of malignancy
If there is malignancy , clean the root canal and fill it with calcium hydroxide (
apeksifikasi )
Teeth with open apex and Luat has been in the mouth for more than 2 hours
Clean the root canal and fill it with calcium hydroxide
Control in 6-8 weeks
Teeth with a closed apex perfectly or partially outside the mouth and are less than 2
hours
Take the pulp tissue in 7-14 days
Medication with calcium hydroxide root canal
Obturation with gutta -percha and sealer after 7-14 days of medication
Teeth with a closed apex perfectly or partially outside the mouth and are more than 2
hours
Root canal treatment both intraoral and extraoral
If done extraoral , avoid chemical or mechanical injury to the root surface














































REFERENCES

Australian Dental Journal 2000;45:1.
2009 The Author. Journal compilation 2009 John Wiley & Sons A/S