Friday 29 th April 2016

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1 Registration and coffee/bread Status of Dental Traumatology worldwide. Is prevention realistic? Lars Andersson Presently almost all countries have published data on the dental trauma exposure of their populations. An overall view of these publications shows that dental trauma is a major risk in all countries. A comparison of figures is difficult to make as different criteria for trauma episodes are often used. Furthermore, trauma incidences (i.e. the dental trauma episodes occurring over a given period of time) are seldom reported. There is also a general lack of information of the cause of accidents. In this presentation a survey will be given of etiology of oral injuries and their relation to bodily injuries and whether modern prevention methods could have prevented these traumas Handling of traumatized children. How to minimize potential psychological impacts? Monty Duggal Luxations and replantations of permanent teeth. What is the value of repositioning, splinting and antibiotics? & Georgios Tsilingaridis All physical dental traumas have a psychological component which may result in psychological stress which may lead to dental fear. The child s immediate reaction to a traumatic experience will often be dominated by tears, horror and chock. In this lecture methods will be shown how to reduce pain in relation to various treatment procedures as will the importance of a good and relaxed patient/ dentist communication. Repositioning, splinting and sometimes administration of antibiotics have for a long time been considered axioms in treatment of luxated and avulsed teeth. Lately experimental animal studies and a single human study have shown that these principles are sometimes invalid. In this presentation the various studies will be described in detail and new guidelines suggested Coffee break How accurate are various pulp diagnostic procedures to diagnose various pulp healing events? Frances M. Andreasen Pulp diagnostic procedures are necessary in the follow-up period after most traumatic dental injuries. The information obtained is one of the key elements in determining whether revascularization and reinnervation are taking place. Only a few studies have examined the value of these procedures in humans and assessed their capacity to show whether the pulp is undergoing healing and/or infection. A number of pitfalls will be shown Lunch

An overall view of these publications shows that dental trauma is a major risk in all countries. A comparison of figures is difficult to make as different criteria for trauma episodes are often used.

2 How frequent is bone invasion in the pulp canal after trauma? And will that lead to complications later? Intrusion of permanent teeth: Results of a multicentre study comparing three treatment procedures. Georgios Tsilingaridis Crown-root fractures: Comparison of three treatment approaches. In previous animal experiments it has been shown that partial and total removal of the Hertwigs epithelial root sheath invite to ingrowth of the alveolar bone and periodontal ligament. In a clinical study of 713 luxated or avulsed and replanted incisors it was found that such a process only occurred in developing teeth and in 4.7% after intrusion, 8.8% after lateral luxation and 6.4% after replantation of avulsed teeth. Long-term observation of these teeth showed that the bone projection gradually diminished. In one case an internal ankylosis developed which necessitated extraction. Intrusion of teeth represents one of the most serious dental traumas as the injury damages both the pulp, periodontal ligament and the gingival attachment. These injuries are rather rare in the permanent dentition. It was therefore decided to combine materials from trauma clinics in Copenhagen, Stockholm and Oslo to get a more representative material. In this study of 230 cases the effect upon pulp and periodontal healing was compared for three treatment approaches, namely awaiting spontaneous re-eruption, orthodontic or surgical repositioning. The results of this study will be presented. Crown-root fractures are often extracted as they are not considered possible to save by traditional restoration. For some time orthodontic extrusion has been recommended and also surgical extrusion has been attempted in a series of clinical studies. Lately a comparison of the two techniques was made where stability of the repositioned teeth was examined. The results of this study will be presented. Finally, a new German study has reported good results of bonding of the coronal fragment Coffee break

In previous animal experiments it has been shown that partial and total removal of the Hertwigs epithelial root sheath invite to ingrowth of the alveolar bone and periodontal ligament.

3 How predictable is treatment of pulp necrosis in teeth with immature root formation? A comparison of three methods. Leif Bakland Pulp necrosis of traumatised developing teeth often ends with treatment failures. The reasons for that can be non-resolution of apical pathosis, progressive root resorption or cervical or midroot fractures. The classical method to treat pulp necrosis in developing permanent teeth has been the use of calcium hydroxide to impose periapical healing including formation of an apical cementum barrier later followed by a guttapercha root filling. For various reasons attempts to avoid long-term use of Ca(OH)2 has been initiated where an apical barrier is created by MTA. In this presentation the long-term results of these two procedures will be described based on a literature review. Within the last decade a new procedure named pulp regeneration has been developed. There appear to be some advantages with this procedure, but many failures are also encountered Questions and Answers

$The reasons for that can be non-resolution of apical pathosis, progressive root resorption or cervical or midroot fractures.$

4 DAY 2 2 DAY Saturday 30 th April Coffee/bread How frequent are primary teeth injuries? Lars Andersson Traumas in the primary dentition long-term consequences of treatment in the primary and permanent dentition. Eva Lauridsen Traumatic injuries are for various reasons very frequent in the primary dentition. This is first of all known to be related to the lack of motor coordination and lack of experience in relation to risk of injury. In the 90 s a large epidemiologic study on trauma covering one year was carried out in a whole Swedish county. This study presented also some new information about traumatic injuries affecting the primary dentition. Results from this prospective study will be presented. Stressful treatment situations may lead to dental fear and anxiety in minor children, and should therefore be minimized. In order to decide whether to preserve an injured tooth or to extract it immediately, it is necessary to consider the frequency of pulp and periodontal healing complications in the primary dentition can they be predicted? How often will these injuries lead to developmental disturbances in the permanent dentition? Can these situations be predicted? These questions will be discussed in this presentation based on recent results from a large study including 840 traumatized primary teeth with long-term follow-up Coffee break How predictable is endodontic therapy in traumatized primary teeth? Consequences of premature tooth loss in the primary dentition. Gideon Holan Extraction is often the method of choice in treatment of injured primary teeth with pulp necrosis. However, endodontic treatment is a possibility. If such a procedure is chosen the close proximity of the apex of primary incisor and the developing successor should be considered as any injury to the enamel epithelium contained in the follicle can result in hypomineralisation of the successor. This applies not only to the mechanical cleansing of the root canal sterilisation of the canal and the choice of root filling. Premature tooth loss in the primary dentition is normally not a problem. However, early and multiple tooth loss may present problems, a phenomenon to be presented Lunch

Eva Lauridsen Traumatic injuries are for various reasons very frequent in the primary dentition.

5 DAY 2 Saturday 30 th April Surgical methods to save developmental disturbed permanent successors Orthodontic methods to save developmental disturbed permanent successors. Olle Malmgren Restoration of developmental disturbed successors. Monty Duggal Intrusion of primary incisors will sometimes lead to tilting of the permanent successor. If the intruded tooth is not removed soon after injury, a crown dilaceration will develop which implies that a portion of the reduced enamel epithelium is atrophied and can no longer ensure proper eruption of the crown dilacerated successor. A surgical exposure of the dilacerated portion will normally lead to full eruption after which the tooth can be restored after removal of the dilacerated coronal part of the crown. Details of the surgical technique will be presented. After early loss of primary incisors scar tissue may be formed in the eruption path for the permanent successor. This will often lead to crown angulation where the incisal edge of the incisor is found close to the loose vestibular mucosa successor and the root shows a marked curvature and extends parallel with the nasal floor. These incisors can be uprighted by a combined surgical/orthodontic procedure where the malformed tooth is tipped so that the crown comes into normal position and the root portion is uprighted. A big aesthetic challenge is to restore malformation of incisors due to developmental disturbances caused by a traumatised predecessor. These malformations will also often cause deep lingual invagination in the pulp of the permanent tooth which represents a risk of pulp necrosis. In this presentation various restorative techniques will be shown Coffee break Cost-benefit analysis of various treatment procedures for crown fractures and tooth loss. & Leif Bakland Crown fractures represent the most frequent trauma injury affecting the permanent dentition. For more than 4 decades restoration with composite has been the favoured treatment. Within the last 10 years a series of long-term studies have shown that the longevity of these restorations is far from ideal. Several studies have shown that 4-5 years survival of these restorations can be expected. An alternative treatment can be laminates where recent long-term studies show very good long-term survival. A new treatment concept is presented, starting with composite restoration in young adulthood and finishing up with a laminate when there is gingival maturity Panel discussion

If the intruded tooth is not removed soon after injury, a crown dilaceration will develop which implies that a portion of the reduced enamel epithelium is atrophied and can no longer ensure proper

The traumatic injuries of permanent teeth and complex therapy

The traumatic injuries of permanent teeth and complex therapy Dr. Katalin Déri Semmelweis Egyetem Department of Pedodontics and Orthodontics Risk Angle II/1 Predisposing factor: overjet insufficient lip