Pacific Coast Society of Orthodontists Bulletin Spring 2014 - (Page 43)

ANNUAL SESSION SUMMARY The Role of Orthodontics in Trauma Management Presented by John Christensen, DDS, MS ,PCSO Annual Session, October 19, 2013. Summarized by Dr. Bruce P. Hawley, PCSO Bulletin Northern Region Editor. Dr. Christensen believes that as orthodontists, we can help to manage teeth that have sustained trauma, either prior to orthodontics or during active treatment. PREVENTION W ith respect to prevention, mouthguards are very protective against traumatic dental injuries. Orthodontic patients can wear either a stock mouthguard or a boil-and-bite type (the latter may not work well, depending on the arch form). The best mouthguard is the one that is worn, however. Males have a somewhat higher rate of dental trauma than females, and the maxillary central incisor is the most commonly traumatized tooth. Increasing overjet results in progressively inadequate lip coverage, and in turn, an increased risk of trauma. Does an increased risk of trauma warrant orthodontic treatment? Previous studies recommended that orthodontic treatment not be rendered for excess overjet strictly to prevent trauma.1,2 The risk factors should be based on the individual's general activity level and history, according to Dr. Christensen. IMMEDIATE TRAUMA Should orthodontics be used to improve trauma outcomes in patients not already undergoing concurrent orthodontic care? To optimize healing, keep the area of root surface of a traumatized tooth as non-traumatically involved, and with as low an orthodontic force, as possible. Manual repositioning of a displaced tooth may be appropriate, as can the use of orthodontic forces. Each traumatic incident is unique, so the practitioner should use his/her previous experience and clinical judgment in each given situation. With an intrusive luxation, the stage of root development and the degree of intrusion are important. If the intrusion is less than 3 mm, observation may be in order. For intrusions of 3 to 6 mm, observe or possibly use orthodontic brackets to extrude the tooth. If greater than SPRING 2014 * PCSO BULLETIN 6 mm, extrude with orthodontic brackets, or possibly with surgical repositioning. The good news is that 9 out of 10 cases can be repositioned successfully with orthodontics. (Note that neither surgery nor orthodontics has been shown to be superior to the other.) Dr. Christensen will start managing an intruded tooth right away, even though, Dr. Christensen as is often the case, the patient cannot be seen until four to five hours have transpired after the injury. The use of self-ligating brackets (SLBs) can help, as the doors open and close and o-rings do not need to be used. Remember to bond SLBs with the doors open, so that they do not have to be opened intraorally after bonding in order to place the archwire. A .012 or .014 nickel-titanium (NiTi) wire with appropriate stops is frequently the wire of choice, although up to a .018 SS wire can be used. Of course, obtain appropriate radiographs, including periapical radiographs. Photographs can be taken for documentation as well as for insurance purposes. For the highest degree of success, it is important to have a plan before performing clinical intervention following trauma. Identify which teeth are the ones injured or displaced, and establish which anchor teeth will be used for stabilization or movement of a displaced tooth. Control any hemorrhage with cotton gauze. For avulsions, the amount of time that the tooth is out of the mouth is a major determinant of treatment success, with the prognosis becoming considerably less favorable beyond 30 minutes. In reimplantation, Dr. Christensen likes to use brackets to aid in final repositioning and stabilizing, as hydrostatic pressure tends to push the tooth back out. The doors to the SLBs can be opened in order to facilitate checking the mobility of the tooth in the days and weeks following reimplantation, and in order to determine when to remove the brackets. 43

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2014

A Magical, Spooky, International, Educational Time in Anaheim
New Columns
View From The Top: President’s Perspective
AAO Council on Scientific Affairs (COSA) Report
AAO Trustee Report
ABO Update
How To Save a PCSO Bulletin Article as a .PDF File
The Importance of Healing
Incoming and Outgoing Radiographs
Resident Spotlight: A.T. Still University, Arizona School of Dentistry & Oral Health Postgraduate Orthodontic Program
Use of the XBOW™ Appliance Vs. the FORSUS™ Appliance for Class II Correction
Advanced Research Avenues at the Roseman University of Health Sciences Orthodontic Program
Dr. Gerald Nelson
The Interdisciplinary Team: Managing Patients with Impacted or Ectopically Positioned Teeth
Miniplate Anchorage for Midface Protraction in Class III Patients and Molar Distalization in Class II Malocclusions
Achieving Financial Independence: A New and Younger Members Featured Lecture
The Role of Orthodontics in Trauma Management
Converting a Tube

Pacific Coast Society of Orthodontists Bulletin Spring 2014