Interventions for treating traumatised permanent front teeth: luxated (dislodged) front teeth

Traumatic injuries to upper front teeth in children and young adults are common. The Cochrane Oral Health Group conducted this review to look at interventions to treat the front permanent (adult) tooth or teeth when they have been displaced from their original position following injury. This review does not include teeth that have been completely knocked out (avulsion).

The latest search of relevant studies was carried out on 20th August 2012.

There are various causes of this kind of traumatic injury including falls, blows, accidents and assaults. Studies have shown that the majority of cases involve boys and young men (60% to 70%).

There are three main kinds of displacement.

- Lateral, where the tooth has been forced sideways (either back or forwards) in the socket and is immobile.
- Extrusion, where the tooth has become loosened and begins to come out of the socket.
- Intrusion, where the tooth has been forced into the bone of the jaw.

After the injury, the teeth may be repositioned into their original position or allowed to spontaneously return to their original position (appropriate for some types of intrusion injury). Repositioning can be undertaken either manually by the dentist or using orthodontic braces. Once the tooth is returned to its original position, splinting may be used to maintain its position. A large variety of splinting techniques have been reported in the literature. An ideal splint should be passive (i.e. it should not cause the tooth to move away from its original position), allow physiological movement (e.g. allow very minor movements of the tooth while maintaining its original position) and be simple to handle during application and removal. From the patient's perspective, the splint should not interfere with biting, cleaning or speech. The length of time the splint should stay in position depends on the injury, the mobility of the tooth and the tissues affected. The injured tooth or teeth will then require long term (at least 12 months) monitoring to assess healing, particularly of the gum and soft tissues around the tooth and crucially the pulp inside it which keeps the tooth alive. Where indicated (i.e. if the pulp inside the tooth dies), further treatment may be required such as root canal treatment.

This Cochrane review investigated what treatments are beneficial for these kinds of injuries including:

- the role of antibiotics and their different types;
- the role of splints, their differing types, and the optimum length of time for their use; and
- the role of repositioning techniques (e.g. the use of orthodontic braces or surgery).

Out of 548 studies identified in the search, no studies were found which met the inclusion criteria. There is therefore no high quality evidence available on which to base an assessment of interventions to treat these injuries. Current treatment guidelines are based on studies with a greater risk of bias using study designs such as case series, animal studies and laboratory-based cellular studies. High quality studies are therefore urgently needed.

Authors' conclusions: 

We found no randomised or quasi-randomised trials of interventions to treat displaced luxated permanent front teeth. Current clinical guidelines are based on available information from case series studies and expert opinions. Randomised controlled trials in this area of dental trauma are required to robustly identify the benefits of different treatment strategies.

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Background: 

Dental trauma is common especially in children and young adults. One group of dento-alveolar injuries is classified as luxation. This group includes a subgroup of severe injuries where the tooth is displaced from its original position. These injuries are classified further by the direction in which the tooth has been displaced, namely: intrusion, extrusion and lateral luxation.

Objectives: 

To evaluate the effects of a range of interventions for treating displaced luxated permanent front teeth.

Search strategy: 

Search strategies were developed for MEDLINE via OVID and revised appropriately for the following databases: Cochrane Oral Health Group's Trials Register (to 20 August 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 8), MEDLINE via OVID (1966 to August 2012), EMBASE via Elsevier (1974 to August 2012), and LILACS via BIREME (1982 to August 2012). Dissertations, Theses and Abstracts were searched as were reference lists from articles. There were no language restrictions.

Selection criteria: 

Randomised or quasi-randomised controlled trials of treatment interventions for displaced luxated permanent front teeth. Included trials had to have a minimum follow-up period of 12 months.

Data collection and analysis: 

Two review authors independently and in duplicate assessed the eligibility of all reports identified in the searches. Authors were contacted for additional information where required.

Main results: 

No randomised or quasi-randomised controlled trials were found.

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