Introduction

Dental Trauma: Improving Treatment Outcomes

Anthony J. DiAngelis, DMD, MPH

Copyright 2000 Journal of the California Dental Association.

I am not certain if the following story is true or purely apocryphal, but it serves to introduce the theme of this month’s Journal of the California Dental Association. A reporter was in the Chicago Bulls’ locker room at the conclusion of another Chicago win during the brilliant Michael Jordan days. Michael was his usual commanding self, scoring 60 points. A rookie teammate played his first game that night, scoring but one point. The reporter, looking for a new angle for his column, asked the rookie "How will you remember your first game with the Bulls?" After a thoughtful pause, he responded, "I’ll remember this as the night Michael and I combined for 61 points."

Given that most oral and dental injuries are sports-related and that it often requires the combined efforts of the entire dental team to restore patients to optimum pre-injury status, I am pleased to introduce a series of articles by the "pros" in dental trauma. Four years ago, contributing editor Dr. Donald Devlin, realizing the breadth and depth of this topic, solicited eight manuscripts on dental trauma for two consecutive issues of the Journal.

In revisiting this topic four years later, it is clear that there is much yet to be discussed. While general dentists and pediatric dentists are usually the frontline providers in the initial management of dentoalveolar injuries, complex cases require the expertise of endodontists, oral and maxillofacial surgeons, orthodontists, periodontists, and prosthodontists.

In the current issue, Dr. Clifton Dummett reminds us of the high frequency of falls and subsequent dentoalveolar injuries in the pediatric dental population. He reminds us that although deciduous teeth may be dispensable, we must communicate to parents that problems and sequelae of deciduous tooth injuries may not become evident until eruption of the permanent teeth.

Dr. Barbro Malmgren presents a conservative technique for managing tooth submergence or infraposition resulting from ankylosis, a frequent complication in tooth replantation. Decoronation is a technique that preserves alveolar bone height and width and has been used successfully for years in Europe. While it has been well-documented in the European dental literature, it is a technique little known in the United States.

One of the newest and most efficacious materials in the field of endodontics is mineral trioxide aggregate. Due to its high biocompatibility, compressive strength, and superior sealing characteristics, MTA has found utility in the management of perforations, apexification, and root-end filling. In his manuscript, Dr. Leif Bakland describes the use and advantages of MTA as a pulp-capping agent. This promises to add to the clinician’s armamentarium in preserving the pulp of traumatically injured immature permanent teeth.

External root resorption represents a significant complication in luxation and avulsion injuries. Dr. Martin Trope provides an insightful look into preventing, minimizing, and reversing resorption. He thoughtfully explores the etiology of external root resorption, presents current therapeutic approaches, and offers a look into promising potential techniques based on his extensive research in this area.

In summary, this issue of the Journal offers the practitioner up-to-date scientific information and clinical approaches to managing the unexpected but often encountered traumatic dental injury.

Contributing Editor

Anthony J. DiAngelis, DMD, MPH, is the chief of dentistry at Hennepin County Medical Center and a professor at the University of Minnesota.