ENDO, 04/2014

Cracked and incompletely fractured teeth are a real challenge for the dentist. A correct and timely diagnosis is not easy, due to the wide variety of complaints and symptoms. The term 'cracked tooth syndrome' is commonly used to refer to teeth with cracks and fractures. The content of this term, however, may differ from author to author and has evolved over time. In the end, there is no clear description covering the complete genre of cracked, fractured, broken or split teeth. The American Association of Endodontists has classified five specific variations of cracked teeth: craze line; fractured cusp; cracked tooth; split tooth; and vertical root fracture. The aim of this review is to provide information for terminology, classification, diagnosis and management. A decision flow chart with five specific variations of cracked teeth and the treatment options is presented. Paper presented by Roeland De Moor at: VWVT (Flemish Scientific Society for Dentistry), Symposium 'Bijten of slijten' (To bite or to abrade), Antwerp, Belgium, April 18-19, 2013. The 'broken tooth' conundrum: terminology, classification, diagnosis and management. Keywords: cracked tooth, craze line, fractured cusp, split tooth, vertical root fracture

Aim: To address and highlight the changes that may occur during orthodontic tooth movement to both dental pulps and teeth, which have undergone various types of dental trauma and to address clinical concerns in the management of these teeth. Methods: Online search engines were used to access published journals along with hand searching available theses, along with any previously published in-depth review articles. Research findings and clinical relevance were considered with regards to levels of evidence or best evidence available. Results: There was a great deal of variability in the studies reviewed, which usually reflected the nature of the study protocols, patient populations and methods of treatment. The key findings, while minimally evidence-based, are summarised relevant to the best evidence available within a relationship that has received little recognition as to its existence. Conclusions: There are changes that occur within the dental pulp due to orthodontic tooth movement and these changes may be accentuated in teeth that have had previously varying degrees of trauma. Furthermore, traumatised teeth may undergo various degrees and types of root resorption that might impact on planned orthodontic and endodontic treatment procedures. Careful and thorough assessment of all teeth, particularly those that have a history of trauma is essential during the treatment planning for orthodontic tooth movement. Keywords: dental pulp, orthodontics, outcomes, symptomology, tooth trauma

Vital pulp therapy after traumatic dental injuries with pulp involvement plays a key role in the treatment of dental injuries, especially in those sustained by young patients. Unlike conventional root canal therapy, maintaining pulp vitality enables the roots of immature teeth to continue growing. Provided that the indication is correct, vital pulp therapy methods have a high success rate, particularly in partial pulpotomy, which has a prognosis of over 90%. Keywords: micropulpotomy, mineral trioxide aggregate, pulp capping, pulpotomy

Trauma to the anterior teeth is a frequent reason for tooth loss in children and adolescents. The transplantation of teeth is an established and biological therapy for replacing missing anterior teeth in these age groups. Premolars and primary canines are suitable for replacing anterior teeth in the maxilla due to their root anatomy and the corresponding emergence profile. This article gives an overview on the indications of tooth transplantation in the anterior maxilla, the surgical procedure and a short survey of the developments in current literature. Keywords: premolar, primary canine, transplantation, trauma

Aim: A maxillary left central incisor had been traumatised and undergone incorrect repositioning, causing apical fenestration of the cortical bone and patient discomfort. The aim of this case report was to evaluate the use of cone beam computed tomography (CBCT) in the diagnosis and treatment evaluation of lateral luxation injuries. Materials and methods: CBCT was used to accurately image and diagnose the lateral luxation. The tooth was root canal treated, orthodontically repositioned and aesthetically restored with resin composite. Results: Root canal treatment resolved the periapical pathology, and orthodontic treatment brought the tooth back into an anatomically appropriate position, with regeneration of labial cortical bone and complete resolution of patient discomfort. The 15-month follow-up was uneventful and the tooth was in good condition, both clinically and radiographically. Conclusion: CBCT providing detailed three-dimensional images of teeth and surrounding tissues was a promising tool for the management of lateral luxation injury. Keywords: cone beam computed tomography, endodontic diagnosis, lateral luxation, orthodontic repositioning

Tooth avulsion significantly damages the supporting periodontium and usually results in pulpal necrosis in permanent teeth with completed apical root formation. However, when the root of a permanent avulsed tooth is incompletely developed, the possibility of retaining pulp viability or achieving revascularisation of the pulp can be considered. Treatment factors such as extraoral time, extent of damage to the surrounding bone and soft tissue, and tooth storage media, when replantation is delayed, will influence healing and tooth retention. A case report in the management of a 6-year-old patient following multiple avulsions of teeth with immature apical development is presented. Keywords: avulsion, incomplete root development, replantation