21/07/2025
ORTHODONTIC TREATMENT OF TRAUMATISED TEETH
Here is a typical referral case I would treat.
CASE SUMMARY
Sk mild II, Incisors II/1, trauma UR1
PLAN
1 - Twin Block functional appliance
2 - Upper and lower fixed appliances
3 - Long term retention with VFRs
While the malocclusion is not insignificant, the main concern with this case was management of historical trauma to UR1 which had caused some shortening of the tooth root.
What does the literature say about orthodontic treatment for traumatised teeth?
Studies consistently show that orthodontic forces can exacerbate root resorption in teeth that have previously suffered trauma, especially luxation injuries (e.g., extrusion, intrusion) and avulsion followed by replantation. The risk is especially high if there has been ankylosis, replacement resorption, or severe inflammatory resorptionprior to treatment (Kindelan 2008, Malmgren 1982).
What are the orthodontic management principles for traumatised teeth?
- Conduct a thorough trauma history and take baseline radiograph.
- Delay treatment at least 6 months, or longer depending on the severity of trauma.
- Use low, controlled orthodontic forces (e.g. increase wire size slowly and incrementally, avoid rectangular wires)
- Avoid lengthy treatment.
- Radiographic monitoring during treatment
What happened in this case?
Some additional root resorption is evident on the second radiograph. The tooth was asymptomatic during treatment, and all is well at the conclusion of orthodontic treatment. In retrospect, I could have taken more radiographs during the course of treatment but I am not sure it would have changed much.
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