Traumatology and Regenerative Endodontics
This domain is judged against the IADT guidelines, which are specific about timing and splinting.
Luxation and fracture
- Concussion and subluxation: observation, no or flexible splinting.
- Extrusion and lateral luxation: reposition, flexible splint for about 4 weeks, then sensibility monitoring.
- Intrusion with a closed apex: allow spontaneous eruption if less than 3 mm, otherwise orthodontic or surgical repositioning; root canal treatment follows because necrosis and resorption are expected.
- Root fracture: reposition and splint for about 4 months if coronal to the crest.
Avulsion
Handle by the crown, do not scrub, replant immediately. Storage in HBSS, milk or saline; extraoral dry time under 60 minutes gives the best prognosis. Flexible splint for 2 weeks, systemic antibiotics, tetanus check. Closed apex: root canal treatment within about 2 weeks if the pulp is necrotic; open apex: consider revascularization.
Regenerative endodontic procedure
Indicated for an immature necrotic tooth with an open apex. Minimal or no instrumentation to preserve stem cells; 20 mL of 1.5% sodium hypochlorite followed by 17% EDTA; an intracanal medicament; at the second visit, induce a blood clot, seal with MTA or a collagen plug, and restore with composite. Success means resolution of the lesion and continued root development. High-concentration hypochlorite and long-term calcium hydroxide are avoided.
Worked example
An 11-year-old avulses an immature central incisor, replanted within 20 minutes. Flexible splint for 2 weeks, soft diet, antibiotics. At follow-up, the pulp is necrotic with an open apex: regenerative procedure rather than conventional apexification.
Traps
Splinting an avulsed tooth for months, causing ankylosis; using high-concentration hypochlorite in a regenerative case; assuming a negative sensibility test immediately after trauma means necrosis.