The anterior maxilla is the most traumatised region during childhood. Complications following trauma occasionally lead to tooth loss and a potential future need for implants. Unfortunately, it is contraindicated to place dental implants until growth is completed. Even in adults continued growth may result in rare cases of infra-occlusion of the implant supported prosthesis.   

It is essential to coordinate the treatment sequence at the time of trauma. A multidisciplinary approach in many of the traumatic injuries is essential to ensure the best outcomes can be achieved.  Predicting the viability of a pulp after an injury can be challenging. The decision to undertake pulp extirpation should not be taken lightly and in many instances, unless there is clear evidence of pulp necrosis with infection, observation rather than intervention is preferable.

After loss of a traumatized anterior permanent maxillary incisor in young adults, treatment options are limited: orthodontic closure of the gap and reshaping the adjacent teeth; or tooth extraction and maintaining the gap with a temporary restoration. Orthodontic space closure has limited indications and requires prosthetic restoration of at least 2 teeth. Extraction and temporary restoration will typically result in a need for bone augmentation before implantation. Other possible treatment options include orthodontic extrusion of the root remnant (in cases of untreatable root fracture or complicated crown-root fracture) and a temporary crown to serve the patient until the completion of growth and development, autogenous tooth transplantation, intentional extraction and immediate tooth replantation, distraction osteogenesis, and decoronation.

Topics Include

- The FACE: an anatomical approach

- Post trauma sequalae: Factors effecting pulpal and periapical healing

- Management of crown fractures

- Management of crown/root fractures

- Orthodontic extrusion following dental trauma

- Orthodontic space closure and various prosthetic options including reshaping adjacent teeth

- Implant treatment after dento-alveolar trauma to permanent teeth

Learning Objectives
- An update of the neurosensory innervation and vascular supply of the face.
- Describe possible late complications if correct treatment of dental trauma is not rendered
- Describe interdisciplinary management following dental trauma 
- Discuss management of crown fractures in the mature and immature tooth
- Discuss management of crown/root fractures in the mature and immature tooth
- Describe the types of clinical problems that can be addressed by regenerative procedures 
- Discuss the protocols and expected outcomes for regenerative endodontic procedures
- Evaluate the indications and contraindications for using regenerative endodontic procedures 
- Describe the clinical consequences when an ankylosed tooth is left in situ
- Discuss various treatment options for the ankylosed tooth