J Korean Assoc Oral Maxillofac Surg.  2024 Jun;50(3):123-133. 10.5125/jkaoms.2024.50.3.123.

Evidence-based management of isolated dentoalveolar fractures: a systematic review

• Burman S
• Lal B
• Alagarsamy R
• Kumar J
• Ankush A
• Rai AJ
• Yunus M

• KMID: 2557618
• DOI: http://doi.org/10.5125/jkaoms.2024.50.3.123

Abstract

Dentoalveolar (DA) trauma, which can involve tooth, alveolar bone, and surrounding soft tissues, is a significant dentofacial emergency. In emergency settings, physicians might lack comprehensive knowledge of timely procedures, causing delays for specialist referral. This systematic review assesses the literature on isolated DA fractures, emphasizing intervention timing and splinting techniques and duration in both children and adults. This systematic review adhered to PRISMA guidelines and involved a thorough search across PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library from January 1980 to December 2022. Inclusion and exclusion criteria guided study selection, with data extraction and analysis centered on demographics, etiology, injury site, diagnostics, treatment timelines, and outcomes in pediatric (2-12 years) and adult (>12 years) populations. This review analyzed 26 studies, categorized by age into pediatrics (2-12 years) and adults (>12 years). Falls were a common etiology, primarily affecting the anterior maxilla. Immediate management involved replantation, repositioning, and splinting within 24 hours (pediatric) or 48 hours (adult). Composite resin-bonded splints were common. Endodontic treatment was done within a timeframe of 3 days to 12 weeks for children and 2-12 weeks for adults. Tailored management based on patient age, tooth development stage, time elapsed, and resource availability is essential.

Keyword

Tooth injuries; Tooth avulsion; Tooth fractures; Tooth loss; Systematic review

Figure

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  Fig. 1 PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flow chart.

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  Fig. 2 A. Flowchart outlining the recommended actions to be undertaken in emergency settings for the strategic management of isolated dentoalveolar trauma-Part I. B. Flowchart outlining the recommended actions to be undertaken in emergency settings for the strategic management of isolated dentoalveolar trauma-Part II. (LA: local anesthesia, GA: general anesthesia, CaOH: calcium hydroxide, RCT: root canal treatment, RPD: removable partial denture, OPG: orthopantomogram, IOPA: intra oral periapical, CT: computed tomography)

Reference

References

1. Andersson L. 2013; Epidemiology of traumatic dental injuries. J Endod. 39(3 Suppl):S2–5. https://doi.org/10.1016/j.joen.2012.11.021. DOI: 10.1016/j.joen.2012.11.021. PMID: 23439040.

2. Motamedi MH. 2003; An assessment of maxillofacial fractures: a 5-year study of 237 patients. J Oral Maxillofac Surg. 61:61–4. https://doi.org/10.1053/joms.2003.50049. DOI: 10.1053/joms.2003.50049. PMID: 12524610.

3. Ravn JJ. 1974; Dental injuries in Copenhagen schoolchildren, school years 1967-1972. Community Dent Oral Epidemiol. 2:231–45. https://doi.org/10.1111/j.1600-0528.1974.tb01658.x. DOI: 10.1111/j.1600-0528.1974.tb01658.x. PMID: 4154162.

4. Iida S, Matsuya T. 2002; Paediatric maxillofacial fractures: their aetiological characters and fracture patterns. J Craniomaxillofac Surg. 30:237–41. https://doi.org/10.1054/jcms.2002.0295. DOI: 10.1054/jcms.2002.0295. PMID: 12231205.

5. Andreasen JO. 1970; Fractures of the alveolar process of the jaw. A clinical and radiographic follow-up study. Scand J Dent Res. 78:263–72. https://doi.org/10.1111/j.1600-0722.1970.tb02073.x. DOI: 10.1111/j.1600-0722.1970.tb02073.x. PMID: 5273694.

6. Glendor U. 2009; Aetiology and risk factors related to traumatic dental injuries--a review of the literature. Dent Traumatol. 25:19–31. https://doi.org/10.1111/j.1600-9657.2008.00694.x. DOI: 10.1111/j.1600-9657.2008.00694.x. PMID: 19208007.

7. Andreasen JO, Andreasen FM, Skeie A, Hjørting-Hansen E, Schwartz O. 2002; Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries -- a review article. Dent Traumatol. 18:116–28. https://doi.org/10.1034/j.1600-9657.2002.00079.x. DOI: 10.1034/j.1600-9657.2002.00079.x. PMID: 12110104.

8. Olynik CR, Gray A, Sinada GG. 2013; Dentoalveolar trauma. Otolaryngol Clin North Am. 46:807–23. https://doi.org/10.1016/j.otc.2013.06.009. DOI: 10.1016/j.otc.2013.06.009. PMID: 24138739.

9. Goswami M, Eranhikkal A. 2020; Management of traumatic dental injuries using different types of splints: a case series. Int J Clin Pediatr Dent. 13:199–202. https://doi.org/10.5005/jp-journals-10005-1746. DOI: 10.5005/jp-journals-10005-1746. PMID: 32742103. PMCID: PMC7366761.

10. Abu-Dawoud M, Al-Enezi B, Andersson L. 2007; Knowledge of emergency management of avulsed teeth among young physicians and dentists. Dent Traumatol. 23:348–55. https://doi.org/10.1111/j.1600-9657.2006.00477.x. DOI: 10.1111/j.1600-9657.2006.00477.x. PMID: 17991234.

11. Lieger O, Zix J, Kruse A, Iizuka T. 2009; Dental injuries in association with facial fractures. J Oral Maxillofac Surg. 67:1680–4. https://doi.org/10.1016/j.joms.2009.03.052. DOI: 10.1016/j.joms.2009.03.052. PMID: 19615582.

12. Batstone MD, Waters C, Porter SA, Monsour FN. 2004; Treatment delays in paediatric dento-alveolar trauma at a tertiary referral hospital. Aust Dent J. 49:28–32. https://doi.org/10.1111/j.1834-7819.2004.tb00046.x. DOI: 10.1111/j.1834-7819.2004.tb00046.x. PMID: 15104131.

13. Needleman HL, Stucenski K, Forbes PW, Chen Q, Stack AM. 2013; Massachusetts emergency departments' resources and physicians' knowledge of management of traumatic dental injuries. Dent Traumatol. 29:272–9. https://doi.org/10.1111/j.1600-9657.2012.01170.x. DOI: 10.1111/j.1600-9657.2012.01170.x. PMID: 22804874. PMCID: PMC3955057.

14. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. 2021; The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 372:n71. https://doi.org/10.1136/bmj.n71. DOI: 10.1136/bmj.n71. PMID: 33782057. PMCID: PMC8005924.

15. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Aromataris E, Munn Z, editors. 2020. Systematic reviews of etiology and risk. JBI reviewer's manual. JBI;p. 219–71. DOI: 10.46658/JBIRM-17-06. PMCID: PMC6429893.

16. Khan MH, Singh G, Charul K, Ezhilarasi S. 2020; Management of dentoalveolar fracture of anterior maxilla following traumatic intrusion of permanent maxillary anterior teeth: a review and case report. Traumaxilla. 2:28–31. https://doi.org/10.1177/26323273211072351. DOI: 10.1177/26323273211072351.

17. Quinto JHS, Bachesk AB, Nogueira LC, Filho LI. 2022; An alternative approach using circummandibular wiring for treatment of dentoalveolar fractures in children: a case report. Craniomaxillofac Trauma Reconstr. 15:169–74. https://doi.org/10.1177/1943387521990283. DOI: 10.1177/1943387521990283. PMID: 35633772. PMCID: PMC9133519.

18. Thakur A, Thakur S. 2021; Management of a complex dentoalveolar traumatic injury with multiple avulsions. Case Rep Dent. 2021:2373785. https://doi.org/10.1155/2021/2373785. DOI: 10.1155/2021/2373785. PMID: 34258075. PMCID: PMC8261170.

19. Nilesh K, Mahamuni A, Taur S, Vande AV. 2020; A simple novel technique for the management of a dentoalveolar fracture in a pediatric patient using a vacuum-formed splint. J Dent Res Dent Clin Dent Prospects. 14:68–72. https://doi.org/10.34172/joddd.2020.010. DOI: 10.34172/joddd.2020.010. PMID: 32454961. PMCID: PMC7235701.

20. Patel C, Bukhari T. 2020; Management of dentoalveolar traumatic injuries in primary dentition: a case report. J Dent Sci. 10:123–7.

21. Vidhya R, Madhu S, Vadakkepurayil K, Anupam KTV. 2017; Management of maxillary dento alveolar fracture with a modified splinting method: a case report. IOSR J Dent Med Sci. 16:51–4.

22. Sreejith VP, Das JR, Anooj PD, Sanal OV. 2015; Management of dentoalveolar fracture in a 2 year old child. Kerala Dent J. 38:27–9.

23. Sangeetha KM, Surendra P, Roshan NM, Subba Reddy VV, Chaur RG, Srinivasa SB. 2014; Management of dentoalveolar fracture with multiple avulsions: a case report with three years follow-up. Int J Case Rep Images. 5:835–8. https://doi.org/10.5348/ijcri-2014144-CR-10455. DOI: 10.5348/ijcri-2014144-CR-10455.

24. Yonezawa H, Yanamoto S, Hoshino T, Yamada S, Fujiwara T, Umeda M. 2013; Management of maxillary alveolar bone fracture and severely intruded maxillary central incisor: report of a case. Dent Traumatol. 29:416–9. https://doi.org/10.1111/j.1600-9657.2011.01111.x. DOI: 10.1111/j.1600-9657.2011.01111.x. PMID: 22233224.

25. De Rossi M, De Rossi A, Queiroz AM, Nelson Filho P. 2009; Management of a complex dentoalveolar trauma: a case report. Braz Dent J. 20:259–62. https://doi.org/10.1590/s0103-64402009000300016. DOI: 10.1590/S0103-64402009000300016. PMID: 19784475.

26. Saito C, Gulinelli J, Cardoso L, Garcia IR Jr, Panzarini S, Poi W, et al. 2009; Severe fracture of the maxillary alveolar process associated with extrusive luxation and tooth avulsion: a case report. J Contemp Dent Pract. 10:91–7. DOI: 10.5005/jcdp-10-1-91. PMID: 19142261.

27. Koyuturk AE, Kusgoz A. 2008; Multiple dentoalveolar traumatic injury: a case report (3 years follow up). Dent Traumatol. 24:e16–9. https://doi.org/10.1111/j.1600-9657.2008.00579.x. DOI: 10.1111/j.1600-9657.2008.00579.x. PMID: 18557754.

28. Sahin S, Saygun NI, Kaya Y, Ozdemir A. 2008; Treatment of complex dentoalveolar injury--avulsion and loss of periodontal tissue: a case report. Dent Traumatol. 24:581–4. https://doi.org/10.1111/j.1600-9657.2008.00607.x. DOI: 10.1111/j.1600-9657.2008.00607.x. PMID: 18821969.

29. Das UM, Viswanath D, Subramanian V, Agarwal M. 2007; Management of dentoalveolar injuries in children: a case report. J Indian Soc Pedod Prev Dent. 25:183–6. https://doi.org/10.4103/0970-4388.37015. DOI: 10.4103/0970-4388.37015. PMID: 18007105.

30. Prabhakar AR, Tauro DP, Shubha AB. 2006; Management of an unusual maxillary dentoalveolar fracture: a case report. J Dent Child (Chic). 73:112–5.

31. Martins WD, Fávaro DM. 2005; Fracture of the alveolar process in a 2-year-old child: a report of an unconventional immobilization. J Contemp Dent Pract. 6:134–8. DOI: 10.5005/jcdp-6-3-134. PMID: 16127482.

32. Martins WD, Westphalen FH, Westphalen VP, Souza PH. 2004; Multiple dentoalveolar traumatic lesions: report of a case and proposition of dental polytrauma as a new term. J Contemp Dent Pract. 5:139–47. DOI: 10.5005/jcdp-5-4-139. PMID: 15558099.

33. Sheroan MM, Roberts MW. 2004; Management of a complex dentoalveolar trauma with multiple avulsions: a case report. Dent Traumatol. 20:222–5. https://doi.org/10.1111/j.1600-9657.2004.00226.x. DOI: 10.1111/j.1600-9657.2004.00226.x. PMID: 15245521.

34. Dhusia AH, Sonawane H, Verma RS, Uchale P, Jagdale H. 2021; Emergency management of maxillary dentoalveolar fracture: a case report. J Dent Spec. 9:76–9. https://doi.org/10.18231/j.jds.2021.019. DOI: 10.18231/j.jds.2021.019.

35. Firstyananda W, Sjamsudin E. 2018; Management of dentoalveolar fracture by using rigid wire and composite splint: a case report. Intisari Sains Medis. 9:85–8. https://doi.org/10.15562/ism.v9i2.266. DOI: 10.15562/ism.v9i2.266.

36. Ali FM, Khan MMA, Faqihi AAMA, Mutawwam FA. 2017; Maxillary anterior region contact sport trauma in a patient having history of proclined maxillary anterior teeth. Saudi J Sports Med. 17:115–7. https://doi.org/10.4103/1319-6308.207571. DOI: 10.4103/1319-6308.207571.

37. Serra-Pastor B, Penarrocha-Diago M, Penarrocha-Diago M, Agustín-Panadero R. 2016; Treatment and restoration of adult dentoalveolar trauma: a clinical case report. J Clin Exp Dent. 8:e634–7. https://doi.org/10.4317/jced.52990. DOI: 10.4317/jced.52990. PMID: 27957283. PMCID: PMC5149104.

38. Faus-Matoses V, Martínez-Viñarta M, Alegre-Domingo T, Faus-Matoses I, Faus-Llácer VJ. 2014; Treatment of multiple traumatized anterior teeth associated with an alveolar bone fracture in a 20-year-old patient: a 3-year follow up. J Clin Exp Dent. 6:e425–9. https://doi.org/10.4317/jced.51374. DOI: 10.4317/jced.51374. PMID: 25593668. PMCID: PMC4282913.

39. Nyárády Z, Orsi E, Nagy K, Olasz L, Nyárády J. 2010; Transgingival lag-screw osteosynthesis of alveolar process fracture. Int J Oral Maxillofac Surg. 39:779–82. https://doi.org/10.1016/j.ijom.2010.01.022. DOI: 10.1016/j.ijom.2010.01.022. PMID: 20452745.

40. Al-Hadad I, Burke GA, Webster K. 2009; Dentoalveolar fracture of the posterior maxilla. Br J Oral Maxillofac Surg. 47:165. https://doi.org/10.1016/j.bjoms.2008.08.004. DOI: 10.1016/j.bjoms.2008.08.004. PMID: 18818006.

41. Finucane D, Fleming P, Smith O. 2004; Dentoalveolar trauma in a patient with chronic idiopathic thrombocytopenic purpura: a case report. Pediatr Dent. 26:352–4.

42. Dale RA. 2000; Dentoalveolar trauma. Emerg Med Clin North Am. 18:521–38. https://doi.org/10.1016/s0733-8627(05)70141-3. DOI: 10.1016/S0733-8627(05)70141-3. PMID: 10967737.

43. Tewari N, Mathur VP, Singh N, Singh S, Pandey RK. 2018; Long-term effects of traumatic dental injuries of primary dentition on permanent successors: a retrospective study of 596 teeth. Dent Traumatol. 34:129–34. https://doi.org/10.1111/edt.12391. DOI: 10.1111/edt.12391. PMID: 29495106.

44. Maeda Y, Kumamoto D, Yagi K, Ikebe K. 2009; Effectiveness and fabrication of mouthguards. Dent Traumatol. 25:556–64. https://doi.org/10.1111/j.1600-9657.2009.00822.x. DOI: 10.1111/j.1600-9657.2009.00822.x. PMID: 19788425.

45. Farrington T, Onambele-Pearson G, Taylor RL, Earl P, Winwood K. 2012; A review of facial protective equipment use in sport and the impact on injury incidence. Br J Oral Maxillofac Surg. 50:233–8. https://doi.org/10.1016/j.bjoms.2010.11.020. DOI: 10.1016/j.bjoms.2010.11.020. PMID: 21295384.

46. Turkistani J, Hanno A. 2011; Recent trends in the management of dentoalveolar traumatic injuries to primary and young permanent teeth. Dent Traumatol. 27:46–54. https://doi.org/10.1111/j.1600-9657.2010.00950.x. DOI: 10.1111/j.1600-9657.2010.00950.x. PMID: 21244628.

47. Muñante-Cárdenas JL, Olate S, Asprino L, de Albergaria Barbosa JR, de Moraes M, Moreira RW. 2011; Pattern and treatment of facial trauma in pediatric and adolescent patients. J Craniofac Surg. 22:1251–5. https://doi.org/10.1097/scs.0b013e31821c696c. DOI: 10.1097/SCS.0b013e31821c696c. PMID: 21772206.

48. Andrade NN, Choradia S, Sriram SG. 2015; An institutional experience in the management of pediatric mandibular fractures: a study of 74 cases. J Craniomaxillofac Surg. 43:995–9. https://doi.org/10.1016/j.jcms.2015.03.020. DOI: 10.1016/j.jcms.2015.03.020. PMID: 26027869.

49. Day PF, Flores MT, O'Connell AC, Abbott PV, Tsilingaridis G, Fouad AF, et al. 2020; International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent Traumatol. 36:343–59. https://doi.org/10.1111/edt.12576. DOI: 10.1111/edt.12576. PMID: 32458553.

50. Tewari N, Bansal K, Mathur VP. 2019; Dental trauma in children: a quick overview on management. Indian J Pediatr. 86:1043–7. https://doi.org/10.1007/s12098-019-02984-7. DOI: 10.1007/s12098-019-02984-7. PMID: 31197645.

51. Bourguignon C, Cohenca N, Lauridsen E, Flores MT, O'Connell AC, Day PF, et al. 2020; International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dent Traumatol. 36:314–30. https://doi.org/10.1111/edt.12578. DOI: 10.1111/edt.12578. PMID: 32475015.

52. Levin L, Day PF, Hicks L, O'Connell A, Fouad AF, Bourguignon C, et al. 2020; International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: general introduction. Dent Traumatol. 36:309–13. https://doi.org/10.1111/edt.12574. DOI: 10.1111/edt.12574. PMID: 32472740.

53. Diangelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, et al. 2012; ; International Association of Dental Traumatology. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol. 28:2–12. https://doi.org/10.1111/j.1600-9657.2011.01103.x. DOI: 10.1111/j.1600-9657.2011.01103.x.

54. Fouad AF, Abbott PV, Tsilingaridis G, Cohenca N, Lauridsen E, Bourguignon C, et al. 2020; International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol. 36:331–42. https://doi.org/10.1111/edt.12573. DOI: 10.1111/edt.12573. PMID: 32460393.

55. Saikia A, Patil SS, Ms M, Cv D, Sabarish R, Pandian S, et al. 2023; Systematic review of clinical practice guidelines for traumatic dental injuries. Dent Traumatol. 39:371–80. https://doi.org/10.1111/edt.12838. DOI: 10.1111/edt.12838. PMID: 36920339.

56. Zaror C, Seiffert A, Deana NF, Espinoza-Espinoza G, Atala-Acevedo C, Diaz R, et al. 2023; Emergency and sequalae management of traumatic dental injuries: a systematic survey of clinical practice guidelines. BMC Oral Health. 23:704. https://doi.org/10.1186/s12903-023-03409-w. DOI: 10.1186/s12903-023-03409-w. PMID: 37777731. PMCID: PMC10543333.

57. Moule A, Cohenca N. 2016; Emergency assessment and treatment planning for traumatic dental injuries. Aust Dent J. 61 Suppl 1:21–38. https://doi.org/10.1111/adj.12396. DOI: 10.1111/adj.12396. PMID: 26923446.

58. Kahler B, Heithersay GS. 2008; An evidence-based appraisal of splinting luxated, avulsed and root-fractured teeth. Dent Traumatol. 24:2–10. https://doi.org/10.1111/j.1600-9657.2006.00480.x. DOI: 10.1111/j.1600-9657.2006.00480.x. PMID: 18173657.

59. Theologie-Lygidakis N, Schoinohoriti OK, Leventis M, Iatrou I. 2017; Evaluation of dentoalveolar trauma in children and adolescents: a modified classification system and surgical treatment strategies for its management. J Craniofac Surg. 28:e383–7. https://doi.org/10.1097/scs.0000000000003720. DOI: 10.1097/SCS.0000000000003720. PMID: 28328609.

60. Garcia-Godoy F, Murray PE. 2012; Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth. Dent Traumatol. 28:33–41. https://doi.org/10.1111/j.1600-9657.2011.01044.x. DOI: 10.1111/j.1600-9657.2011.01044.x. PMID: 21794081.

61. Law CS. 2013; Management of premature primary tooth loss in the child patient. J Calif Dent Assoc. 41:612–8. https://doi.org/10.1080/19424396.2013.12222343. DOI: 10.1080/19424396.2013.12222343. PMID: 24073500.