International Association Of Dental Traumatology Guidelines Research Articles

Management of luxation injuries in line with International Association of Dental Traumatology guidelines – Two case reports

Luxation injuries represent significant traumatic events for permanent teeth. This article presents the management of intrusive and extrusive luxation injuries, following the International Association of Dental Traumatology (IADT) guidelines, through two case reports. The first case involves a 30-year-old female with an intruded maxillary left central incisor, managed through surgical extrusion, stabilization, and endodontic treatment. The second case features a 15-year-old female with an extruded maxillary left central incisor, repositioned and splinted. Follow-up examinations revealed the resolution of symptoms in both cases. These cases highlight the efficacy of IADT guidelines in diagnosing and treating luxation injuries, resulting in favorable outcomes.

Knowledge, Attitude and Practice Towards Emergency Management of Avulsed Tooth among Dental Practionator in Pakistan: A Questionnaire-Based Survey

Background: The management of dental traumatic injuries, particularly avulsed permanent teeth, necessitates a comprehensive understanding and proficient clinical skills among dental practitioners. With the increasing prevalence of dental injuries due to various factors, the knowledge and practices of dentists in emergency and clinical management are pivotal for successful outcomes. This study aims to evaluate the current state of knowledge, attitudes, and practices among Pakistani dentists regarding the management of avulsed teeth, highlighting areas for improvement and adherence to international guidelines. Objective: To assess the knowledge, attitudes, and practices of dental practitioners in Pakistan concerning the emergency management of avulsed permanent teeth and to identify gaps in knowledge and practice compared to the International Association of Dental Traumatology (IADT) guidelines. Methods: A cross-sectional survey was conducted among 120 dental professionals in Pakistan, using an online questionnaire from August to September 2022. The survey comprised three sections: demographic information, knowledge and attitudes towards dental trauma education, and practices in the emergency management of avulsed teeth. Descriptive statistics were employed to analyze the data, utilizing SPSS version 25.0 for statistical analysis. Results: The survey revealed that 47.5% of respondents felt they received enough information during their undergraduate education, yet a significant proportion reported forgetting much of this knowledge over time. Regarding post-graduation knowledge sources, conferences and medical journals were the most cited (26.7% and 24.2%, respectively). In terms of practice, 79.2% correctly identified HBSS as the optimal storage medium for avulsed teeth, and 60% adhered to rinsing the tooth with saline before replantation. Awareness of the critical extra-oral dry time being under 60 minutes was noted in 59.2% of participants, and a majority were in favor of initiating root canal treatment 7 to 10 days post-replantation for teeth with a closed apex, aligning with IADT recommendations. However, a preference for rigid splints over flexible ones was observed in 54.2% of respondents, indicating a deviation from best practices. Conclusion: The study identified a satisfactory level of knowledge among Pakistani dentists regarding some aspects of avulsed tooth management but also highlighted significant gaps, particularly in the use of flexible splints and recollection of undergraduate training. Continuous education and adherence to IADT guidelines are essential for improving the management of dental traumatic injuries.

Critical appraisal of the 2020 IADT Guidelines: A personal commentary.

The 2020 International Association of Dental Traumatology (IADT) Guidelines feature several important changes in the treatment recommendations for traumatic dental injuries (TDIs) from the previous 2012 iteration of these Guidelines. This evidence-based narrative review aims to provide a detailed appraisal of five specific changes incorporated in the 2020 IADT Guidelines, based on the available literature evidence that may have prompted these changes. The paper discusses three excellent additions/changes to the new Guidelines: (i) inclusion of a core outcome set for reporting TDIs; (ii) more conservative management of primary dentition TDIs including the changed recommendations for radiation exposure and managing primary dentition luxation injuries; and (iii) the changes in the treatment recommendations for permanent dentition avulsion injuries. The paper further debates whether two other changes made in the current IADT Guidelines for-(i) intrusion injuries in immature teeth; and (ii) complicated crown-root fractures in mature teeth-have sufficient evidence to support the changed recommendations.

Retrospective analysis of survival of avulsed and replanted permanent teeth according to 2012 or 2020 IADT Guidelines.

This study aimed to compare the survival of replanted teeth that followed the 2012 or the 2020 International Association of Dental Traumatology (IADT) guidelines. Sixty-two permanent replanted teeth were retrospectively assessed (IADT 2012, n = 45; IADT 2020, n = 17). Five years after replantation (from January 2017 to December 2021), clinical and radiographic examinations were performed. A significance level of 95% was considered to evaluate the outcomes. Thirty-one teeth (50.0%) remained in their sockets and 31 (50.0%) were lost due to external root resorption. Of the 25 (40.3%) teeth replanted within one hour, 16 (64.0%) remained in their sockets, and 9 (36.0%) were lost. Twenty-two (71.0%) of all 31 lost teeth had an extra-alveolar time of more than one hour. Twelve teeth remained in their sockets without resorption: 8 (66.7%) were replanted within one hour, 2 (16.7%) followed the 2012 IADT, and 2 (16.7%) the 2020 IADT guidelines for late replantation. There was a significant difference (p <0.05) in the extra-alveolar time (< one hour), but without difference between the guidelines in late replantation (p > 0.05). Replanted teeth following both, 2012 or 2020 IADT guidelines, have similar clinical outcomes. The extra-alveolar time of less than one hour was demonstrated to be important to keep the permanent tooth in its socket.

Dentists' knowledge of dental trauma based on the International Association of Dental Traumatology guidelines: An Australian survey.

Background/AimTraumatic dental injuries are the result of impact injuries to the teeth and/or soft and hard tissues within and around the vicinity of the oral cavity and pose a very serious public health dilemma. The aim of this study was to appraise the level of knowledge of dentists in Australia regarding the management of traumatic dental injuries based on the International Association of Dental Traumatology (IADT) guidelines.MethodologyA link to an electronic questionnaire investigating personal and professional information and twelve questions about dental trauma was distributed by email using the Qualtrics Survey Software to ensure anonymity of the respondents, to members of the Australian Dental Association. The respondents were grouped according to demographic characteristics and practice profiles. Data were evaluated by the Student’s T test or one‐way ANOVA with post hoc testing using Fisher's least significant difference, with the α level set at 5%.ResultsA total of 180 complete responses were obtained. The overall mean number of correct answers was 7.55 ± 1.91 from a maximum possible score of twelve. Gender, year of primary dental qualification, dentist identity (general dentist or specialist), area of main practice or region worked by the practitioner did not significantly affect the mean scores. However, increased knowledge of the IADT guidelines was significantly associated with the number of trauma cases treated and the dentists' self‐reported knowledge.ConclusionsThe overall knowledge of Australian dentists regarding the management of traumatic dental injuries based on the IADT guidelines was generally good but it was also deficient in some areas.

Influence of clinical factors, IL4 and IL6 genes polymorphisms in functional healing in late replantation.

To investigate the genetic association in a sample of replanted teeth, it is necessary to observe the extreme phenotypes, such as, teeth that underwent functional healing and those extracted due to severe external root resorption. Thus, this study aimed to investigate the association of age of the patients, root development, storage media, and polymorphisms in the interleukin 4 (IL4) and interleukin 6 (IL6) genes with teeth that presented extreme outcomes, as functional healing or extraction, in a group whose replantation techniques did not follow the International Association of Dental Traumatology (IADT) 2012 guidelines. Forty-three avulsed and replanted teeth that did not follow IADT 2012 guidelines and underwent functional healing or were extracted were included. Periapical radiographs employed for this study were taken soon after tooth replantation and after 1 year. For genotypic IL4 and IL6 genes analysis, DNA of oral mucosa cells was extracted. Real-time- PCR performed for genotyping polymorphisms in IL4 and IL6 genes. Clinical and genetic variables were analyzed by the Chi-square test and the "Z" test. P values < .05 were considered significant. The results showed that functional healing and extraction were associated with storage media and with the rs2243268 of IL- 4 gene polymorphisms. As conclusion, the C rs2243268 allele of IL4 gene may have a positive relationship with functional healing teeth that were replanted not following the 2012 IADT guidelines. Keeping the tooth dry is associated to a fast loss of avulsed and replanted teeth after 1-year follow-up.

Assessment of Awareness Among Dental Practitioners Regarding The Management of Dental Traumatic Injuries, Based On The International Association of Dental Traumatology (IADT) Guidelines 2020: A Cross-Sectional Questionnaire Survey

Aim: The aim of this study was to assess the knowledge of dental practitioners in Central Indian region, regarding the treatment and management of dental traumatic injuries, using the International Association of Dental Traumatology (IADT) Guidelines 2020 as a reference. Materials and Methods: A total of 514 dental practitioners across Central India participated in a cross-sectional study by means of virtual survey. A two part electronic questionnaire was created using google forms, investigating 7 profession based questions and 16 trauma based questions and were sent to all the dentists registered with Dental Council of India in Central India.The responses were analysed to evaluate the awareness among dental practitioners regarding the management of dental traumatic injuries. Statistical Analysis: Descriptive statistics was performed by using the proportional or frequency distribution of the parameters. The respondents were then grouped according to the branch of speciality if any and the data was evaluated by the one-way ANOVA with post-hoc, with p value &lt;0.005. Results: In the present study, out of a total score of 20,the mean knowledge score for dental practitioners was 8.20 (only 54.86% of the 20 questions were answered correctly) and 282 participants out of 514 had an average level of knowledge, Conclusion: The overall level of knowledge of dentists from Central India region of the revised IADT guidelines is average.

What is new in the 2020 International Association of Dental Traumatology emergency treatment guidelines?

Over the past eight years, there have been marked changes in the recommendations for the management of traumatic dental injuries (TDIs). The recently published International Association of Dental Traumatology (IADT) guidelines for the emergency management of TDIs provide a comprehensive manual for clinicians to refer when assessing and managing patients presenting with these types of injuries. Clinicians should be prepared to utilize these new guidelines which were released in 2020. The aim of this short communication is to support those with previous knowledge regarding the IADT guidelines, to identify the changes in treatment modality, and to provide backing for those exposed to trauma guidelines for the first time. In the present communication, the areas of TDIs have been separated into primary and permanent teeth plus avulsions, with a tabular format highlighting the main changes in the emergency management from the previous version in 2012. This format has been devised to aid the clinicians' understanding of the variations over time and facilitate recall of the new guidelines. For the first time, the 2020 IADT Guidelines present a Core Outcomes Set (COS) that includes outcomes that were relevant to all TDIs and outcomes related to only one or several TDIs. However, the COS is not the object of the present publication.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations of these teeth are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning, and follow up are important for achieving a favorable outcome. Guidelines should assist dentists and patients in decision making and in providing the best care possible, both effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. These Guidelines represent the best current evidence based on literature search and expert opinion. The primary goal of these Guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines cover the management of fractures and luxations of permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.

YouTube™ as a source for patient education about the management of dental avulsion injuries.

Traumatic dental injuries, including avulsion, are relatively common, with a reported prevalence of up to 4.5%. The Internet and video-sharing websites are frequently used as a resource for patient accessible health information. YouTube™ , the online video leader, is a popular choice with patients, who decide to seek advice when managing an avulsed tooth. The aim of this study was to examine the quality of information offered by videos on YouTube™ for those individuals seeking information regarding the emergency management of an avulsed tooth. The quality of information was compared to the guidelines of the International Association of Dental Traumatology (IADT). YouTube™ was searched systematically for videos on avulsion using the terms 'knocked tooth out' and 'dental avulsion'. Strict inclusion and exclusion criteria were adhered to, and videos were assessed on several variables. The usefulness of the selected videos in providing adequate information about avulsed teeth was then evaluated using a 9-point score based on the IADT guidelines. Descriptive statistics were consequently generated. A total of 120 videos were analysed, 13% (n=16) of which met the inclusion-exclusion criteria. Most had been uploaded by healthcare professionals (81%, n=13) in the United States (63%, n=10). Videos had generally low completeness scores (mean: 4.375±1.9; range: 2-7). Completeness was not affected significantly, either by viewers' interactions or by the date of upload. YouTube™ generally hosts videos with low usefulness with regard to the management of avulsed teeth. Therefore, dentists should be aware of this resource and warn parents/carers regarding the reliability of information and the misleading content which is available on YouTube™ videos.

Dentists' knowledge of dental trauma based on the International Association of Dental Traumatology guidelines: A survey in South Brazil.

Dental trauma is a public health issue with a high prevalence in children. The aim of this study was to evaluate the level of knowledge of dentists in Rio Grande do Sul, Brazil, of the management of traumatic dental injuries, using the International Association of Dental Traumatology (IADT) Guidelines as a reference. An electronic questionnaire investigating personal and professional characteristics and 12 questions about dento-alveolar trauma, was sent to all registered dentists of the Regional Council of Dentistry of Rio Grande do Sul (n=14753). The respondents were grouped according to the sociodemographic and professional profiles and the data were evaluated by the Student-T test or one-way ANOVA, with Tukey's post-hoc, with α=5%. A total of 1414 dentists responded to the survey (9.59% response rate). The overall mean self-reported knowledge of dental trauma was 5.87±1.57, of a maximum possible score of 12. Some factors associated with a higher knowledge of the IADT guidelines were: female gender, previous clinical experience, years from qualification, self-reported knowledge, and academic postgraduate degree. Dentists who are specialized in endodontics (6.58±1.63) and pediatric dentistry (6.05±1.44) achieved higher levels of knowledge on dental trauma. Analysis of the characteristics (gender, location, and proportion of specialists) of the respondents confirmed that they were representative of the target population. The overall level of knowledge of dentists from Rio Grande do Sul of the IADT guidelines is moderate. These results highlight the need for continuing education on dento-alveolar trauma in this population.

Complications and survival rates of teeth after dental trauma over a 5-year period

The purpose of this study was to evaluate whether the current guidelines of the International Association of Dental Traumatology (IADT) for emergency care of traumatised teeth result in lower complication rates. Therapeutic strategies of 361 dental injuries in 291 patients treated at a university dental hospital over a 5-year period were investigated by evaluating the patients' records. Adherence to the guidelines of the IADT (Flores et al. Dent Traumatol 17:1-4, 2001; 49-52, 2001; 97-102, 2001; 145-148, 2001; and 193-196, 2001; Flores et al. Dent Traumatol 23:66-71, 2007; 130-136, 2007; and 196-202, 2007) was evaluated. Complications were also recorded according to the patients' records and analysed relative to the treatment and injury pattern. During follow-up visits, the teeth were inspected regarding pulp vitality and overall function of the injured tooth. The Kaplan-Meier survival analysis of pulps and teeth was performed for different injury categories. The majority of injuries (322/361; 89.2%) were treated according to the guidelines. When IADT guidelines were followed, complication rates were significantly lower than for cases treated without adherence to the guidelines. The most frequent complication was the loss of restoration, followed by pulp necrosis, abnormal mobility, and tooth loss. The overall survival analysis showed that in the permanent dentition, the loss of pulp vitality and tooth occurs within the first 6months but may also occur later. The results of this study indicate that traumatised teeth that were treated according to the recommendations had a lower complication rate. In addition, the majority of pulp necrosis and tooth losses in the permanent dentition occurred within the first 6months after trauma. These results indicate that early follow-up visits are essential to promptly treat complications. Adherence to the IADT guidelines for treatment of dental trauma may lead to more favourable outcomes when compared to cases treated without compliance to the guidelines.

IADT guidelines for treatment of traumatic dental injuries

In the emergency situation, immediate decisions have to be taken. The prognosis for many trauma injuries is depending on a prompt and correct decision. For the clinician, it is not easy to gather all information and draw conclusions from scientific literature when facing a trauma patient. There is a need for guidelines for the clinician in such situations. The International Association of Dental Traumatology (IADT) has developed guidelines for the emergency situation. This is the third time IADT is publishing guidelines for management of traumatic dental injuries. The first set of guidelines was published in 2001 and was followed by a new set of guidelines in 2007. It is now time to release a third set of guidelines. As pointed out before, we are today far from evidence-based traumatology (1). This is because of the fact that traumatology is a field where it is not possible or ethical in the acute phase of the injury to ask for consent from patient and parents to participate in a randomized controlled study. Instead, we must still rely on results from clinical studies on later treatment, often retrospective, studies and experimental in vivo studies (2, 3). When writing guidelines, IADT has formed core groups of experts of different specialties with experience in research and clinic who have searched the literature, discussed, shared experience, and presented guideline documents based on evidence and best practice for further discussion and final approval of the IADT board of directors. In this issue, the first series of guideline documents: Fractures and Luxation of Permanent Teeth is presented. In following issues, guidelines for Avulsed permanent teeth and guidelines for traumatic dental injuries in the Primary dentition will be presented. The documents will be found on IADTs web site http://www.iadt-dentaltrauma.org, and the articles can also be accessed and downloaded via the same web page. Clinicians and trauma patients worldwide will really benefit from this.

Guidelines for the Management of Traumatic Dental Injuries: 1. Fractures and Luxations of Permanent Teeth.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

The Positive Influence of Atopy on the Prognosis of Avulsed and Replanted Teeth Despite Differences in Post-trauma Management

Introduction The aim of this study was to evaluate any potential influence of a patient’s Th2 immunologic profile on the occurrence of root resorption in avulsed and replanted teeth; tooth replantation cases in which different post-trauma management protocols were examined. Materials and Methods In this study, the presence or absence of root resorption was evaluated in 88 avulsed and replanted teeth. In the International Association of Dental Traumatology (IADT) group, the replantation technique and endodontic treatments were performed in accordance with the IADT guidelines. In the non-IADT group, the teeth were replanted using techniques and protocols that deviated from the IADT guidelines in some way. Follow-up of the replanted teeth included monthly clinical and radiographic examinations over the course of 1 year. Evaluation of patients’ atopy was based on a medical examination, personal and family allergic history, and a skin prick test. Results Of 47 teeth of atopic patients, 39 (82.98%) did not exhibit root resorption, whereas 8 (17.02%) did. Of the 41 teeth of nonatopic patients, 24 (58.54%) did not exhibit resorption, whereas 17 (41.46%) did. Conclusions These results show the importance of a predominantly Th2 immunological profile, which was represented by atopic patients, in replantation after dental avulsion despite differences in post-trauma management.

Guidelines for the management of traumatic dental injuries. III. Primary teeth

Trauma to the primary dentition present special problems and the management is often different as compared with permanent teeth. An appropriate emergency treatment plan is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases in which the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence based on literature research and professional opinion. In this third article out of three, the IADT Guidelines for the management of traumatic injuries in the primary dentition, are presented.

Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth

Avulsion of permanent teeth is the most serious of all dental injuries. The prognosis depends on the measures taken at the place of accident or the time immediately after the avulsion. Replantation is the treatment of choice, but cannot always be carried out immediately. An appropriate emergency management and treatment plan is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases in which the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence based on literature research and professional opinion. In this second article of three, the IADT Guidelines for management of avulsed permanent teeth are presented.

Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth

Crown fractures and luxations occur most frequently of all dental injuries. An appropriate treatment plan after an injury is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence, based on literature research and professional opinion. In this first article of three, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth

Crown fractures and luxations occur most frequently of all dental injuries. An appropriate treatment plan after an injury is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence, based on literature research and professional opinion. In this first article of three, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth

Avulsion of permanent teeth is the most serious of all dental injuries. The prognosis depends on the measures taken at the place of accident or the time immediately after the avulsion. Replantation is the treatment of choice, but cannot always be carried out immediately. An appropriate emergency management and treatment plan is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases in which the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence based on literature research and professional opinion. In this second article of three, the IADT Guidelines for management of avulsed permanent teeth are presented.