A reflection on current protocols in management of Dental Trauma in a growing child patient.

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Professor Monty Duggal

A reflection on current protocols in management of Dental Trauma in a growing child patient. Tradition versus a bright new future

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In this course the speaker will outline his treatment philosophy for the management of young permanent teeth which have suffered trauma resulting in injury to the pulp and to the periodontal ligament.  The emphasis of this course is the lasting effect that trauma can have on the oral health of a growing child, and the use of the period of growth and development to ensure that the child has a good long term outcome.  An update on the current approaches for the management of the pulp and PDL that should be based on knowledge of cellular biology will be presented.  Any attempt to provide treatments without an understanding of the tissue responses to injury or treatment are doomed to failure.    Traditional approached have involved Apexification with the use of calcium hydroxide.  Calcium hydroxide has many advantages but also there is a growing body of evidence on its detrimental effects on the integrity of dentine and dentinal proteins.  Mineral Tri-oxide Aggregate has also been recently used, its main advantage being that it allows a barrier to be formed immediately, so that root canal obturation can be achieved.  The speaker will discuss some disadvantages associated with MTA owing to its alkalinity, which is similar to that of calcium hydroxide.  Recently a lot has been written about the use of stem cells for regeneration of the pulp for non vital immature teeth.  This approach which is termed as Regenerative Endodontics seems to offer a new biological approach, which would allow root development, but is largely untested and lacking evidence from clinical studies.  The speaker will share his experience with the use of this technique and also share the protocol followed at the Leeds Dental Institute and some of the clinical cases that have been managed with this approach.  Histological evidence will also be presented to see what type of tissue grows into the root canal when this technique is used.  Limitations of this technique will be presented.

Many practitioners will be called upon to manage acute dento-alveolar trauma that has resulted in injures to the PDL.  The management of injuries such as luxation, root fractures and avulsions are challenging especially in children where the anxiety and a traumatic episode are superimposed on the surgical problem.  In this lecture the latest recommendations for the management of such injuries will be explored and the new data on the outcomes will be presented.  The speaker will also use Video clips to familiarize the participants with the Trauma guide, which is a wonderful tool for all practitioners to use in their day to day practice. The speaker is one of the Board members that manage the Trauma guide.

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