Received: 15 December 2018 | Revised: 25 April 2019 | Accepted: 25 April 2019

DOI: 10.1111/edt.12476

ORIGINAL ARTICLE

Orthodontic management of traumatized teeth: A national

survey of UK orthodontists

Cara Sandler1 | Siobhan Barry2 | Simon Littlewood3 | Tumadher Al‐Musfir4 |

Hani Nazzal3,4

1
Brighton & Sussex University Hospital,
Brighton, UK Abstract
2
Manchester Dental Hospital, Manchester, Background/Aim: There is a lack of research into orthodontic movement and man‐
UK
agement strategies of traumatized teeth. The aim of this survey was to assess the
3
Leeds Dental Institute, Leeds, UK
4
knowledge of UK‐based orthodontists in the orthodontic management of trauma‐
Hamad Medical Corporation, Doha, Qatar
tized teeth.
Correspondence Materials/Methods: A 24‐item questionnaire survey was electronically distributed to
Cara Sandler, Maxillofacial Office, BSUH
Outpatients Department, Eastern Road, all members of the British Orthodontic Society.
Brighton BN2 5BE, UK. Results: A total of 213 respondents completed the survey with the majority of these
Email: sandler.cara@gmail.com
being UK registered specialists in orthodontics. Three responses were excluded as
one was not based within the UK and two were orthodontic trainees with <1 year
of experience, leaving a total of 210 respondents. The majority had orthodonti‐
cally treated up to three patients with a history of dental trauma in the preceding
3 months. Obtaining a trauma history was done by the majority of respondents. A
wide variation in times waited by respondents before orthodontically treating teeth
with different types of traumatic injuries was observed. Similarly, the preferred or‐
thodontic management strategies of traumatized teeth differed substantially among
respondents. Almost all respondents were interested in further training in the man‐
agement of dental trauma.
Conclusions: The study showed a wide variation in the orthodontic management
of traumatized teeth among UK‐based orthodontists. Further training and national
guideline establishment are indicated for orthodontic management of traumatized
teeth in the UK.

KEYWORDS
dental trauma, orthodontic management, survey

1 | I NTRO D U C TI O N
In the United Kingdom (UK), approximately 12% of 12‐year‐olds and
10% of 15‐year‐olds have evidence of traumatic dental injuries (TDIs)
to their incisors.1 It has been shown that certain malocclusions are
predisposed to dental trauma. A clear link between the risk of dental
trauma and increased overjet has been demonstrated, 2 in which an
overjet of >3 mm doubles the risk of dental trauma. Early orthodontic
treatment for such a large overjet has been shown to be more ef‐
fective at reducing the risk of incisal trauma than later treatment in
adolescence.3 Furthermore, over 10% of orthodontic patients have
sustained dental injuries before starting their orthodontic treatment.4
Orthodontists regularly treat patients who have suffered all
forms of dental trauma. Such dental injuries could complicate and/or

Dental Traumatology. 2019;00:1–10. wileyonlinelibrary.com/journal/edt © 2019 John Wiley & Sons A/S. | 1
Published by John Wiley & Sons Ltd
2 |
delay orthodontic management of malocclusions. Traumatized teeth
have been shown to be associated with a higher risk of root resorp‐
tion in response to orthodontic forces.5 Although the evidence is
currently inconclusive as to whether orthodontic tooth movement
of traumatized teeth increases the risk of pulp necrosis, cautious
management of these teeth is recommended.6,7 Consequently, de‐
tailed clinical and radiographic assessment as well as a full trauma
history is paramount prior to orthodontic treatment in order to guar‐
antee the best outcome.
Although advice regarding the time required before orthodon‐
tic movement of teeth that have suffered dental trauma has been
previously published,6 there are currently no national guidelines or
published advice regarding different orthodontic management strat‐
egies/techniques for management of traumatized teeth.
As dental trauma is common in the United Kingdom, with more
than one in ten children being affected,1 and with some reports of
more than one in ten patients experiencing dental trauma before or‐
thodontic treatment, it is appropriate that information about ortho‐
dontists’ experiences and opinions on management of traumatized
teeth be obtained. Therefore, the aim of this study was to assess
the knowledge and experience of UK orthodontists, trainee ortho‐
dontists and dentists who practise orthodontics on the orthodontic
management of traumatized teeth.
2 | M ATE R I A L S A N D M E TH O DS
This was a cross‐sectional survey, with a 24‐item online question‐
naire used to evaluate UK orthodontists’ and orthodontic trainees’
experience in the orthodontic management of patients with a his‐
tory of dental trauma. Institutional ethical approval was obtained
from the University of Leeds Research Ethics Committee before
commencement of the study (070318/HN/243). The question‐
naire was developed using the online survey tool (previously Bristol
Online Survey) and piloted on a small group of orthodontists and
orthodontic trainees at the University of Manchester, for ease of
understanding and reduction of ambiguity of questions, before
administration.
An invitation email explaining the survey and the questionnaire
was circulated electronically to members of the British Orthodontic
Society between 30 April and 20 July 2018 with a reminder email
sent on 11 June 2018. Individual follow up with non‐respondents
was not carried out due to the anonymity of the survey.
Information collected in the questionnaire included the following:
• Demographics: Data on positions held, duration of work in this
field, orthodontists’ type of practice (practice, hospital service
etc) and region of work,
• Exposure: The number dental trauma cases seen in the previous
3 months,
• Clinical practice:
o Whether respondents routinely asked about a history of den‐
tal trauma when initially examining patients.
SANDLER et al.
o In patients with evidence/history of dental trauma, the most
appropriate time, if any, respondents would wait before start‐
ing orthodontic movement for a range of different traumatic
injuries.
o Management techniques used in moving traumatized teeth
during orthodontic movement.
• Participants’ interest in further training/information on the or‐
thodontic management of traumatized teeth.
Data were coded and analysed using the online survey tool. Descriptive
statistics analysing participants’ responses were computed. Simple de‐
scriptive statistics only were used for baseline demographic and clin‐
ical data.
3 | R E S U LT S
A total of 213 participants completed the survey, of which three
responses were excluded as one was not based within the UK and
two were orthodontic trainees with <1 year of experience, and it
was considered that they had not obtained enough knowledge/
experience to take part in this survey. Therefore, a total of 210
responses were included in the final analysis. The largest group
of respondents (n = 92, 43.8%) were UK registered specialists in‐
cluding Post‐Certificate for Completion of Specialist Training in
orthodontics (specialists in consultant training), and around one‐
third were consultant orthodontists (n = 68, 32.4%). The remaining
respondents (n = 50, 24%) were specialist registrar level or gen‐
eral dental practitioners (GDPs) with interest or further training in
orthodontics (MClinDent/MDentSci) but not on the specialist list
(Figure 1A). The number of years’ clinical experience ranged from
1 to 40 years.
The majority of respondents worked in NHS primary care (N = 89,
42%) followed by NHS hospital setting (N = 76, 36%) (Figure 1B).
Nearly all respondents were based in England (N = 180, 86%) and
the rest were evenly split between Scotland, Wales and Northern
Ireland (Figure 1C).
Nearly all respondents (n = 195, 92.9%) reported seeing patients
with some form of dental trauma within the preceding 3 months,
and nearly 40% of respondents (n = 81, 38.6%) reported treating
between one to three patients with a history of dental trauma in the
preceding 3 months. Only a small number of respondents (n = 15,
7.1%) reported not seeing any patients with dental trauma in the pre‐
ceding 3 months (Figure 2).
Most respondents (n = 128, 61%) reported routinely asking about
a history of dental trauma during initial orthodontic assessment. The
remaining respondents enquired about a history of trauma in pa‐
tients showing signs of trauma (n = 43, 20.5%), signs of trauma or
an increased overjet (n = 37, 17.7%) or only if there was an increased
overjet (n = 2, 1%).
Inconsistencies in the reported appropriate times to wait before
starting orthodontic movement on a tooth which had suffered dif‐
ferent types of dental trauma were observed (Figure 3).
SANDLER et al.
F I G U R E 1 Demographics of respondents A, bar chart showing number (percentage) of respondents’ job roles, B, bar chart showing
numbers (percentages) of respondents’ place of work, C, pie chart showing distribution of respondents’ area of work in the UK
F I G U R E 2 Bar chart showing respondents’ exposure to dental
trauma patients in the past 3 mo of completing the survey
When questioned on the most appropriate time to wait before
starting orthodontic movement on a tooth which had suffered a
crown or crown/root fracture, the majority of respondents were rel‐
atively evenly divided between 12 months (n = 51, 24.3%), 6 months
(n = 51, 24.3%) and 3 months (n = 48, 22.9%) (Figure 3A).
Eighty‐five respondents (40.5%) said that they would wait
12 months before moving a tooth that had a root fracture.
Interestingly, over one‐fifth (n = 45, 21.4%) said that they would refer
a root‐fractured tooth to another orthodontic colleague (Figure 3B).
For teeth with minor damage to the periodontium, such as con‐
cussion, the majority of respondents (62.9%, n = 132) said that they
would wait 3 months prior to orthodontic movement (Figure 3C).
In managing teeth with severe periodontal injury, respondents were
split between waiting 6 months (n = 61, 29%) and 12 months (n = 58,
27.6%) prior to orthodontic movement (Figure 3D).
One‐third of respondents (n = 69, 32.9%) reported waiting
3 months before moving a tooth that had been root canal treated
| 3
(obturated with gutta percha) (Figure 3E), while one‐quarter of
respondents (n = 53, 25.2%) said that they would wait 12 months
before moving a tooth that had been treated with regenerative end‐
odontic techniques (Figure 3F).
Respondents unsure of the answer or those referring patients
to other orthodontic colleagues reported different reasons for such
choices including the need for interdisciplinary care (n = 56, 26.7%),
lack of knowledge of guidelines (n = 24, 11.4%) and lack of experi‐
ence (n = 23, 11%) (Figure 4).
To manage teeth that had suffered crown and crown/root frac‐
tures, even numbers of respondents said that they would modify the
archwire sequence to reduce orthodontic forces (n = 121, 57.6%),
carry out regular pulp sensibility testing (n = 119, 56.7%) or carry out
regular radiographic examination (n = 112, 53.3%) (Figure 5A).
To manage teeth which had suffered a root fracture, around half
of the respondents said that they would carry out regular radio‐
graphic review (n = 113, 53.8%) in addition to modifying the archwire
sequence to reduce orthodontic forces (n = 104, 49.5%) (Figure 5B).
To manage traumatized teeth that have suffered minor damage
to the periodontium such as concussion, over half reported modi‐
fying the archwire sequence to reduce orthodontic forces (n = 117,
55.7%), two‐fifths would carry out regular pulp sensibility testing
(n = 86, 41%) and one‐third treated traumatized teeth, in the same
manner as non‐traumatized teeth (n = 68, 32.4%) (Figure 5C).
To manage traumatized teeth that have suffered moderate‐to‐se‐
vere damage to the periodontium such as intrusion, nearly three‐quar‐
ters of the respondents reported modifying the archwire sequence
to reduce orthodontic forces (n = 152, 72.4%). Other respondents
reported carrying out regular radiographic review (121, 57.6%) and
carrying out regular pulp sensibility testing (117, 55.7%) (Figure 5D).
4 | SANDLER et al.

F I G U R E 3 Time waited by the respondents before orthodontic movement of teeth with different types of TDIs (recommended waiting
times according to Kindelan et al6 are highlighted in red), A, time waited before moving crown and crown/root‐fractured teeth, B, time
waited before moving root‐fractured teeth, C, time waited before moving teeth with minor damage to the periodontium, D, time waited
before moving teeth with severe damage to the periodontium, E, time waited before moving root canal–treated teeth (due to trauma)
obturated with gutta percha, F, time waited before moving traumatized teeth treated with RET

F I G U R E 4 Bar chart showing reasons

given by the respondents (numbers
[percentages]) for being unsure or for
referring patients with a history of dental
trauma to orthodontic colleagues
SANDLER et al. | 5

F I G U R E 5 Bar charts showing respondents’ orthodontic management strategies in moving teeth with different traumatic dental injuries
such as A, crown and crown/root fractures, B, root fractures, C, minor damage to periodontium, D, severe damage to periodontium, E, root‐
filled teeth, due to trauma, obturated with gutta percha, F, traumatized teeth treated with RET, G, ankylosed teeth
6 | SANDLER et al.

F I G U R E 6 Bar charts showing a comparison of results between specialists and trainees: A, comparison of answers from specialists and
trainees when answering questions on time waited before moving root‐fractured teeth and B, comparison of answers from specialists and
trainees when answering questions on management strategies for root canal–treated teeth due to trauma

For management of teeth that have been root canal treated due
to trauma and obturated with gutta percha, just under half reported
treating these teeth in the same manner as non‐traumatized teeth
(n = 99, 47.1%). Two‐fifths of the respondents reported either carrying
out regular radiographic examination (n = 85, 40.5%) or would modify
the archwire sequence to reduce orthodontic forces (n = 84, 40%).
Surprisingly, 18 respondents (8.6%) reported carrying out regular pulp
sensibility testing on root canal–treated teeth (Figure 5E).
For management of traumatized teeth treated with regenerative
endodontic technique, no single strategy was the management of
choice for more than half of respondents (Figure 5F).
To manage ankylosed teeth, over three‐quarters of the respon‐
dents said that they would leave the tooth off the archwire (n = 165,
78.6%) (Figure 5g). Eight respondents (3.8%) listed using an anky‐
losed tooth for anchorage during treatment. Six respondents (2.8%)
said that they take a multidisciplinary approach to management
of traumatized teeth. Other management strategies suggested in‐
cluded extraction of an ankylosed tooth, decoronation of an anky‐
losed tooth, referring to the trauma guidelines or transplant.
Respondents who chose to refer cases to an orthodontic col‐
league reported different reasons such as the need for interdisci‐
plinary care (N = 51, 21%), lack of experience (n = 23, 9.6%), lack of
knowledge of guidelines (n = 16, 6.7%) and lack of training (n = 10,
4.2%). Interestingly, nearly all respondents said that they would like
further information or training on the orthodontic management of
traumatized teeth (N = 192, 91%).
Overall, there were similar patterns in the responses of trainees
and specialists in terms of time waited before moving traumatized
teeth (Figure 6A) and management strategies (Figure 6B). In all ques‐
tions regarding management strategies, trainees said they would refer
to orthodontic colleagues more frequently than specialists answered
that they would refer to orthodontic colleagues. On average, 37.5%
of specialists and 35.6% of trainees answered questions correctly on
time waited before moving traumatized teeth.
4 | D I S CU S S I O N
The distribution of the questionnaire survey was through the
British Orthodontic Society mailing list, which includes most UK
registered orthodontists, dentists with interests in orthodontics,
orthodontic specialists and speciality trainees. The authors
acknowledge that it is possible that some UK‐based orthodontists
are not members of the British Orthodontic Society. In addition, the
mailing list also includes non–UK‐based members, which resulted in
the need to discard one data set. Nevertheless, the results included
SANDLER et al.
participation of a large number of UK‐based orthodontists, dentists
with interests in orthodontics, orthodontic specialists and speciality
trainees with an acceptable representation of orthodontists across
the country.
The questionnaire invitation was emailed to a total of 1570
British Orthodontic Society members showing an overall re‐
sponse rate of 14%. Unfortunately, it was not possible to identify
with certainty the number of UK‐based orthodontists within the
total number of invitees as some of these members were interna‐
tional, general practitioners and students. Although the study was
limited by a relatively low response rate, the response rate was
comparable to other published surveys. A recent published BOS
survey generated a response rate of 16% using a similar online sur‐
8
vey tool. Although online surveys generate lower response rates
than paper‐based questionnaires,9 they allow distribution without
the need to obtain participants contact details which are usually
subject to data protection. Despite such a low response rate, the
results highlight inconsistencies in the time and techniques such
patients are treated with, in addition to a high interest in more
training in the management of such cases. The respondents had a
wide range of levels of clinical experience, from across the United
Kingdom and working in many different settings. The majority of
respondents (85%) were from England meaning that the survey
mostly represents those working and training in England rather
than the UK. However, when practitioners based in England were
excluded, compared to the data as a whole, the results were similar
in all areas.
It is essential for orthodontists to carry out a thorough exam‐
ination of new patients, including routinely asking about historic
episodes of dental trauma. Despite the obvious reasons why it is
important for orthodontists to fully assess a traumatized tooth,
only 61% of respondents reported routinely asking about a his‐
tory of dental trauma. Orthodontic movement of previously trau‐
matized teeth is linked to an increased rate of root resorption,
where root resorption was already occurring due to trauma. 5
Despite the inconclusive evidence about the development of pulp
necrosis following orthodontic movement of previously trauma‐
tized teeth, careful monitoring and treatment of such cases are
recommended. 6,7
The remaining respondents reported asking about dental trauma
only with evidence of increased overjet or clinical evidence of previ‐
ous dental trauma. Although an increased overjet of 3 mm or more
has been shown to be associated with a twofold increase in the risk
of dental trauma, 2 such an approach carries the risk of overlooking
patients with history of dental trauma.
Relying only on signs of dental trauma, although useful, also
carries the risk of overlooking some injuries. Bony healing of teeth
with mid‐root fractures, for instance, might not be evident clinically.
These teeth should be treated with caution as the coronal fragment
usually has a compromised crown:root ratio which could worsen by
orthodontic surface resorption. Identifying such cases prior to or‐
thodontic movement allows the clinician to obtain appropriate in‐
formed consent highlighting the risks of orthodontic treatment. A
| 7
full assessment of traumatized teeth including crown colour, pres‐
ence of draining sinuses or swellings, mobility, tenderness, percus‐
sion tests (to diagnose ankylosis), radiographs and pulp sensibility
tests is needed.
Comparing the recommended observation periods prior to or‐
thodontic movement of traumatized teeth published by Kindelan6
(Table 1) to those reported by the respondents, major inconsisten‐
cies were noted. Of the different traumatic injuries, most respon‐
dents were able to identify the correct recommendation with minor
damage to the periodontium (63%) while the least number of re‐
spondents able to identify the correct recommendation was evident
for crown/crown root fractures (23%).
Despite the weak evidence supporting the recommendations of
appropriate lengths of time following traumatic dental injuries be‐
fore orthodontic tooth movement,10,11 such recommendations are
based on the best available evidence. In severe periodontal injuries,
orthodontic tooth movement is not recommended before complete
periodontal healing has occurred which occurs around 6 months
after injury. Orthodontic movement prior to such healing might
compromise periodontal and pulp healing leading to unnecessary
complications.
There is a lack of high‐quality evidence to advise orthodontists in
relation to when is the best time to move previously traumatized and
subsequently root‐filled teeth.12 It is advised that as long as the peri‐
odontal ligament is healthy, normal orthodontic forces may be used
on root‐filled teeth.11 Although based only on expert opinion, nearly
half of the respondents agreed with the recommendation from
Drysdale and Gibbs that a tooth with good quality root filling should
be managed in the same way as a normal tooth.11 Management
of a root‐filled tooth includes taking regular radiographs, one be‐
fore starting orthodontic treatment and one 6 months to 1 year
later13,14—which 40% of the respondents said they would do.
Surprisingly, 8.6% of respondents said that they would carry
out regular pulp sensibility tests on root‐filled teeth—a figure which
could be put down to a lapse in concentration while filling out the
questionnaire.
Regenerative endodontic technique (RET) is a form of tissue en‐
gineering used to restore the tooth to a healthy state. It can be used
on immature permanent teeth with infected root canal systems
where the aim is to allow continued root development, increase
thickness in the dentinal walls and apical closure. There is minimal
evidence on the effect of orthodontics on RET‐treated teeth.15
Currently, only two case studies reporting orthodontic movement
of RET‐treated teeth exist; therefore, it was not surprising that the
majority of the respondents did not know how to manage a RET‐
treated tooth.7,16
A number of respondents required further information before
answering the questions. This could be attributed to the fact that the
majority of clinical decisions require a thorough history and treat‐
ment decisions in the area of dental trauma require multidisciplinary
care.
Unfortunately, there are no published specific orthodontic man‐
agement guidelines in managing traumatized teeth. Therefore, the
8 | SANDLER et al.

TA B L E 1 Observation periods and orthodontic management strategies for different types of traumatic dental injuries

Type of dental
injury Observation period Orthodontic management recommended techniques

Crown and Three months—as long as there are
crown/root radiographic signs of establish‐
fractures ment of a hard tissue barrier and
a coronal pulpotomoy has been
carried out if there was pulpal
involvement13
Root fractures One to two years, or shorter if
asymptomatic
The coronal fragment must be
treated as a tooth with a short
root if healing by connective
tissue
Teeth should not be moved until
successful endodontic treatment
and connective tissue healing
of the coronal fragment has
occurred
Minor dam‐ Three months
age to the
periodontium
Moderate/severe One year if no ankylosis can be
damage to the detected. Orthodontic movement
periodontium is not recommended before com‐
plete periodontal healing has oc‐
curred, around 6 mo. If teeth are
orthodontically moved between
6 and 12 mo, and the tooth does
not move as expected, ankylosis
should be considered
Root canal– The observation period depends
treated teeth, on the nature of the original trau‐
due to trauma, matic injury in a mature closed
obturated with apex tooth, following an initial
gutta percha dressing of calcium hydroxide and
obturation with Gutta Percha
Traumatized
teeth treated
with regenera‐
tive endodontic
technique
• Informed consent must be gained with the patient/person with parental responsibil‐
ity warned that root resorption and/or pulp necrosis and infection may occur during
the active orthodontic phasea
• Baseline pulp and root health records must be obtained for comparisons during
orthodontic treatment a
• Regular radiographic review
• Regular pulp sensibility testing
• Modify the archwire sequence to reduce orthodontic forces
• Informed consent must be gained with the patient/person with parental responsibil‐
ity warned that root resorption and/or pulp necrosis and infection may occur during
the active orthodontic phasea
• Specific warning with regard to the compromised crown root ratio and future tooth
mobility/loss is requireda
• Baseline pulp and root health records must be obtained for comparisons during
orthodontic treatment a
• Regular radiographic review
• Regular pulp sensibility testinga
• Modify the archwire sequence to reduce the orthodontic forces
• Informed consent must be gained with the patient/person with parental responsibil‐
ity warned that root resorption and/or pulp necrosis and infection may occur during
the active orthodontic phasea
• Baseline pulp and root health records must be obtained for comparisons during
orthodontic treatment a
• Regular radiographic reviewa
• Regular pulp sensibility testinga
• Modify the archwire sequence to reduce the orthodontic forces
• Informed consent must be gained with the patient/person with parental responsibil‐
ity warned that root resorption and/or pulp necrosis and infection may occur during
the active orthodontic phasea
• Baseline pulp and root health records must be obtained for comparisons during
orthodontic treatment a
• Regular radiographic review
• Regular pulp sensibility testing
• Modify the archwire sequence to reduce orthodontic forces
• Informed consent must be gained with the patient/person with parental responsibil‐
ity warned that root resorption may occur during
the active orthodontic phasea
• Baseline pulp and root health records must be obtained for comparisons during
orthodontic treatment a
• Regular radiographic reviewa
• Informed consent must be gained with the patient/person with parental responsibil‐
ity warned that root resorption and/or infection of the root canal system may occur
during the active orthodontic phasea
• Treatment objectives may be limited or modified at
the start of orthodontic treatment a
• Baseline pulp and root health records must be obtained for comparisons during
orthodontic treatment a
• Regular close monitoring of the RET‐treated teeth throughout the course of ortho‐
dontic treatment is necessarya
• Where possible, partial or complete exclusion of RET‐treated teeth from orthodon‐
tic forces is beneficial
• Light, short‐acting forces (<70 g) should be used in orthodontic movement of RET‐
treated teetha

(Continues)
SANDLER et al. | 9

TA B L E 1 (Continued)

Type of dental
injury Observation period Orthodontic management recommended techniques

Ankylosed teeth • Management by interdisciplinary team is recommended as such cases require long‐
term planning that might include advanced techniques such as decoronation and
tooth autotransplantationa
• Treatment objectives may be limited or modified at
the start of orthodontic treatment with clear view of long‐term plans (a plan for loss
of the tooth)a
• Baseline pulp and root health records must be obtained for comparisons during
orthodontic treatment a
• Leave off the archwire or utilize the tooth for anchorage

Note: Orthodontic periods are based on the recommendation published by Kindelan et al.6
a
Recommendations based on the literature and best practice advice.

management strategies reported by most respondents are collated
and represented in Table 1. In addition, other recommendations are
added to the Table based on the literature and best practice. Such
management strategies should in general include:
• Informed consent from the patient/person with parental respon‐
sibility with specific warning of root resorption and/or pulp necro‐
sis and infection during the orthodontic treatment.
• Treatment objectives may be limited or modified at
the start of orthodontic treatment with a clear view of long‐term
plans.
• Baseline pulp and root health records should be obtained for com‐
parison during orthodontic treatment.
• Regular radiographic review, in line with the International
Association of Dental Traumatology guidelines,17,18 with a
minimum of pre‐, middle and post‐orthodontic radiographic
assessment.
• Regular pulp sensibility testing, in line with the International
Association of Dental Traumatology guidelines,17,18 with a mini‐
mum of pre‐, middle and post‐orthodontic pulp testing. Pulp sen‐
sibility testing is considered useful in assessing the pulp status of
traumatized teeth. However, such data should be used in conjunc‐
tion with other clinical signs and symptoms.
• Where needed, consultation with a paediatric dentist/endodon‐
tist/restorative dentist is recommended.
• Modification of the archwire sequence in order to reduce ortho‐
dontic forces where possible and consider adjusting treatment
aims to minimize time in appliances.
• In severe trauma cases resulting in replacement resorption and/or
ankylosis, a plan for loss of the tooth should be placed including
the need for advanced techniques such as decoronation, tooth
autotransplantation, extraction of affected teeth with space
closure/tooth camouflage or tooth replacement using dentures/
fixed prosthetics.
of this survey. This is in no small part due to the lack of quality ev‐
idence on which to base current practice. As a direct consequence
of this, there are no published specific orthodontic management
guidelines for managing traumatized teeth. The results of this sur‐
vey suggest increasing awareness of the importance of conducting
research and the need to establish best practice/evidence‐based
guidelines on the appropriate orthodontic management of trauma‐
tized teeth.
It is essential for orthodontists to fully assess the long‐term
prognosis for any teeth which have sustained dental trauma.
They must also consider the implications of tooth movement on
previously traumatized teeth. There are excellent resources from
the International Association of Dental Traumatology which sum‐
marize the general dental management of traumatic dental inju‐
ries.17,18 Furthermore, the literature reviews, by Kindelan et al 6
and Duggal et al,7 discuss the evidence with regard to the timing
and general implications of dental trauma on orthodontic man‐
agement of traumatized teeth. However, there are currently no
guidelines for orthodontists for the management of traumatized
teeth.
5 | CO N C LU S I O N
Management of traumatized teeth remains a challenge in all aspects
of dentistry, including orthodontics. This is the first survey of UK‐
based orthodontists evaluating their knowledge of dental trauma.
This survey highlighted different techniques used by orthodontists
and dentists in managing and moving different types of traumatized
teeth. This questionnaire, also, highlighted the need for further in‐
formation or training on orthodontic management of traumatized
teeth.
AC K N OW L E D G E M E N T S

Currently, orthodontists, in relationship to the management of trau‐ The authors would like to thank the orthodontic department at the
matized teeth, are somewhat confused, as evidenced by the results University of Manchester for piloting the questionnaire survey and
10 | SANDLER et al.
the British Orthodontic Society for distributing the final question‐
naire to all its members.
C O N FL I C T O F I N T E R E S T
The authors confirm that they have no conflict of interest.
ORCID
Cara Sandler https://orcid.org/0000-0003-3318-6035
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How to cite this article: Sandler C, Barry S, Littlewood S,
Al‐Musfir T, Nazzal H. Orthodontic management of
traumatized teeth: A national survey of UK orthodontists.
Dent Traumatol. 2019;00:1–10. https​://doi.org/10.1111/
edt.12476​