Dental implants to replace teeth lost due to trauma

The recent successes of Team Singapore in the Rio Olympics and Paralympics will no doubt spur both the able-bodied and the disabled to adopt a more sporting lifestyle. While physical fitness helps reduce the risks of diseases such as hypertension, stroke, heart attack, etc, the process of attaining fitness poses a risk to health as well. Many people fall and sustain fractures and sprains. The face and teeth are particularly vulnerable. Besides sports, motor vehicles accidents is a also a contributor to traumatic injuries to teeth. Fortunately, teeth that are loss due to trauma can be replaced with dental implants.

Sports

Sports-related injuries are a common cause of tooth loss. Falls from cycling, rollerblading, skateboarding, or any form of accelerated commuting is one of the most common causes of traumatic tooth loss. In fact, a former colleague once remarked that rollerblades were invented to generate more work for dentists. In the past, sports injuries were mainly sustained by younger patients. These are kids playing different kinds of sports in school. There are many ways of breaking or knocking out teeth during sports; getting hit by a squash racket, getting elbowed in a basketball match, being knocked in the mouth by a soccer ball, plunging into a swimming pool that was too shallow, being in the line of trajectory of a baseball, etc. However, increasingly, more adults are sustaining injuries through sports. This is due to the increase awareness of health and the adoption of a sporting lifestyle.

The management of fractured and avulsed teeth in an adult is different from that of a growing child. In pre-pubescent children, the fractured teeth are preserved with root canal treatment as far as possible. This is to keep the root within the jaw bone to maintain the space and development of the jaws. Children also do not tolerate removable prosthesis well and they are not ready for fixed prostheses such as implants and bridges which can affect the normal development of the bone.

In teenagers, much depends on the state of growth. Girls tend to mature earlier than boys. It is estimated that more than 95% of skeletal growth would have been completed one year after the first menstrual cycle. Boys, on the other hand, can continue to grow right up to their early twenties. Dental implants can be done for girls as early as 15 or 16 but for boys, it is best to delay implant placement till about 20. The main problem with placing an implant into the jaw bone of a growing patient is that the position of the implant, once placed, remains static. As the jaw bone grows, the size increases and the shape changes, bringing the natural teeth along but any implant that has been placed previously will not move along with these changes. As such, dental implants should not be placed in growing patients. Reversible treatment modalities such as removable dentures and adhesive bridges should be done while waiting for growth completion.  

For adults and teenagers who are deemed to have completed growth, implants can be done to replace the lost teeth. In some cases, the immediate implants can be placed while in others, it is best to defer placement till the traumatized tissues have healed. The decision depends largely on whether the supporting bone has been fractured and whether the gum around the socket has been torn. In the absence of such collateral damage, the replacement of an avulsed or fractured tooth can be done immediately. Early placement of an implant helps in maintaining the bone mass. However, if there is a concurrent fracture of the supporting bone, it is best to wait a couple of months for the fractured bone to heal before placing the implant. This will minimize the variables at play and ensure a less complicated recovery. Similarly, injuries to the gum should also be given some time to heal before placing an implant. While the gum is not involve in supporting the implant, it is important in terms of the final aesthetic outcome as teeth lost due to trauma usually involve the front teeth.

Road traffic accidents

Teeth that were lost due to road traffic accidents are usually accompanied by more collateral damage. In such cases, teeth replacement is of a much lower priority compared with treatment of the other injuries that threaten life, limbs and vision. By the time the patient is ready for assessment for teeth replacement, the oral wounds would have healed considerably. There is usually a lot of bone loss as the impact of such accidents is far greater. Assessment for implant replacement will have to take into consideration the wider implication of facial aesthetics. To achieve a good functional and aesthetic outcome, significant bone grafting is usually needed to rebuild the broken bones. The shape and proportion of the jaws should be rebuilt to provide not just sufficient bone mass to house the implants, but to hold the implant prosthesis in a facially aesthetic position. Such reconstructive jaw surgeries requires combines techniques in bone grafting and orthognathic surgery to re-create the ideal shape of each jaw and their relative proportion and relation to each other.

Slip-and-falls

This is another category of traumatic tooth loss. People can slip and fall at home, at work, or out in the street walking. This may be caused by extrinsic factors such as a wet floor, uneven tiles on the pavement, etc, or intrinsic factors such as fainting, stroke, heart attack, epilepsy, etc. The extrinsic factors are a stroke of bad luck or simply carelessness. Intrinsic factors, however, need to be investigated to rule out occult diseases. These injuries are similar in severity to the sports injuries and can be treated as such.

Accidents are never uniform and the injuries that they cause are spread across a spectrum. Some sports related injuries can result in severe damage to the supporting bone while some road traffic accidents can have minimal injury. The overall management of the patient should take precedence and upon successful treatment of life and limb threatening condition or ruling out of occult systemic causes of accidents, replacement of teeth lost can commence based on the degree of trauma to the supporting bone and gum.