TRAUMATIC INJURIES OF THE TEETH Fracture

a.Crown
b.Crown-Root
c.Root

Crown Fracture- involves enamel and dentin

a. Complicated-with pulp exposure

I. Concussion
II. Luxation
III. Fracture

“When treating dental trauma, TIMELINESS OF CARE is key

b.Uncomplicated-without pulp exposure
to saving the tooth. It is, therefore,important for all dentists to
(+) sensitivity and vitality tests, (-) percussion, normal
have an understanding of how to diagnose and treat the most
mobility
common dental injuries.”
Crown/Root Fracture- involves enamel, dentin and
Ref: Treatment for Traumatic Dental Injuries,American Association of
Endodontists cementum; w/ loss of tooth structure
(+) sensitivity and vitality tests, (+) percussion, coronal
Information regarding the patient and the injury should include: fragment mobile
1. Patient's name, age, sex, address and contact Root Fracture-involves root structure
numbers (include weight foryoung patients) (+ )percussion,transient (-) sensitivity tests,coronal
2. Central nervous system symptoms exhibited after the fragment mobile/displaced
injury
3. Patient's general health
4. When, where and how the injury occurred
5. Treatment the patient received elsewhere
6. History of previous dental injuries
7. Disturbances in the bite
8. Tooth reactions to thermal changes or sensitivity to
sweet/sour
9. If the teeth are sore to touch or during eating
10. If the patient is experiencing spontaneous pain in the
teeth

AAE recommends:
One (1) occlusal and two (2) periapical radiographs with
TREATMENT:
different lateral angulations for all dental injuries.
Crown and Crown/Root Fracture
-If CBCT is available, it should be considered
a. No pulp exposure:Restoration
Sensibility/Vitality tests: Cold test and Electric Pulp Test**
b. With Pulp exposure:
**Cold Test>Pulp Test for young individuals
Immature roots:Pulp Capping/
Partial Pulpotomy(Cvek Pulpotomy*)+Restoration
“The aim to treating dental trauma should be to either maintain
Mature roots:RCT+Restoration
or regain pulpal vitality in traumatized teeth.”
● using CaOH or MTA
WHY?
Dental trauma frequently occurs in pre-teens in whom teeth
Objective of Treatment:
have not yet fully developed and root development will cease
Remaining pulp should continue to be vital,
without a vital pulp.
(-) sensitivity, pain or swelling
Rx: (-) internal/external resorption
(-) abnormal canal calcification
(-)periapical radiolucency
 Root Fracture (+) percussion, initially (-) sensitivity tests, (+) vitality tests
Displaced coronal segment: Reposition with splint ASAP (-) radiographic abnormalities
-for 4 Weeks, longer if fracture is near the cervical area Treatment: If needed, stabilize tooth using flexible splint for
-Monitor for at least 1 year, if pulp necrosis develops > RCT two weeks,
‘ Monitor for pulpal changes

EXTRUSIVE LUXATION
Tooth appears elongated and excessively mobile
(+) percussion, (-) sensitivity and vitality tests
CONCUSSION Rx: widened pdl space
Injury to the tooth supporting structures without displacement
or abnormal mobility Treatment and Pulpal Consideration
(+) percussion, (+) sensitivity and vitality test Tx:
(-) radiographic abnormalities Rinse area with saline solution -> Reposition tooth by
Treatment: No immediate treatment needed; gentle re-insertion into the socket -> Suture gingival
Constant monitoring laceration > Stabilize tooth using splint
~Monitor for pulp vitality

Incomplete root formation:

-If pulp becomes necrotic:
apexification/pulp revascularization

Complete root formation: - Pulp necrosis is a common

complication,
If diagnosed: Root Canal Treatment

LUXATION
● SUBLUXATION: injury to tooth-supporting structure
with abnormal mobility, but without displacement

● EXTRUSIVE LUXATION: displacement of the tooth

outward or incisally

● LATERAL LUXATION: displacement of the tooth in

any lateral direction except axially; usually
associated with fracture of facial or cortical bone

● INTRUSIVE LUXATION: displacement of the tooth

inward or into the alveolar bone

SUBLUXATION
 Rx: (-) PDL space in all or part of the root, CEJ more apical
than adjacent, non-injured tooth

Treatment
Tooth with incomplete root formation:
Up to 7mm intrusion: allow for spontaneous eruption, if (-),
initiate orthodontic repositioning within 3 weeks
>7mm: reposition surgically or orthodontically within 3 weeks

Tooth with complete root formation:

Up to 3mm, <17y/o: re-eruption without intervention, if (-) after
2- 3 weeks, reposition before ankylosis develops,
3-7 mm: reposition surgically or orthodontically within 3 weeks
>7mm: reposition surgically -> splint for 2 weeks

Treatment: Pulpal Consideration

LATERAL LUXATION Incomplete root formation:
Tooth appears immobile or locked, ~If pulp becomes necrotic: apexification/pulp revascularization
fracture of alveolar bone may be palpable Complete root formation:
(+) percussion, (-) Sensitivity and Vitality -Pulp necrosis expected, initiate RCT within two weeks after
Tests the injury
Rx: PDL space appear enlarged
Note: after cleaning and disinfection, temporary dressing of
Tx: Calcium Hydroxide recommended up to 4 wecks
-Rinse with saline - Reposition tooth
(either digitally or with forceps) - suture
gingival laceration -> Stabilize using tooth
using splint
~Monitor for pulp vitality
Treatment: Pulpal Consideration
Incomplete root formation:
-If pulp becomes necrotic:
apexification/pulp revascularization

Complete root formation:

~Pulp necrosis is a common complication, if diagnosed:
RCT

AVULSION
*In the case of avulsion and the tooth being out of its socket,
one should immediately place the tooth in a physiological
solution of specialized media (such as Hank’s Balanced Salt
Solution™) or milk, or saline if
those are not available.

INTRUSIVE LUXATION
Tooth appears partilly or totally Infra-occluded, immobile and
locked
~Fracture of AB may be palpable
(+) Percussion, (-) Sensitivity and Vitality Tests
* References:
1) Recommended Guidelines of the AAE for the Treatment of
Traumatic
Dental Injury, 2013
2) Treatment for Traumatic Dental Injuries, American
Association of
Endodontists, 2014
3) http/wwwdentaltraumaguide.org/Defaultaspx

"We should take comfort that while we may have

more still to endure, better days will return. We will be with our
friends again; we will be with our families again; we will meet
again”- Queen Elizabeth