MANAGEMENT

OF
TRAUMATIC INJURIES

Prof. MAGED NEGM

 Traumatic injuries are common at the age of 2 –
12 years

Type and extent of injury vary according to:

•Type of accident.
•Force impact.
•Resiliency of the hitting object.
•Shape and size of the hitting object.
•Direction of the force.
 Classification:

Several classifications are available, however the

following classifications are recommended:

•Ellis and Davey’s classification :

1. Class I: Simple fracture of the crown
involving enamel only.
2. Class II: Extensive crown fracture
involving enamel and dentine with no
pulp exposure.
3. Class III: Extensive crown fracture
involving enamel and dentine with pulp
exposure.
4. Class IV: Traumatized tooth becomes non
vital (with or without loss of crown
structure).
5. Class V: Tooth lost due to trauma.
6. Class VI: Root fracture with or without crown
structure.
7. Class VII: Tooth displacement without crown
or root fracture.
8. Class VIII: Crown fracture en masse.
9. Class IX: Fracture of deciduous teeth.
•WHO classification :

The WHO gave the following classification

with code no. corresponding to the
International Classification of Diseases.
 873.60 Enamel fracture :
Includes both enamel chipping and incomplete fracture
(cracks) which is called “crown infractions”.

873.61 Crown fracture without pulp involvement :

involving enamel and dentine with no pulp exposure
(uncomplicated).

873.62 Crown fracture with pulp involvement :

A complicated fracture involving enamel, dentine, with
pulp exposure,
 873.63 Root fracture:
limited to fractures of roots only. Involving
cementum, dentin and pulp.

873.64 Crown-root fracture :

Includes both uncomplicated (no exposure),
and complicated (pulp exposure) types.
Enamel, dentin and cementum are involved.
873.66 Tooth luxation (dislocation):
Comprises concusion, subluxation, and luxation.
In case of concussion tooth is sensitive to
percussion without loosening or displacement.
Subluxation refers to loosening without
displacement.
Luxation includes both loosening and displacement .
Luxation is usually accompanied by comminution
(fragmentation) of alveolar bone.
 873.67 Intrusion or extrusion:
Intrusion is a displacement of the tooth into the socket and
accompanied by fracture of alveolar socket. Extrusion is a partial
displacement of the tooth out of its socket.

873.68 Avulsion:
Complete displacement of the tooth out of its socket.

873.69 Other injuries:

such as laceration of soft tissues or oral cavity.

802.20 ; 802.40 Fracture or comminution of the alveolar process.

802.21 ; 802.41 Fracture of the body of the mandible or maxilla

and may include the alveolar process.
 WHO classification includes both primary and
permanent teeth.

WHO includes all the teeth and is not limited

to the anterior teeth like ELLIS classification.
 Examination of traumatic injuries :

•Chief complaint:
Pain and other symptoms should be listed in order
of importance to the patient.

•History of present illness :

When, where and how trauma happened.
A trauma to lips and anterior area crowns, roots or
bone fractures of anteriors are expected.

Any previous treatment has been given an

important question to ask.
•Medical history :

Patient should be asked for :

1. Allergy.
2. Medical disorders such as; bleeding tendency,
diabetes, epilepsy etc.
3. Current medications taken by the patient.
4. Immunity to tetanus : If 5 years or more elapsed
since the last dose of vaccine was taken, a booster
dose should be given immediately.
 Clinical examination :

1. Extra oral examination facial bone

fracture.

2. Soft tissue examination such as lips,

tongue, cheeks and floor of the mouth.

3. Examination of lacerated tissues for hard

objects, tooth fragments and foreign
bodies.
4. Occlusion and TMJ abnormalities indicate fracture of
jaws or alveolar bone.
5. Teeth cracks, fractures, pulp involvement or change in
color.
Root fracture is felt placing finger on mucosa over the
tooth and moving the crown.
6. Supporting structures periodontal structures and
alveolar bone.
Percussion condition of the periodontal ligament.
7. Mobility: if adjacent teeth move alveolar fracture.
Crown fracture crown is mobile but tooth remains
in position.
8. Radiographic examination fractures,
displacement, foreign objects, internal anatomy , apical
development and relation of fracture to the pulp and
alveolar crest.
9. Pulp condition may give a positive response and
changes to negative after sometime and vice versa.
 Pulp may take 9 months for normal blood
flow to return after trauma.

Vitality tests should be done immediately

post traumatic and repeated subsequently,
ice sticks are preferred penetrate
deep well in the teeth.
 Management of Traumatic Injuries

(I) Soft TissueInjuries:

Description: Injuries to oral soft tissues can be Lacerations,
Contusions or Abrasions of the Epithelial layer or Combinations.
Treatment: Controlling bleeding, Repositioning displaced tissue &
Suturing.
Prognosis: Oral soft tissues heal rather quickly.

(II) Teeth Fractures:

Description: Injuries includes all fractures from Enamel infraction
to Complicated Crown-Root fractures.
Enamel Fracture:
(WHO # 873.60) = Crown Infraction

I.e. Chips & cracks of Enamel not crossing DEJ but

terminating at the border or an incomplete fracture
of enamel without loss of tooth structure.
Biologic Consequences:
Theoretically, these fractures are “Weak points”
through which bacteria & their by-products can travel
to challenge the pulp. However, in the majority of cases,
the pulp if vital after the initial injury, will overcome the
challenge.
Diagnosis:
* Transillumination or indirect light or Dyes.
e.g. a fiber-optic or resin curing light.
* Pulp sensitivity ; varied +ve or -ve??
Treatment:
* Vital Pulp: Conservative treatment e.g. smoothening of rough
edges or application of composite resin.
* Non-vital pulp: Postpone 6-8 Weeks, if remain non-vital ; --}
require RCT.
Significance:
* Even in minor traumatic injuries or Enamel fracture, may
cause---}
damage to apical neuro-vascular bundle ---} Pulp necrosis.
However, in shock condition re-response occurs later.
Follow-up: 3, 6, & 12 months & every year.
Prognosis: Very Good; pulpal complications are extremely
rare (0.1%)
Crown Fracture without Pulp Involvement
(WHO # 873.61) ; Uncomplicated Crown Fracture
or Ellis Class II
I.e. Crown fracture involving Enamel or Enamel
& Dentin without pulp exposure.
Incidence: 30 %
Biological Consequences:
* If the fracture involves the enamel only, ---}
the effects are minimal & complications may
be due to a concomitant injury to the
attachment apparatus.
* If the dentin is exposed ---} a direct pathway
exists for noxious stimulant to pass through
D.Ts. To the pulp. However, the pulp has the
potential to successfully defend itself with partial
closure of the DTs & reparative dentin
* Chronic pulpal inflammation or even necrosis may occur.
Diagnosis:
* Clinical, Pulp Vitality & Radiographic.
* Commonly a lip bruise or laceration is present because brusing
of the lip is expected when injury occurs.
Effect:
* Crown fractures that expose DTs may potentially
---} contamination & inflammation of the pulp.
* The outcome is either formation of irritational
dentin or pulp necrosis which depend on:
1- The proximity of the fracture to the pulp;
the distance of the fracture from the pulp.
2- The surface area of dentin exposed.
3- Size of the DTs
4- Concomitant injury to the pulp’s blood supply.
5- Length of time between trauma & treatment.
6- Possibly the type of initial treatment performed.
7- Age of the patient.
Treatment:
* Early treatment similar to crown infraction.
* Enamel fracture only ---} Just smoothen the sharp edges.
* E.&D. fracture ---} Treatment should take place as soon as possible
- Sealing of dentinal tubules with Ca(OH)2.
; this will disinfect the fractured dentinal surface & stimulate
closure of DTs ---} less permeable to noxious stimulant
- Sealing of DTs with dentin bonding agents, ---}create a tight
seal to protect the pulp.
* Fracture covering e.g. Bonded Restoration or Temporary Crown.
* If the fracture crown fragment is available ---} use it to restore
the tooth with Re-attachment technique.
* Non-vital tooth ---} RCT.

Follow-up: 3 ,6 & 12 months & every year.

Prognosis: Extremely Good.

Crown Fracture with Pulp Involvement
(WHO # 873.62) ; Complicated Crown Fracture
or Ellis Class III
I.e. Crown fracture involving Enamel, Dentin
& Pulp.
Incidence: 2 - 13 % of all dental injuries.
Biologic consequences:
* The degree of pulp involvement varies from
a pinpoint exposure to a total deroofing of
the coronal pulp.
* Bacterial contamination of the pulp prevent healing &
repair unless the exposure can be covered to prevent
further contamination.
Pulp reaction:
The initial reaction is hemorrhage at the site of the pulp
wound. Next, a superficial inflammatory response occurs,
followed by either destructive (necrotic) or proliferative
(pulp polyp) reaction.
* If left untreated will always ---} Pulp Necrosis.

* Traumatic injuries if favored ---} Proliferative

reaction, because the fractured surface is usually
flat, allowing salivary rinsing with little chance of
impaction of debris, i.e. in the first 24 hours the
inflammation not extend more than 2 mm into the pulp.

* While in the presence of bacterial contamination

---} local pulp necrosis & a slow apical spread of
pulpal inflammation.
Diagnosis:
Clinical, Biting Test.
Treatment:
* Treatment planning is influenced by tooth maturity & extent of
fracture.
There are 2 treatment options:

* Vital Pulp Therapy

I.e. preserve the potential for
continued root development ;
So if the tooth:

(1) Immature tooth:

- Pulp Capping
I.e. Covering of the exposed
Non-infected, Non-inflamed
pulp tissue with a material to
seal it & preserve healthy pulp vitality.
- Shallow (Partial) Pulpotomy (Cvek Technique).
I.e. Removal of part of the pulp from pulp chamber &
cover the remaining part with capping material.

- Pulpotomy (Cervical 0r Total Pulpotomy)

I.e. Removal of affected pulp tissue from pulp
chamber & cover or preservation of healthy
pulp tissue in the RCs
- Apexification or Apexogenesis.

Apexogenesis = Treatment of a vital pulp in an immature tooth to

permit continued root growth & apical closure.

Apexification = The process of creating an environment within

the root canal & periapical tissues after pulp
death that allows a calcified barrier to form
across the open apex
(2) Mature tooth:
- Pulpectomy with Non-surgical RC Therapy.

I.e. Total removal of pulp tissue from both pulp

chamber & RCs, cleaning , shaping &
obturation of RCs with obturating material.

- Pulpotomy.

* The choice of treatment depends on:

1- The stage of tooth development.
2- Time between the accident & treatment.
3- PDL attachment damage.
4- Restorative treatment plan.
Materials Used in Vital Pulp Therapy:
* Calcium hydroxide e.g. Dycal
* MTA; very effective in vital pulp therapy.
* Tri-calcium phosphate.
* ZOE.
* Formocresol + ZOE.
* IRM.
* Collagen +Calcium
phosphate Gel.

Prognosis: Success if:

1- No clinical signs or symptoms.
2- No evidence of periradicular pathological changes.
3- No evidence of resorption (Internal or External).
4- Evidence of continued root formation in developing teeth.
Crown Root Fractures:
Involves enamel, dentin and cementum with or
without pulp involvement.
Usually oblique fractures.

Incidence:
Anterior teeth usually occurs
by direct
trauma causing chisel fracture.
Posterior teeth due to large size
restoration or vigorous force of lateral
condensation.
 Diagnosis :

Crown root fractures are complex injuries which are difficult to

diagnose and treat. These cases exhibit the following features:
•Inflammatory changes in the pulp and periodontal ligament because
of encroachment of the attachment apparatus.
•Sensitivity to hot and cold.
Radiographs are taken at different angles. Transillumination can also
be used.
•Coronal fragment is mobile causing pain during mastication.
 Treatment:
The objective of the treatment is to:
•Allow healing of the broken root.
•Restoration of the coronal portion.
 To achieve these objectives, management of these cases
should be as follow:

•In case of unexposed pulp the loose fragments are bounded

together by applying bonding agents or removing them and
restoration with acid etch and composite.
•In case of pulp exposure; pulpotomy or RCT are done.
•If the remaining tooth structure is adequate,
RCT followed by crown lengthening, if needed, and crown
restoration are done.
•If crown length is inadequate then surgical removal
of the coronal fragments, surgical extrusion of the
root are done followed out with post and core build up.
•Orthodontic extrusion of the root may also
be done followed by post and core build up.
•If the fracture line extends below the alveolar crest,
gingivectomy and osteotomy may be done before coronal
restoration.
Prognosis:

Depends on the quality of coronal restoration and

management of the broken tooth.
Root fracture:

Root fractures represents a complex healing pattern due to

involvement of dentin, cementum, pulp and periodontal ligament.
Root fractures commonly result from a horizontal impact.
 Diagnosis:

1. Mobility.
2. Tenderness to palpation of mucosa.
3. Pain on biting.
4. Coronal displacement may or may not be present.
5. Bleeding from the gingival sulcus may or may not be present.
6. Radiographically:
Careful review of radiographs are quite important using different
angulations, especially when there is no separation between
segments.
Root fractures are usually transverse to oblique in nature requiring
varying radiographic angles (450,900 and 1100 degrees), to give the
chance to the beam to pass directly through the fracture line.
Therefore, the central radiographic beam should be at
right angle to the direction of the fracture line, not parallel to it.
In case of separation of broken segment diagnosis is easy.
 Classification of root fractures :

•Horizontal fractures (at right angle to the long axis of

the tooth).

•Vertical fracture (parallel to the long axis).

•Chisel fracture; oblique (terminates at

different levels on the opposing surfaces.
Usually sliding on each other).
 Horizontal fractures are divided into:

•Coronal fracture: in the coronal third of the root.

•Middle fracture (mid-root): in the middle third of the

root.

•Apical fracture: in the apical third of the root.

Healing of fractured roots:

Broken capillaries in the pulp and

periodontal ligament hemorrhage.
Blood flows into the fracture site clots organized C.T.
C.T. remodels calcific tissue.
Repair of fractured roots:

Four alternative forms of repair are described, three of them

are union healing and the fourth is non-union healing.
A. Calcific healing (callus union):

Fragments are close or with little separation and

little mobility.
Callus formation externally on
the root surface and internally on the canal wall.
Pulp may remain vital with less degree of
response.
Mobility within the physiologic limits.
A thin layer of fibrous C.T. remains
radiographically appears as a delicate line.
B. Connective tissue healing:

Fragments are separated further with some

mobility.
A fibrous attachment similar to a periodontal
ligament forms between segments.
Fractured dentin surfaces lined by
cementum.
Mobility little.
Pulp testing normal.
Radiographically a definite
fracture line.
C. Combined bone and connective tissue healing:

Fragments are separated further with further mobility.

Growth of new bone between segments.
Fractured surfaces are lined by cementum.
Periodontal ligament between the broken fragments and the new bone.
Mobility tooth is quite firm.
Pulp testing normal.
Radiographically a definite fracture line.
 D. Non-union healing with granulation tissue:

Severe dislocation, mobility and pulp contamination pulp

necrosis either partial (coronally) or total.
Pulp necrosis stimulates inflammation granulation
tissue formation.
Inflammation spread to alveolar bone resorption of
alveolar bone,
Tooth becomes loose, sensitive to percussion, discoloured,
and slightly extruded.
Radiographically widening of fracture line and loss of
surrounding alveolar bone.
 Treatment philosophy:

•Majority of teeth with root fractures maintain vitality.

•Although the pulpal tissues are not essential to healing, they are
preferable to a foreign material in the fracture site.

•Fracture should be reduced as soon as possible and broken tooth

firmly immobilized.

•Excessive lateral pressure on the coronal portion should be

avoided during repositioning to avoid tearing of pulpal tissues.
•Pulp contamination with saliva through the fracture line
should be avoided.

•Every effort is made to enhance healing of pulpal

tissues.

•If necrosis of the coronal portion of the pulp occurred,

reunion with calcified tissues is not likely to occur.

•Stabilization of the coronal segment should be done as

soon as possible, keeping in mind that mobility
increases as fracture line moves coronally.
 Treatment of root fractures:

•Apical third fracture; when tooth is

asymptomatic with no mobility and pulp is vital
🡪 no treatment is needed.

•Apical third fracture with coronal displacement

🡪 repositioning and splinting to the
neighboring teeth for 2 to 3 weeks (wire splint).
 If the pulp of the coronal segments becomes
necrotic, the following treatment options are
available:

1. No separation RCT. for both coronal &

apical segments.

2. Apical segment contains vital pulp RCT.

of coronal segment only.

3. Widely separated segments RCT. Of

coronal segment & surgical removal of apical
segment.
4. Widely separated segments apexification
of coronal segment, with no treatment of the
apical segment, which is usually having a vital
pulp.
5. Narrow separated segments in case of coronal
& middle fractures intraradicular
splinting with a rigid post.
6. In case of coronal & middle fractures surgical
removal of the apical fragment & insertion of
endodontic implant.
7. Coronal third fractures near the alveolar
crest🡪 removal of the coronal segment
followed by root removal with post & core
restoration.
6. In case of coronal & middle fractures surgical removal
of the apical fragment & insertion of endodontic implant.
7. Coronal third fractures near the alveolar crest
removal of the coronal segment followed by root
removal with post & core restoration.
 Follow-up and prognosis:
Pulp testing & radiographic examination at 1 week ,1,3,6&12 months.

•Majority of root fractures heal spontaneously or after splinting.

•The time of splinting varies from 1 week to 3 months or more

depending on the location of fracture & degree of mobility.

•If periodontal attachment failed to heal & the periodontal probe

penetrates down to the fracture site prognosis is bad.

•If mobility remained splint is reapplied & occlusal stresses are

relieved.

•If mobility continued after 4 to 6 months permanent splinting

with adjacent teeth (crowns, acid etch , bonding & composite)
 Indications of healing success:

1. No or minimal mobility.
2. Positive response to vitality testes.
3. Tooth is comfortable.
4. No discoloration.
5. Radiographic healing.

Prognosis of vertical root fractures is bad in the majority

of cases due to the broad area of fracture and difficulty to
reassemble and seal.
 Prognosis of chisel fractures (oblique) is bad
due to difficulty to immobilize as a result of
sliding of edges on each others.
 Luxation (displacement) of teeth:

Luxation injuries trauma to supporting structure of the

teeth.

from minor crushing of periodontal ligament and

neurovascular supply
Ranging

To total displacement of the teeth.

Caused by sudden impact such as a blow, fall, or striking a hard

object.
 Types of luxation injuries:

1. Concussion.
2. Subluxation.
3. Lateral luxation.
4. Extrusive luxation (extrusion).
5. Intrusive luxation (intrusion).

Incidence 30 to 40 % of all dental injuries.

 1. Concusion:
•No displacement.

•No mobility.

•Tenderness to percussion because of oedema or hemorrhage of

periodontium.

•The majority respond normally to pulp testing.

2. Subluxation.

•Senstivity to percussion.

•Some mobility.

•Sulcular bleeding due a damage of the periodontal

ligament fibers.

•No displacement.
 Treatment of concussion and subluxation:

•Radiographic examination to rule out root fracture.

•Relief of occlusion by selective grinding of opposing teeth.

•Immobilization of the injured teeth.

•RCT should not be carried out at the first visit, because

negative pulp testing and discoloration can be reversible.
 Follow-up and prognosis:

Follow-up at 1 week, 1,3,6&12 months.

Prognosis: A minimum risk of pulp necrosis and root
resorption.
 3. Lateral luxation:

•Displacement bucally, lingualy, mesially or distally i.e away from its

long axis.
•Sulcular bleeding indicating rupture of periodontal fibers and blood
vessels.
•Sensitivity to percussion.
 4. Extrusive luxation (extrusion):
•Tooth is displaced coronally, to some extent, through its socket
along its long axis.
•Increase in mobility.
•Clinically, the incisal edge is in supra occlusal level than the
neighboring teeth and the cervical margin appears coronal to the
gingival crest.
•Tender to percussion.
•Radiographically, there is some distance between the
radiographic apex and the bottom of the socket.
 Treatment of lateral and extrusive luxation:

•Local anesthesia.
•Repositioning of luxated teeth with minimal, atraumatic, required
force.
•Laterally luxated teeth must be dislodged from the cortical plate
(labial or palatal) by moving it first coronally out of the cortical
bone and then fitted into its original position.
•For extruded tooth; a slow and steady pressure is exerted by the thumb
finger, on the incisal edge, in apical direction. Sometimes the tooth may
resist repositioning due to accumulation of coagulated blood between
the apex and bottom of the socket. A semilunar flap and trephination
should then be done opposite to the periapical area for evacuation of
blood (surgical venting).

•Teeth of both cases should then be splinted for 2 to 3 weeks.

•If signs of loss of vitality are noticed, immediate RCT and injection of
intracanal Ca(oH)2 is done for approximately 2 weeks.
Follow-up and prognosis

Pulp testing is done regularly. Ca(oH)2 will prevent

inflammatory root resorption.

Normal healing of the periodontal ligament will take

place.
 5. Intrusive luxation (intrusion):
•Teeth is forced into its socket in an apical direction .
•Sever damage occurs to the pulp and the supporting structure.
•Alveolar bone fracture at the bottom of the socket with penetration
of apex into it.
•Clinically, tooth is in infraocclusal level.
•Tooth is locked firmly into the socket with no mobility.
•On percussion metallic sound is produced.
•Radiographically, the apex appears deeper than the bottom of the
socket with interruption of the continuity of the lamina dura.
 Treatment:

•Repositioning may be done by loosening the tooth

surgically, aligning it and splinting with adjacent teeth.
•Severely intruded teeth are repositioned by attaching an
orthodontic appliance to extrude it.
•In immature teeth, spontaneous reeruption occurs. If
reeruption stops before normal occlusion, an orthodontic
appliance is used.
Follow-up and prognosis:

Regular clinical and radiographic examination.

Healing of these cases is complicated because of the extensive
damage.
Therefore, follow-up is quite important and if the pulp was affected
RCT with intracanal Ca(oH)2 injection should be done.
 Avulsion (extra-articulation):
Complete displacement of the tooth outside the socket.

Incidence and causes:

•16% of all traumatic injuries,

Sports, falling down and automobile accidents are frequent
causes.
 The sequelae to avulsion of a tooth are:
•Pulp necrosis.
•Surface resorption. It is non invasive process done by macrophages
to remove physically damaged tissues, followed by a repair process.
•Inflammatory resorption. Occurs as a result of a necrotic infected
pulp giving rise to bacteria and toxins into the periodontal ligament,
these irritants cause resorption of both root and adjacent bone.
•Replacement resorption (ankylosis) occurs as a result of extensive
damage to periodontal ligament and cementum.
Healing occurs from the alveolar side creating a
union between tooth and bone.
Dentin is replaced by bone with lamina dura and
root assume a moth-eaten appearance.
Clinically no mobility and metallic sound with
percussion.
Young patients tooth remains in an infraocclusion
position.
 Treatment philosophy of avulsed tooth:
•The sooner the avulsed tooth is replanted the better is its
prognosis.
•Periodontal ligament cells should be prevented from drying
which can result in loss of their physiology and morphology.
•If It is not possible to maintain viable cells, we should at least
slow down the resorption process.
•If immediate reimplantation of the tooth is difficult it should be
kept in a suitable storage medium.
The following storage media are mentioned in order of
preference:
 The following storage media are mentioned in order of
preference:

•Hank’s balanced solution (Save-A- Tooth):

It is biocompatible, with ideal pH and osmolality, and keeps
periodontal cells viable for 24 hours.
HBS can rejuvenate degenerated ligament cells and maintain
success rate 90%.
•Milk:
Maintains vitality of periodontal cells for 3 hours. It is
relatively bacteria-free with pH and osmolality
compatible with vital cells.

•Sterile saline.

•Saliva:
Keeps the tooth moist. However, it is not ideal
because of the presence of bacteria and incompatible
pH and osmolality.

•Water:
The least desirable medium because it results in
hypotonic rapid cell lysis.
 Treatment:

Tooth out of socket for less than 30 minutes:

•Place in the solution.
•Wash the socket with the same solution.
•Reimplant the tooth and ask the patient to bite down
firmly on a piece of gauze.
•Splint with flexible splints such as wire, arch bar or acid
etch and composite.
•Put the patient on soft diet and antibiotic coverage.
•Splint should not stay longer than 7 to 10 days.
 Tooth out of socket for 30 minutes to 2 hours:

•Place it in the solution for 30 minutes.

•Local anesthesia.

•Periodontal ligament is dead, therefore it should be

removed along with the pulp.

•Place the tooth for 30 minutes in 5% sodium hypochlorite.

•Then place it for 5 minutes in each of the following;

saturated citric acid, 1% stannous fluoride, 5% doxycycline
before reimplantation.
These teeth will get ankylosed like a dental implant.
 Precautions:

•Do not touch a viable root with hands, forceps, gauze, or

try to scrub or clean to avoid injury to the periodontal
ligament.

•Do not overlook fractures of either teeth or alveolus.

•Do not reimplant primary teeth.

 Reimplanted primary teeth heal with ankylosis which will:

•Result in cosmotic deformity due to slow growth of the area of

ankylosis.

•Ankylosis also interferes with eruption of permanent teeth.

Tooth should be reduced coronally to avoid occlusal trauma.

RCT should be started after 7 to 10 days except if the tooth has
an open apex.
Thank You