Dental Trauma

LOGO
Dental trauma
in
primary dentition
Thidarat Nuansri
Department of Family and Community Dentistry
Division of General Dentistry
Faculty of Dentistry Chiang Mai University
Contents
1 Prevalence
2 Examination protocol
3 Guideline for diagnosis & treatment
4 Sequelae
LOGO
Introduction
Gupta M. 2011
LOGO
AAPD 2011
Prevalence
62–69% of cases occur mostly in the anterior region
The most frequently are the maxillary central incisors;

between 63% and 92%.
The greatest incidence at the toddler stage
a lack of motor coordination

the rudimentary stage of reflexes
The most of the injuries and the more

serious ones happen in the ages 2–4 years
Christophersen P, Freund M, Harild L. 2005
Gupta M. 2011
Flores MT 2002,
Diab M. et.al 2000
Sennhenn-Kirchner S, Jacobs H-G. 2006
LOGO
Mendoza-Mendoza A. et.al 2014
Prevalence
Girl & Son

the first year : no significant differences
after the first year a higher prevalence in males

ratios range from 1.2:1 to 1.82:1.
Indoor> outdoor
child abuse is highly associated with head and teeth injuries
LOGO
Diab M. et.al 2000
Examination protocol
underlying
permanent tooth
AAPD guidelineLOGO
2011, 2013
Important factors for treatment selection

 Child’s maturity and ability to cope
 Lack of cooperation: fear & distressing
 Time for shedding of the injured tooth
 The occlusion
 Invaded permanent tooth germ
AAPD guideline 2013

LOGO
medical history separating young children

dental history from the parents is not advised
tetanus immunization
Behavioral Clinical
history consideration examination
When,where, and how

the injury happened
www.dentalcouncil.or.th/public
Gupta M. 2011 LOGO
Extra oral intraoral radiographic
 head and neck  Sensibility &  degree of development

 temporomandibular joint percussion test are not and relationship
reliable  occlusal view
 mandibular functions
 lacerations and  extraoral lateral view
 facial asymmetry
 swelling of the lips hematomascheck
 Nostrils bleeding  Injured teeth
 the subcutaneous  Occlusion
hemorrhage near the  alveolar fragment
nostrils
www.dentalcouncil.or.th/public
Gupta M. 2011 LOGO
Guideline for diagnosis & treatment
The
g
care uideline
f or m s
anag for the im
eme
nt of mediate
prim o
ary t r urgent
eeth
injur
ies.
www.themegallery.com LOGO
Fracture
Enamel fracture
Enamel dentin
fracture
Alveolar fracture
Crown fracture with

exposed pulp
Root fracture
Crown–root
fracture
International Association of Dental Traumatology (IADT) guidelines 2012

LOGO
Endorsed by the American Academy of Pediatric Dentistry (AAPD) 2013
Enamel fracture
Clinical findings
Fracture involves enamel
Radiographic findings
No radiographic abnormalities
Treatment
Smooth sharp edges

LOGO
ที่มาภาพ: Andreason J.O., Andreason F.M., Andersson L. 2007
Enamel dentin fracture
Clinical findings
Fracture involves enamel and dentin; the pulp is not exposed
• No radiographic abnormalities
• The relation between the fracture and the pulp chamber will be disclosed
Treatment
• seal completely the involved dentin with glass ionomer
• in case of large lost tooth structure,restored with composite

LOGO
Crown fracture with exposed pulp
Clinical findings
Fracture involves enamel and dentin,and the pulp is exposed
The stage of root development can be

determined from one exposure
Treatment
 depending on the child′s maturity and ability to cope.
 preserve pulp vitality by partial pulpotomy.
 Calcium hydroxide is a suitable material
 Extraction

LOGO
Crown–root fracture
Clinical findings
 Fracture involves enamel, dentin, and root structure
 The pulp may or may not be exposed
 May include loose, but still attached, fragments of the tooth
 There is minimal to moderate tooth displacement
 In laterally positioned fractures, the extent in relation to the
gingival margin can be seen
 One exposure is necessary to disclose multiple fragments

ที่มาภาพ: Andreason J.O., Andreason F.M., Andersson L. 2007LOGO
Crown–root fracture
Treatment : Depending on the clinical findings
● Fragment removal only ● Extraction in all other

- involves only a small part instances
of the root
- large enough to allow coronal
restoration

LOGO
Root fracture
Clinical findings
The coronal fragment may be mobile and may be displaced
The fracture is usually located mid-root or in the apical third
Treatment
 the coronal fragment is not displaced = no treatment is required
 the coronal fragment is displaced,
 repositioning and splinting
 extract only fragment. The apical fragment should be left to
be resorbed

ที่มาภาพ: Andreason J.O., Andreason F.M., Andersson L. 2007 LOGO
Alveolar fracture
Clinical findings
 The fracture involves the alveolar bone and may extend to adjacent bone
 Segment mobility and dislocation are common findings
 Occlusal interference is often noted
 The horizontal fracture line to the apices of teeth and successors
 A lateral radiograph: information about the relation between the two dentitions
Treatment
 Reposition any displaced segment and then splint
 General anesthesia is often indicated
 Stabilize the segment for 4 weeks
 Monitor teeth in fracture line

LOGO
Follow-up procedures for fractures
1 2-3 3-4 6-8 6 1 Favorable outcome Unfavorable
wk wks wks wks m year outcome
Enamel fracture
Enamel dentin fracture C
Crown fracture with C C+R C+R Continuing root Signs of apical periodontitis;
exposed pulp development in immature no continuing Root
teeth and a hard tissue development in immature
barrier *teeth extraction or root canal
treatment
Crown–root fracture C C+R (C*) ● Asymptomatic; ● Symptomatic; signs of
In cases of fragment continuing root apical periodontitis
development in no continuing
immature teeth root development in
immature
Root fracture - Signs of repair None
- No displacement C C C+R between fractured
& segments
(C*) - Continuous resorption
- Extraction of the left apical fragment
Alveolar fracture C S+C C+R C+R ● Normal occlusion ● inflammatory root

+R & ● No signs of apical resorption of primary teeth
(C*) periodontitis ● permanent successors
● No signs of require follow up until full
disturbances in the eruption
permanent successors
C, Clinical examination; R, Radiographic examination; S, Splint removal; (C*), Clinical and radiographic monitoring until eruption of the permanent successor.

Endorsed by the American Academy of Pediatric Dentistry (AAPD) 2013LOGO
Luxation
Concussion
Subluxation
Extrusive luxation
Lateral luxation
Avulsion
LOGO
Concussion
Clinical findings
tender to touch
has normal mobility
no sulcular bleeding
 Abnormalities are usually not found

 Normal periodontal space
 Occlusal exposure is recommended to screen
Treatment
No treatment is needed. Observation

LOGO
Subluxation
Clinical findings
Increased mobility but has not been displaced
Bleeding from gingival crevice may be noted
 No radiographic abnormalities
 Normal periodontal space
 The radiograph used as a reference point of future complications
Treatment
 No treatment is needed; Observation

 Brushing with a soft brush
 use of alcohol-free 0.12%chlorhexidine topically on the affected area
swabs twice a day for 1 week

LOGO
Subluxation

LOGO
Extrusive luxation
Clinical findings
Increased mobility but has not been displaced
Bleeding from gingival crevice may be noted
 Increased periodontal ligament space apically

Treatment
 minor extrusion in an immature developing

Treatment
 Repositioning
 based 
on leaving for spontaneous alignment
 the degree of displacement, mobility
 Severe
 root formation
extrusion in a fully formed
 the ability of the child to cope
 Extraction is the

Chaenwithaya Y., Chaenwithaya W. 2013 LOGO
Lateral luxation
Clinical findings Usually displaced in a palatal/lingual,or labial direction

It will be immobile
 No occlusal interference
 allowed to reposition spontaneously
 Minor occlusal interference
 slight grinding
 More severe occlusal interference
 gently repositioned by combined labial and palata
 Severe displacement
 extraction
Occlusal film
 increased periodontal ligament space apically
 show the position of the
International displaced
Association tooth
of Dental Traumatology (IADT) guidelines 2012
 relation to theที่มาภาพ:
permanent successor
Andreason J.O., Andreason F.M., Andersson L. 200 LOGO
Lateral luxation
Treatment
LOGO
Intrusion
Clinical findings
The tooth can be impinging upon
the succedaneous tooth bud
 the apex is displaced toward/through the labial bone plate

 the apical tip can be visualized
 the tooth appears shorter than its contra lateral
 the apex is displaced toward the permanent tooth germ
 the apical tip cannot be visualized
 the tooth appears elongated
LOGO
Intrusion
Clinical findings
Extraction or
Controversy ?
preservation
Treatment
 labial bone plate displaced

 left for spontaneous repositioning
 displaced into the developing tooth germ

 extract

LOGO
Diab M., ElBadrawy HE. 2000 part III
Avulsion
Clinical findings
The tooth is completely out of the socket
Essential to ensure that the missing tooth is not intruded
Treatment
Not recommended to replant avulsed primary teeth
LOGO
Follow-up procedures for luxation injuries
1 2-3 3-4 6-8 6 1 Favorable outcome Unfavorable outcome

wk wks wks wks m year
Concussion C C Continuing root development ● No continuing

in immature teeth Root development
● Dark discoloration of crown.
● No treatment is needed
unless apical periodontitis
develops
Subluxation C C ● Continuing root development in ● No continuing root

immature teeth development in immature teeth
● Transient red/gray ● Dark discoloration of crown
discoloration a yellow No treatment is needed unless
discoloration indicates pulp apical periodontitis develops
obliteration and has a good
prognosis
Extrusive C C+R C+R C+R ● Continuing root development in ● No continuing root
luxation immature teeth development in immature teeth
● Transient red/gray ● Dark discoloration of crown
discoloration a yellow No treatment is needed unless
discoloration indicates pulp apical periodontitis develops
obliteration and has a good
prognosis

Follow-up procedures for luxation injuries
1 2-3 3-4 6-8 6 1 Favorable outcome Unfavorable outcome

wk wks wks wks m year
Lateral luxation C C C+R C+R ● Asymptomatic ● No continuing

“immobile” ● Clinical and radiographic root development in immature teeth
signs of normal or healed ● Dark discoloration of crown
periodontium No treatment is needed unless
● Transient discoloration apical periodontitis develops
might occur
Intrusion C C+R C C+ C+R ● Tooth in place or erupting ● Tooth locked in place

R &(C*) ● No or transient discoloration ● Persistent discoloration
● Radiographic signs of apical
periodontitis
● Damage to the permanent
successor
Avulsion C C+ C+R Damage to the permanent
R &(C*) successor

Case report:extrusive luxation
เด็กชายไทย อายุ 5 ปี
CC: ฟันเคลื่อนที่
PI: ตกจากโต๊ะเรียนเมื่อ 30 นาทีที่
แล้ว
I/O: 61 เคลื่อนออกจากเบ้าฟัน
ประมาณ 1 มม. ไม่พบการแต่หักของ
กระดูกเบ้าฟัน มีเลือดออกจากขอบ
เหงือก
ภาพรังสี:  LA, IRR of PDL space at the
Widening
distal aspect
root of tooth 61
ใช้นิ้วดันฟันกลับเข้าที่เบาๆ เทียบ
ตำแหน่งกับฟันข้างเคียง
 ตรวจสอบการสบฟัน
 Post-op ผู้ปกครอง
LOGO
Chaenwithaya Y., Chaenwithaya W. 2013
วัน 3 6
แรก เดือน เดือน
LOGO
Chaenwithaya Y., Chaenwithaya W. 2013
51 3 เดือน 51 6 51 1 ปี 2 ปี
61 9 เดือน เดือน 61 1 ปี 6
61 1 ปี เดือน
 การเคลื่อนที่และการดันฟันกลับสู่ตำแหน่งเดิมไม่ได้กระทบต่อ
หน่อฟันแท้
 การดันกลับเข้าที่เดิมโดยพิจารณาจากฟันข้างเคียงที่ไม่เคลื่อน
ช่วยป้ องกันไม่ได้กระทบต่อหน่อฟันแท้
 การเปลี่ยนสีฟันเพียงอย่างเดียว ไม่ได้เป็ นข้อบ่งชี้ในการรักษา
Chaenwithaya Y., Chaenwithaya LOGO
W. 2013
Case report: intrusive luxation
A 3-year-old boy
CC: pain in the maxillary anterior region
PI : had fallen on the floor the day before.
I/O :
- 61 was submerged in the alveolar bone away
- slightly palatally inclined
- no mobile
- tender to palpation and percussion.
- no signs of alveolar fracture
radiographic:
 amoxicillin foreshortened
and Ibugesic for 3 days.
tooth
 wait for spontaneous reeruption
 regular check-up
 Post-op,OHI
LOGO
Gupta M. 2011
Case report:intrusive luxation
 the underlying permanent tooth germ must be kept in mind

4 monthsis important
 regular check-up 4 months & 1 week extracted tooth
LOGO
Gupta M. 2011
LOGO
Sequelae
 the prevalence ranged 20.2% to 74.1%

 the most prevalent sequelae in the permanent incisors
 dental enamel defects: enamel hypoplasia & enamel discoloration
Lenzi MM 2014
a statistically significant result between

intrusion and enamel discoloration with
enamel hypoplasia.
Mendoza-Mendoza A. et.al 2014,Lenzi MM 2014
LOGO
Lenzi MM 2014
Sequelae: factors
the age of the child at the time of injury
the younger the child, the greater the prevalence and severity
Lenzi MM 2013
Christophersen P, Freund M, Harild L. 2005
Diab M.,ElBadrawy HE. 2000 part III
63% of <2 years old

53% of 3- and 4-year-olds
24% of 5 and 6-year-olds
Andreasen JO., Ravn JJ. 1971
66% of patients up to an age of 3 years suffered from Sequelae

Most peak 2-3 years
LOGO
Sequelae: factors
the age of the child at the time of injury
Injuries occur before 3 years old result in variety of anomalies

a possible cause could be the incomplete level of

mineralization of bone and dental germ at that time.
Lenzi MM 2013 Sennhenn-Kirchner S, Jacobs H-G. 2006
damage is bigger when the age at the time of injury is under 2 years.
“Less calcified of bone that can not protect tooth germ”
Selliseth 1970
LOGO
Sequelae: factor
 the type and severity of injury:

 More severe traumas such as intrusion and avulsion are associated to
more serious developmental disorders.
Lenzi MM 2013
 intrusion is associated with an increased frequency of complications

in both the deciduous and the permanent teeth.
Mendoza-Mendoza A. et.al 2014,Lenzi MM 2014
 the stage of development of the successor

 the association with fractures of the alveolar bone
 เพิ่มโอกาสที่จะมีผลต่อหน่อฟันแท้ที่กำลังเจริญ ทั้งต่อรูปร่างและต่อ
การสะสมแร่ธาตุ
Diab M.,ElBadrawy HE. 2000 part III. Lenzi MM 2013
LOGO
Sequelae
Primary teeth Permanent successors
oo coronal
coronaldiscoloration
discoloration  discoloration of enamel
oo pulpal
pulpalnecrosis
necrosis  enamel hypoplasia
oo pulp
pulpcanal
canalobliteration
obliteration(PCO)
(PCO)  crown dilacerations
oo pathologic
pathologicexternal
external  duplication of the root
root
rootresorption
resorption  root dilacerations
oo abscess/cellulitis
abscess/cellulitisformation
formation  partial or complete cessation
oo failure
failureof
ofreeruption
reeruption
oo of root formation
ankylosis
ankylosis  malformation
 eruption disturbances
Diab M.,ElBadrawy HE. 2000 part II Lenzi MM 2013

Borum MK, Andreasen JO. 1998 Diab M.,ElBadrawy HE. 2000 part III
LOGO
Sequelae on primary teeth
Coronal
Obliteration discoloration
Pulp necrosis Ankylosis
Root resorption Cellulitis
Diab M., ElBadrawy HE. 2000 part II,III

Borum MK, Andreasen JO. 1998 LOGO
Sequelae
CORONAL DISCOLORATION
 The most prevalent sequelae Qassem A, et. al. 2014
 3 groups: transient gray, permanent gray, yellow

 appear during the first few weeks after the injury or delayed for months.
 55%- 48% of intruded incisors color changes before spontaneous reeruption.
Gray discoloration
 70% are diagnosed within
the first month
 capillaries rupture > red cells
degenerate>penetrates the
dentinal tubules>reddish
gray>gray
 color can be reversible if the
pulpal tissue survives
Diab M., ElBadrawy HE. 2000 part II
Holan G. 2004
Qassem A, et. al. 2014 LOGO
72.1% PCO
15% transient
gray
3.4% PN
18% permanent 8.6% PCO

78%
gray
65.7% PN
81.5% PCO
31% yellow
1.7% PN
LOGO
Borum MK, Andreasen JO. 1998
Sequelae
fade to
original shade persisting
yellow dark
Holan G. 2004
LOGO
Sequelae
 52% of the teeth fade or possess a lighter yellowish shade

 Yellowish teeth develop significantly less pathologic signs
 More than 50% of dark coronal discoloration teeth remain
clinically asymptomatic till the eruption of the permanent teeth
 There is still a dilemma: which treatment is better??
 Early endodontic treatment
 follow-up
 with infection and root resorption may require extraction.
HolanLOGO
G. 2004
Sequelae
Pulpal vitality??
Not Pulpal
confirm necrosis
Follow up Pulp therapy
LOGO
Sequelae
Yellow discoloration
 34% to 41% following intrusion.
 Following appears as reddish
gray/light gray
 reflects calcification
LOGO
Sequelae
reerupted intruded incisors affected with

yellow discoloration
highly associated with
partial/total obliteration of the pulp cavity
 managed by close observation

 normal root resorption&eruption
pattern.
LOGO
Sequelae: coronal discoloration
subluxation
follow up
3 wks after injury
1 year after injury
LOGO
Andreason J.O., Andreason F.M., Andersson L. 2007
Sequelae Paper นี้ รีวิว ผลที่ตามมาที่เป็ นไปได้ของ
intrusion Pulp necrosis
Clinical signs
 discoloration radiograghs
 soft tissue changes  thickening of PDL space
 spontaneous pain  external or internal
 sensitivity on percussion and inflammatory root resorption
palpation  periapical radiolucency
 Increased tooth mobility
 fistula
 permanent gray discoloration
variables
variables
 age of the patient at the time of injury,
 age
R.I.P  degree of displacement of the tooth
 trend with increasing severity of luxation
 degree of loosening
 Presence alveolar bone fracture
 presence of crown fracture Borum MK, Andreasen JO. 1998

Borum MK, Andreasen JO. 1998 LOGO
Sequelae Pulp canal obliteration
 calcific metamorphosis
 35.9% of traumatized teeth
 68.3% show yellow color
 radiographically evident on
~1 year after trauma
variables
 displacement of the tooth at time of injury
 physiologic root resorption at time of trauma.
 The presence of crown fx decrease the risk of obliteration.
LOGO
Borum MK, Andreasen JO.
Sequelae
Pathologic external root resorption
 a common following intrusion (14%)

 The irritated pulpal tissue stimulates an inflammatory
response and the release of osteociast-activating agents
 usually noted on a follow-up radiograph
 usually managed with extraction
LOGO
Sequelae
Abscess or cellulitis formation
 Bacterial infection
 induce gingival redness and swelling, spontaneous
bleeding, pain, malaise, and fever
 Long-term becomes a chronic abscess: purulent exudate
erupting from a fistula.
 requires immediate management by extraction
 antibiotic therapy may be initiated
LOGO
Sequelae
Failure of reeruption and ankylosis
 20% to 22% of intruded primary incisors did not reerupt

fully / in perfect alignment / failed to reerupt completely
 2.4-6% ankylosis
 labially away from the permanent tooth germ are expected
to reerupt and to realign spontaneously.
 alveolar bone fracture prevent the reeruption
LOGO
Sequelae
Complications
Complications in traumatized
in traumatized primary
primary incisors
incisors
LOGO
Sequelae Other study
 crown discoloration was the most prevalent sequelae.

 subluxated teeth: IRR, fistula, crown discoloration, and PCO
occurred within 180 days after trauma
 Intruded teeth: IRR, crown discoloration, and PCO were observed
within the 181–365 days & the 1–2 years periods. TDI
 sequelae were still diagnosed even after 4 years.
 the importance of frequent follow-up
LOGO
Qassem A, et. al. 2014
Sequelae on permanent teeth
www.themegallery.com LOGO
Sequelae
Permanent successors
 discoloration of enamel
 enamel hypoplasia
 crown dilacerations
 duplication of the root
 root dilacerations
 partial or complete cessation of root formation
 malformation
 eruption disturbances
Lenzi MM 2013
LOGO
Sequelae: permanent successors
discoloration of enamel
A B

White
White or
oryellow-brown
yellow-brown discoloration
discoloration
 Injury
Trauma during
Injury during formation
formation stage
stageofofenamel
enamelbefore
before2-3
2-3year
yearold
old

 Trauma during
during the
themineralization
mineralization stage
stage


 highly
highly related
related with
with intrusion
intrusion
 44%
44% intrusion,
intrusion,before
before 44years
years suffering
sufferingfrom
fromwhite/yellow-brown
white/yellow-brown teeth
teeth


 May
May
White> be
be established
established
insufficient radiologically
radiologically
calcification during the maturation
 White> insufficient calcification during the maturation

 yellow-brown>
yellow-brown>hemoglobin
hemoglobinenter
enterthe
themineralizing
mineralizingportion
portion
C D

LOGO
ที่มาภาพ Andreason J.O., Andreason F.M., Andersson L.
Sequelae
Enamel hypoplasia following intrusion

trauma at the age of 2.8 years.
Circular enamel hypoplasia following

subluxation of the teeth 51, 61 and 62 at
the age of 3.4 years.
LOGO
Dilacerations & malformation
years Crown
Crowndilacerations

Intrusion
Intrusionaround
aroundthe
theage
ageof
of22years dilacerations

Foreshortened
Foreshortenedon onthe
theocclusal
occlusalradiographic
radiographicimage
image

May
Maynormally/facial/lingual
normally/facial/lingualversion
versioneruption
eruption

May
Maylater
laterdevelop
developpulp
pulpnecrosis
necrosis>>apical
apicalperiodontitis
periodontitis>>chronic
chronicabscess
abscess
LOGO
ที่มาภาพ: Andreason J.O., Andreason F.M., Andersson L.
Sequelae
Crown malformation following

intrusion of tooth 61 at
the age of 2 years irregular root
formation of the neighbouring teeth
(a) radiological
(b) postoperative findings.
LOGO
Dilacerations & malformation
Severe crown and root deformation of tooth 11

following intrusion of 51 and 61at the age of 16 month
years root
root dilacerations

Intrusion
Intrusionbetween
between2-52-5years dilacerations

Hertwig’
Hertwig’epithelial
epithelialsheath
sheathdefect
defector
ordisplace
displace

Teeth
Teethmay
maybecome
becomeimpact
impact

ที่มาภาพ Sennhenn-KirchnerLOGO
S, Jacobs H-G.
Sequelae
Kind of Number Sequel Number

injury of teeth of teeth
Intrusion 8 Deformation of crown and/or root 5
Irregular eruption 1
Enamel hypoplasia 2
Subluxation 9 Irregular eruption 3
Enamel hypoplasia 6
Avulsion 8 Enamel hypoplasia 2
Root fracture 1 Irregular eruption 1
LOGO

ที่มาภาพ: Andreason J.O., Andreason F.M.,LOGO
Andersson L.
horizontal
discolouration enamel
10 teeth hypoplasia
2 teeth
hypoplasia
3 teeth
No
crown
dilacerations
the younger the child is at the time of traumatic

the higher risk of developmental disturbances in the permanent successors
LOGO
Christophersen P, Freund M, Harild L 2005
conclusion
LOGO
conclusion
LOGO
LOGO

Dental Trauma

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LOGO

3 Guideline for diagnosis & treatment

62–69% of cases occur mostly in the anterior region

The most frequently are the maxillary central incisors;

The greatest incidence at the toddler stage

a lack of motor coordination

The most of the injuries and the more

Girl & Son

after the first year a higher prevalence in males

Important factors for treatment selection

AAPD guideline 2013

medical history separating young children

When,where, and how

Extra oral intraoral radiographic

 head and neck  Sensibility &  degree of development

Crown fracture with

International Association of Dental Traumatology (IADT) guidelines 2012

International Association of Dental Traumatology (IADT) guidelines 2012

International Association of Dental Traumatology (IADT) guidelines 2012

The stage of root development can be

International Association of Dental Traumatology (IADT) guidelines 2012

 One exposure is necessary to disclose multiple fragments

International Association of Dental Traumatology (IADT) guidelines 2012

Treatment : Depending on the clinical findings

● Fragment removal only ● Extraction in all other

International Association of Dental Traumatology (IADT) guidelines 2012

The fracture is usually located mid-root or in the apical third

International Association of Dental Traumatology (IADT) guidelines 2012

International Association of Dental Traumatology (IADT) guidelines 2012

Enamel dentin fracture C

Alveolar fracture C S+C C+R C+R ● Normal occlusion ● inflammatory root

International Association of Dental Traumatology (IADT) guidelines 2012

 Abnormalities are usually not found

No treatment is needed. Observation

International Association of Dental Traumatology (IADT) guidelines 2012

 No treatment is needed; Observation

International Association of Dental Traumatology (IADT) guidelines 2012

International Association of Dental Traumatology (IADT) guidelines 2012

 Increased periodontal ligament space apically

 minor extrusion in an immature developing

International Association of Dental Traumatology (IADT) guidelines 2012

Clinical findings Usually displaced in a palatal/lingual,or labial direction

 the apex is displaced toward/through the labial bone plate

 labial bone plate displaced

 displaced into the developing tooth germ

International Association of Dental Traumatology (IADT) guidelines 2012

The tooth is completely out of the socket

Essential to ensure that the missing tooth is not intruded

Not recommended to replant avulsed primary teeth

1 2-3 3-4 6-8 6 1 Favorable outcome Unfavorable outcome

Concussion C C Continuing root development ● No continuing

Subluxation C C ● Continuing root development in ● No continuing root

International Association of Dental Traumatology (IADT) guidelines 2012

1 2-3 3-4 6-8 6 1 Favorable outcome Unfavorable outcome

Lateral luxation C C C+R C+R ● Asymptomatic ● No continuing

Intrusion C C+R C C+ C+R ● Tooth in place or erupting ● Tooth locked in place

International Association of Dental Traumatology (IADT) guidelines 2012

 the underlying permanent tooth germ must be kept in mind

 the prevalence ranged 20.2% to 74.1%

a statistically significant result between

63% of <2 years old

66% of patients up to an age of 3 years suffered from Sequelae

Injuries occur before 3 years old result in variety of anomalies

a possible cause could be the incomplete level of