• Examination and diagnosis

Consider traumatic injuries as emergency,

• To relieve pain.
• Reduce psychological stress.
• Facilitate reduction of # or avulsion.
• For good prognosis.
When did injury occurred ?

• Time interval between injury and treatment started.

• Alter possible prognosis and line of treatment specially in cases of
re-implantation, pulp exposure, bone# and severe soft tissue
injuries.

Where did injury occurred ?

• For tetanus prophylaxis.

• How did injury occurred ?

• Direction of blow which tells possible structure affected.

• Object in mouth like pacifier labial displacement of teeth.

• Young child and women with multiple soft tissue injury at

deferent stage of healing improper history child abuse.
Treatment else where ?

• Storage of avulsed teeth.

• Medication taken.
• Re-implantation and immobilization considered.

History of previous injury ?

• Sustained repeated injury influence pulp vitality test.

• Affects healing capacity of pulp and PDL.
General health and medical history ?

• Allergic reaction
• Epilepsy
• Bleeding disorder
• Differs emergency and later treatment
Examination

• Color change of traumatized tooth noted occurs in post injury period.

• Deranged occlusion
• Abnormal mobility
• Palpation of alveolar process
• Percussion
• Vitality test
• Radiographic examination
 Management of patient

• Emergency management
A- Airway with cervical spine control

B- Breathing and ventilation

C- Circulation and hemorrhage control

D- Disability neurological states

• Central nervous system injury
 Classification based on tissue and site

All injuries to the face may be divided into two basic groups,

• Injuries to soft tissues

• Injuries to bone
• Rabinowitch Classification (1956)

• Fractures of the enamel

• Fractures into the dentin

• Fractures into the pulp

• Fractures of the root

• Comminuted fractures

• Displaced teeth
 Ellis and Davey Classification (1960)

• Class 1 - Simple fracture of the crown involving little or no dentin.

• Class 2 - Extensive fracture of the crown involving considerable

dentin, but not the dental pulp.
• Class 3 - Extensive fracture of the crown involving considerable
dentin and exposing the dental pulp.

• Class 4 - The traumatized teeth that become non-vital with or

without a loss of crown structure.

• Class 5 - Teeth lost as a result of trauma

• Class 6 - Fracture of the root with or without a loss of the crown
structure.

• Class 7 - Displacement of a tooth without fracture of the crown or

root.

• Class 8 - Fracture of crown en masse and its replacement.

• Class 9 - Traumatic injuries to primary teeth.
Modification of Ellis classification by McDonald, Avery and
Lynch (1983)

• Class 1 - Simple fracture of the crown involving little or no dentin.

• Class 2 - Extensive fracture of the crown involving considerable
dentin, but not the dental pulp.
• Class 3 - Extensive fracture of the crown
with an exposure of the dental pulp.

• Class 4 - Loss of the entire crown.

 WHO Classification (1992)

• Adapted from WHO Geneva 1992.

• Based on anatomy, therapeutic and prognostic consideration.
• It is applied to both primary and permanent teeth.
• Code numbers used according to the International classification of
diseases 1992
Injuries to the hard dental
tissues and pulp

Enamel infraction N
502.50: An incomplete
fracture (crack) of the enamel
without loss of tooth
substance.
Injuries to the hard dental
tissues and pulp

Enamel infraction N
502.50: An incomplete
fracture (crack) of the enamel
without loss of tooth
substance.
Enamel fracture
(Uncomplicated crown
fracture) N 502.50: A
fracture with loss of tooth
substance confined to
enamel.
Enamel - dentin fracture
(Uncomplicated crown
fracture) N 502.51: A
fracture with loss of tooth
substance confined to enamel
and dentin but not involving
pulp.
Complicated crown
fracture N 502.52

A fracture involving
enamel and dentin
and exposing the
pulp.
Uncomplicated crown
root fracture N 502.54

A fracture involving
enamel, dentin and
cementum but not
involving the pulp.
Complicated crown root
fracture N 502.54

A fracture involving
enamel, dentin and
cementum and exposing
pulp.
Root fracture N
502.53: A fracture
involving dentin,
cementum and the
pulp.
Injuries to the periodontal
tissues

Concussion N 503.20: An
injury to the tooth supporting
structures without abnormal
loosening or displacement of
the tooth.
Subluxation N 503.20

An injury to the tooth

supporting structures
with abnormal loosening
but without displacement
of the tooth.
Subluxation N 503.20

An injury to the tooth

supporting structures
with abnormal loosening
but without displacement
of the tooth.
Extrusive luxation
(peripheral
dislocation, partial
avulsion) N 503.20

Partial displacement of
the tooth out of its
socket.
Lateral luxation N
503.20

Displacement of the tooth

in a direction other than
axially. This is
accompanied by fracture
of the alveolar socket.
Intrusive luxation (central
dislocation) N 503.21:
Displacement of the tooth into
the alveolar bone. This injury
is accompanied by fracture of
the alveolar socket.
Exarticulation (complete
avulsion) N 503.22

Complete displacement of
the tooth out of its
socket.
Injuries of the supporting
bone

Comminution of alveolar
socket (mandible N
502.60, maxilla N 502.40):
Crushing and compression of
the alveolar socket. intrusion
and lateral luxation.
Fracture of the alveolar
socket wall

(mandible N 502.60,
Maxilla N 502.40)

A fracture contained to
the facial or lingual
socket wall.
Fracture of the alveolar
process

(Mandible N 502.60,
Maxilla N 502.40)

A fracture of the alveolar

process which may or may not
involve the alveolar socket.
Fracture of mandible and maxilla

(Mandible N 502.61, Maxilla N 502.42)

A fracture involving the base of the mandible or

maxilla and often the alveolar process (jaw
fracture). The fracture may or may not involve
the alveolar socket.
Injuries to gingival or oral
mucosa

Laceration of gingival or
oral mucosa N S01.50: A
shallow or deep wound in the
mucosa resulting from a tear
and usually produced by a
sharp object.
Contusion of gingival or oral
mucosa N S00.50

A bruise usually produced by

an impact from a blunt object
and not accompanied by a
break of the continuity in the
mucosa, causing sub-mucosal
hemorrhage.
Abrasion of gingiva or
oral mucosa N S00.50

A superficial wound
produced by rubbing or
scraping of the mucosa
leaving a raw bleeding
surface.
BY ANDREASEN
Classification of trauma in injury of hard
tissues and pulp.
• This is based on W.H.O. classification.
• 873.60  Incomplete fracture.
• 873.61  Uncomplicated crown fracture.
• 873.62  Complicated crown fracture.
• 873.64  Uncomplicated crown and root
fracture.
• 873.64  Complicated crown and root
fracture.
• 873.63  Root fracture.
Injuries to the periodontal tissues:
• 873.66  Concussion.
• 873.66  Subluxation (loosening).
• 873.67  Intrusive luxation (central dislocation).
• 873.67  Extrusive luxation (peripheral
dislocation, partial avulsion).
• 873.66  Lateral luxation.
• 873.68  Exarticulation (Avulsed tooth).
Injuries to the supporting bone:
• Mandible No. 802.20, maxilla No. 8.2.40 –
comminution of alveolar socket.
• Mandible No. 802.20, Maxilla No. 802.40 –
Failure of alveolar socket wall.

• Mandible No. 802.20, Maxilla No.

802.40 – Fracture of alveolar process.

• Mandible No. 802.21, Maxilla No.

802.42 – Fracture of mandible / maxilla.
Injuries to Gingiva/ Oral mucosa:
• 873.69  Laceration of gingiva/oral
mucosa.
• 920.X0  Contusion of gingiva/oral
mucosa.
• 910.00  Abrasion of gingiva or oral
mucosa.
• BASRANI CLASSIFICATION
• Crown fractures.
– Fracture of enamel.
– Fracture of enamel and dentin.
• Without pulp exposure.
• With pulp exposure.
• Root fractures.
• Crown root fractures.
BY ULFOHN
• His classification is based on clinical endodontics and
does not reveal the extent of fracture or amount of
dentin exposed.
• He based his classification on 3 aspects:
• Clinical state of the pulp.
• Pulp and dentin as one organ.
• Determination of treatment.
• Crown fractures:
– Of enamel.
– With indirect pulp exposure through dentine.
– With direct pulp exposure.
ETIOLOGY
• Iatrogenic injuries in new born
• Fall in infancy

• Child physical abuse

• Automobile / bicycle Accident

• Drug related /Mental retardation
• Dentinogenesis imperfecta
• Contact sports
Management of infraction and
fracture of enamel
• Smoothening of rough edges.

• Composite resin using acid-etch technique

Treatment of enamel and dentine
Fracture
• Most effective method is placement of a
protective material over exposed dentin to allow
the pulp to form a protective barrier e.g.
Ca(OH)2 placement (Dycal).
• The fracture site must be covered with a
restoration material such as acid-etch composite
restoration.
• Because of the extent of fracture and because of
esthetics reason – crown may be required.
• Re-attachment of fractured fragments can also
be done
Treatment of fracture with pulpal
involvement
• Depends on maturity of the tooth.

Incomplete Root Formation

Complete root formation
PULP CAPPING
PULPECTOMY
APEXIFICATION
ENDODONTIC TREATMENT
PULPOTOMY

APEXOGENESIS
Treatment guideline for
avulsed tooth with open apex
• Avulsed Tooth Immature Pulp
• Open apex – 2 mm
No Dry Storage Time Dry Storage Time
Repositioning of avulsed tooth with complete root
formation

Tooth and socket are cleaned with saline

Prepare socket
Reposition tooth

Splinting is done