Management of Traumatic

Dental Injuries
Dr. musa mohammedtom musa
B.d.s, Mfdrcsi, MSc clinical restorative
dentistry, implant Diploma BAIRD
Academy
 Management of Traumatic Dental
Injuries
LEARNING OBJECTIVES:
1. Describe the clinical and radiographic features
of the different forms of dental injuries.
2. Describe possible short- and long-term
responses of pulp, periradicular tissues, and
hard tissues to the injuries listed above.
3. List pertinent information needed when
examining patients with dental injuries (from
health history, nature of injury, and symptoms).
 Management of Traumatic Dental
Injuries
LEARNING OBJECTIVES:
4. Describe the diagnostic tests and procedures
used in examining patients with dental injuries and
interpret the fi ndings.
5. Describe the differences in treatment strategies
for traumatic dental injuries in primary and
permanent dentition.
6. Recognize surface resorption, infl ammatory
(infectionrelated) resorption, and replacement
(ankylosis-related) resorption, and describe their
respective treatment strategies.
 Management of Traumatic Dental
Injuries
Age is an important factor in trauma to teeth. By
age 14, about 25% of children will have had an
injury involving their permanent teeth.
when dental injuries occur in children, every effort
must be made to preserve pulp vitalit
Classifi cation of traumatic injuries promotes better
communication and dissemination of information.
The system used in this chapter is based on
Andreasen’s modifi cation of the World Health
Organization’s classifi cation1,3 (Bo
 Management of Traumatic Dental
Injuries
EXAMINATION AND DIAGNOSIS
history and clinical examination.
history
Chief Complaint
History of Present Illness
Medical History
Clinical Examination:
Soft Tissues
Facial Skeleton
Facial Skeleton
Teeth and Supporting Tissue
 Management of Traumatic Dental
Injuries
EXAMINATION AND DIAGNOSIS
history and clinical examination.
history
Chief Complaint
History of Present Illness
Medical History
Clinical Examination:
Soft Tissues
Facial Skeleton
Facial Skeleton
Teeth and Supporting Tissue
 Crown-Root Fractures
These fractures are usually oblique and involve
both crown and root. Anterior teeth show the
so-called chiseltype fracture, which splits the
crown diagonally and extends subgingivally to a
root surface
Management:
Emergency Care
pulpotomy or pulpectomy?
loose fragments have been removed or bonded
Need for gingivectomy , osteoplasty or
orthodontic extrusion.
Extraction and replacement.
Root Fractures
horizontal root fractures, and transverse
may be difficult to detect
Clinically, root fractures may present as mobile
or displaced teeth, with pain on biting.
Symptoms are generally mild.
Root Fractures
Generally, the more cervical the fracture, the
more mobility and displacement of the coronal
segment and a greater likelihood of pulp
necrosis of this segment if not promptly
repositioned
Root Fractures
Management
Initial treatment for root fractures repositioning
and stabilization should be classed as an acute
priority for best results.
Repositioning of displaced coronal tooth
segments is easier if performed soon after the
injury.
Root Fractures
Management
segment must be splinted to allow repair of the
periodontal tissues. Four to six weeks of
stabilization is usually sufficient, unless the
fracture location is close to the crest of the
alveolar bone, in which case longer splinting
time periods may be advisable.
Root Fractures
Sequelae of Root Fractures
Root fractures are often characterized by
development of calcific metamorphosis
(radiographic obliteration) in one (usually
coronal) or both segments; therefore EPT
reaings may be very high or absent.
Root Fractures
Sequelae of Root Fractures
Lack of response to EPT by itself, however, in the
absence of other evidence of pulp necrosis
(bony lesions laterally at the level of the fracture
or symptoms of irreversible pulpitis or necrosis)
does not indicate a need for root canal
treatment.
Root Fractures
Luxation Injuries

Luxation injuries involve trauma to the

supporting structures of teeth and often affect
the neural and vascular supply to the pulp.
the more severe luxation (involving more
displacement), the greater the damage to the
periodontium and dental pulp.
Luxation Injuries

Concussion
The tooth is sensitive to percussion only. There
is no increase in mobility, and the tooth has not
been displaced. The pulp may respond normally
to testing, and
no radiographic changes are found
Luxation Injuries

Subluxation
Teeth with subluxation injuries are sensitive to percussion
and also have increased mobility. Often sulcular bleeding
indicating vessel damage and tearing of the is present,
periodontal ligament.
The teeth are not displaced, and the pulp may respond
normally to testing
Luxation Injuries

Extrusive Luxation
These teeth have been partially displaced from the
socket along the long axis.
Extruded teeth have greatly increased mobility, and
radiographs show displacement. The pulp usually
does not respond to testing.
Luxation Injuries

Lateral Luxation
The teeth may be displaced lingually, buccally, mesially, or
distally. If the apex has been displaced
into the surrounding alveolar bone, the tooth may be
quite firm.
Percussion sensitivity may or may not be
present, with a metallic sound if the tooth is firm,
indicating that the root tip has been forced into the
alveolar bone.
Luxation Injuries

Intrusive Luxation
These teeth are forced into their sockets in an
axial (apical) direction, at times to the point of
being buried and not visible. They have no
mobility, resembling ankylosis
Luxation Injuries

Examination and Diagnosis

Monitoring pulpal status requires a schedule of pulp
testing and radiographic evaluations for a long enough
period of time to permit determination of the outcome
with a degree of certainty (may require 2 or more years).
Pulpal status is best monitored with pulp testing, radiographic
findings, developing symptoms, and observation for crown
color changes.
Luxation Injuries

Treatment of Luxation Injuries

For concussion injuries, no immediate
treatment is necessary.
Subluxation may likewise require no treatment unless
mobility is moderate; if mobility is graded 2, stabilization
may be necessary for a short period of time (1 to 2
weeks).
Luxation Injuries

Treatment of Luxation Injuries.

Extrusive and lateral luxation injuries require
repositioning and splinting. The length of time needed for
splinting varies with the severity of injury. Extrusions may
need only 2 weeks for splinting, whereas luxations that
involve bony fractures need 4 weeks.