This document discusses the classification, clinical presentation, diagnosis, and treatment of various types of traumatic dental injuries including concussions, luxations, fractures, and root fractures. It describes the visual signs, sensitivity to percussion, mobility testing, sensitivity testing, radiographic findings, objectives of treatment, and specific treatment approaches for each type of injury. The types of injuries covered include concussions, luxations, enamel fractures, enamel-dentin fractures, enamel-dentin-pulp fractures, crown fractures, crown-root fractures both with and without pulp involvement, and root fractures. Treatment may include repositioning displaced teeth, splinting, monitoring for pulp necrosis, pulp capping, pulpotomy, root canal treatment, extraction

1. TRAUMATIC
I N J U R I E S O F
TEETH
Prepared by:
Group B

2. ➢Case History
✓Chief complaint
✓History of present illness
✓Medical History
Traumatic Injuries of
Teeth

3. ➢Clinical Examination
✓External Examination
✓Soft Tissues
✓Facial Skeleton
✓Teeth and Supporting Structures
Traumatic Injuries of
Teeth

4. ➢Radiographic Examination
✓Periapical
✓Occlusal
✓Panoramic
Traumatic Injuries of
Teeth

5. ➢(1) Concussion
➢(2) Luxation
➢(3) Fracture
Traumatic Injuries of
Teeth

6. ➢tooth is not mobile
➢not displaced
➢periodontal ligament (PDL)
absorbs injury + inflammed
✓leaves tooth tender to
biting pressure + percussion
Concussion

7. ➢Visual sign:
✓not displaced
➢Percussion test:
✓tender to touch or tapping
➢Mobility test:
✓no increased mobility
Concussion

8. ➢Pulp Sensibility Test:
✓positive result
✓it is important in assessing
future risk of healing
complications
✓lack of response to the test
indicates an increased risk
of later pulp necrosis
Concussion

9. ➢Radiographic findings:
✓no radiographic
abnormalities
➢Radiographs:
✓occlusal
✓periapical
✓lateral view from mesial +
distal aspect of tooth in
question
Concussion

10. ➢Treatment Objectives:
✓usually there is no
treatment
➢Treatment:
✓monitor pulpal condition
for at least 1 year
Concussion

11. ➢Patient Instructions:
✓soft food for 1 week
✓brush with soft bristle
✓rinse with chlorhexidine
0.1% to prevent plaque
accumulation
Concussion

12. ➢tooth is displaced in
a labial, lingual or lateral
direction
➢PDL is usually torn
➢fractures of supporting
alveolus may occur
Luxation

13. ➢similar to extrusion injuries
✓partial or total separation
of periodontal ligament
Luxation

14. ➢Visual sign:
✓displaced, usually in a
palatal/lingual or labial
direction
➢Percussion test:
✓usually gives a metallic
(ankylotic) sound
➢Mobility test:
Luxation

15. ➢Pulp Sensibility Test:
✓likely give a lack of
response except for teeth
with minor displacement
✓test is important in assessing
risk of healing complications
✓positive result at the initial
examination indicates a reduced
risk of future pulp necrosis
Luxation

16. ➢Radiographic findings:
✓widened periapical ligament
space best seen on occlusal
or eccentric exposures
➢Radiographs:
✓occlusal
✓periapical
✓lateral view from mesial +
distal aspect of tooth in
question
Luxation

17. ➢Treatment Objective:
✓reposition + splint a displaced
tooth to facilitate pulp +
periodontal ligament healing
Luxation

18. ➢Treatment:
✓rinse the exposed part of root
surface with saline before
repositioning
✓apply local anesthesia
✓reposition tooth with forceps
or with digital pressure to
disengage it from its bony
socket
Luxation

19. ➢Treatment:
✓gently reposition it into
its original position
✓stabilize the tooth for 4 weeks
using a flexible splint
✓4 weeks is indicated due to
associated bone fracture
Luxation

20. ➢Patient Instructions:
✓soft food for 1 week
✓brush with soft bristle
✓rinse with chlorhexidine
0.1% to prevent plaque
accumulation
Luxation

21. ➢Ellis and Davey classification
of crown fracture is useful in
recording extent of damage to
crown
✓ Class I – simple
fracture of crown
involving little or no
dentin
✓Class II – extensive fracture
of crown involving considerable
Fracture

22. ✓ Class III – extensive fracture
of crown with an exposure of
dental pulp
✓Class IV – loss of entire crown
Fracture

23. ➢Enamel Fracture
➢Enamel-Dentin Fracture
➢Enamel-Dentin-Pulp Fracture
➢Root Fracture
Fracture

24. ➢fracture confined to the
enamel with loss of tooth
structure
Enamel Fracture

25. ➢Visual sign:
✓visible loss of enamel
✓no visible sign of exposed
dentin
➢Percussion test:
✓not tender
✓if tenderness is observed
evaluate tooth for a possible
luxation or root fracture injury
Enamel Fracture

26. ➢Mobility test:
✓normal mobility
➢Sensibility test:
✓usually positive
✓test may be negative initially
indicating transient pulpal
damage
Enamel Fracture

27. ➢Sensibility test:
✓monitor pulpal response
until definitive pulpal
diagnosis can be made
✓test is important in assessing
risk of future healing
complications
✓lack of response at initial
examination indicates an increased
risk of later pulpal necrosis
Enamel Fracture

28. ➢Radiographic findings:
✓enamel lost is visible
➢Radiographs:
✓occlusal
✓periapical
✓recommended to rule out
possible presence of root
fracture or a luxation injury
Enamel Fracture

29. ➢Treatment:
✓if tooth fragment is available,
it can be bonded to the tooth
✓grinding or restoration with
composite resin depending on
extent + location of fracture
Enamel Fracture

30. ➢fracture confined to enamel
+ dentin with loss of tooth
structure, but not involving
pulp
Enamel-Dentin Fracture

31. ➢Visual sign:
✓visible loss of enamel
+ dentin
✓no visible sign of exposed
pulp tissue
➢Percussion test:
✓not tender
✓if tenderness is observed
evaluate tooth for a possible
luxation or root fracture injury
Enamel-Dentin Fracture

32. ➢Mobility test:
✓normal mobility
➢Sensibility test:
✓usually positive
✓test may be negative initially
indicating transient pulpal
damage
Enamel-Dentin Fracture

33. ➢Sensibility test:
✓monitor pulpal response
until definitive pulpal
diagnosis can be made
✓test is important in assessing
risk of future healing
complications
✓lack of response at initial
examination indicates an increased
risk of later pulpal necrosis
Enamel-Dentin Fracture

34. ➢Radiographic findings:
✓enamel-dentin lost
is visible
➢Radiographs:
✓occlusal
✓periapical
✓recommended to rule out
displacement or possible
presence of root fracture
Enamel-Dentin Fracture

35. ➢Treatment:
✓if tooth fragment is available,
it can be bonded to the tooth
✓otherwise perform provisional
treatment by covering exposed
dentin with glass ionomer
or a permanent restoration
using a bonding agent +
composite resin
Enamel-Dentin Fracture

36. ➢(Complicated Crown Fracture)
➢a fracture involving enamel +
dentin with loss of tooth
structure + exposure of pulp
Enamel-Dentin-Pulp
Fracture

37. ➢Visual sign:
✓visible loss of enamel
+ dentin
✓exposed pulp tissue
➢Percussion test:
✓not tender
✓if tenderness is observed
evaluate tooth for a possible
luxation or root fracture injury
Enamel-Dentin-Pulp
Fracture

38. ➢Mobility test:
✓normal mobility
➢Sensibility test:
✓usually positive
Enamel-Dentin-Pulp
Fracture

39. ➢Sensibility test:
✓test is important in assessing
risk of future healing
complications
✓lack of response at initial
examination indicates an increased
risk of later pulpal necrosis
Enamel-Dentin-Pulp
Fracture

40. ➢Radiographic findings:
✓lost of tooth substance
is visible
➢Radiographs:
✓occlusal
✓periapical
✓recommended to rule out
displacement or possible
presence of luxation or root
fracture
Enamel-Dentin-Pulp
Fracture

41. ➢Treatment:
✓if young patients with open
apices, it is very important to
preserve pulp vitality by
pulp capping or partial
pulpotomy in order to secure
further root development
✓this treatment is also
treatment of choice in patients
with closed apices
Enamel-Dentin-Pulp
Fracture

42. ➢Treatment:
✓Calcium hydroxide compunds
+ MTA are suitable materials
for such procedures
✓in older patients with closed
apices + luxation injury with
displacement, root canal
treatment is usually
treatment of choice
Enamel-Dentin-Pulp
Fracture

43. ➢fracture involving:
✓enamel
✓dentin
✓cementum
✓with loss of tooth structure
✓but not exposing pulp
Crown-Root Fracture
without pulp involvement

44. ➢Visual sign:
✓crown fracture extending
below gingival margin
➢Percussion test:
✓tender
Crown-Root Fracture
without pulp involvement

45. ➢Mobility test:
✓coronal fragment mobile
➢Sensibility test:
✓usually positive for apical
fragment
Crown-Root Fracture
without pulp involvement

46. ➢Radiographic findings:
✓apical extension of fracture
usually not visible
➢Radiographs:
✓occlusal
✓periapical
✓recommended to detect fracture
lines in root
✓cone beam exposure can reveal
whole fracture extension
Crown-Root Fracture
without pulp involvement

47. ➢Treatment:
✓Fragment removal only
• removal of superficial
coronal crown-root fragment
• subsequent restoration of
exposed dentin above gingival
level
Crown-Root Fracture
without pulp involvement

48. ➢Treatment:
✓Fragment removal + gingivectomy
(sometimes ostectomy)
• removal of coronal segment
with subsequent endodontic
treatment + restoration with
a post-retained crown
Crown-Root Fracture
without pulp involvement

49. ➢Treatment:
✓Orthodontic extrusion of
apical fragment
• removal of coronal segment
with subsequent endodontic
treatment + orthodontic
extrusion of remaining root
with sufficient length after
extrusion to support a post-
retained crown
Crown-Root Fracture
without pulp involvement

50. ➢Treatment:
✓Surgical extrusion
• removal of mobile
fractured fragment
• subsequent surgical
repositioning of root in a more
coronal position
Crown-Root Fracture
without pulp involvement

51. ➢Treatment:
✓Decoronation (root submergence)
• implant solution is planned,
root fragment may be left in
situ after in order to avoid
alveolar bone resorption
• thereby maintaining volume of
alveolar process for later
implant installation
Crown-Root Fracture
without pulp involvement

52. ➢Treatment:
✓Extraction
• with immediate or delayed
implant-retained crown
restoration or a coventional
bridge
• fractures with severe apical
extension, the extreme being
a vertical fracture
Crown-Root Fracture
without pulp involvement

53. ➢fracture involving:
✓enamel
✓dentin
✓cementum
✓with loss of tooth structure
✓exposure of pulp
Crown-Root Fracture
with pulp involvement

54. ➢Visual sign:
✓crown fracture extending
below gingival margin
➢Percussion test:
✓tender
Crown-Root Fracture
with pulp involvement

55. ➢Mobility test:
✓coronal fragment mobile
➢Sensibility test:
✓usually positive for apical
fragment
Crown-Root Fracture
with pulp involvement

56. ➢Radiographic findings:
✓apical extension of fracture
usually not visible
➢Radiographs:
✓occlusal
✓periapical
✓cone beam exposure can reveal
whole fracture extension
Crown-Root Fracture
without pulp involvement

57. ➢Treatment:
✓Fragment removal + gingivectomy
(sometimes ostectomy)
• removal of coronal segment
with subsequent endodontic
treatment + restoration with
a post-retained crown
Crown-Root Fracture
with pulp involvement

58. ➢Treatment:
✓Orthodontic extrusion of
apical fragment
• removal of coronal segment
with subsequent endodontic
treatment + orthodontic
extrusion of remaining root
with sufficient length after
extrusion to support a post-
retained crown
Crown-Root Fracture
with pulp involvement

59. ➢Treatment:
✓Surgical extrusion
• removal of mobile
fractured fragment
• subsequent surgical
repositioning of root in a more
coronal position
Crown-Root Fracture
with pulp involvement

60. ➢Treatment:
✓Decoronation (root submergence)
• implant solution is planned,
root fragment may be left in
situ after in order to avoid
alveolar bone resorption
• thereby maintaining volume of
alveolar process for later
implant installation
Crown-Root Fracture
with pulp involvement

61. ➢Treatment:
✓Extraction
• with immediate or delayed
implant-retained crown
restoration or a coventional
bridge
• fractures with severe apical
extension, the extreme being
a vertical fracture
Crown-Root Fracture
with pulp involvement

62. ➢fracture confined to the
root of tooth involving:
✓cementum
✓dentin
✓pulp
Root Fracture

63. ➢Visual sign:
✓coronal segment may be
mobile
✓some cases displaced
✓transient crown discoloration
(red or gray) may occur
✓bleeding from gingival sulcus
may be noted
Root Fracture

64. ➢Percussion test:
✓tooth may be tender
➢Mobility test:
✓coronal segment may be
mobile
Root Fracture

65. ➢Sensibility test:
✓the test is important in assessing
risk of healing complications
✓a positive sensibility test
at the initial examination
indicates a significantly
reduced risk of later pulpal
necrosis
Root Fracture

66. ➢Sensibility test:
✓may give negative results
initially
✓indicating transient or permanent
neural damage
✓pulp sensibility test is usually
negative for root fractures
except for teeth with minor
displacements
Root Fracture

67. ➢Radiographic findings:
✓root fracture line is
usually visible
✓fracture involves root of
the tooth in a horizontal
or diagonal plane
Root Fracture

68. ➢Treatment:
✓rinse exposed root surface
with saline before repositioning
✓if displaced, reposition the
coronal segment of the tooth as
soon as possible
✓check that correct position
has been reached radiographically
Root Fracture

69. ➢Treatment:
✓stabilize the tooth with flexible
splint for 4 weeks
✓if the root fracture is near
cervical area of the tooth
stabilization is beneficial for
a longer period of time (upto 4
months)
Root Fracture

70. ➢Treatment:
✓monitor healing for at least
1 year to determine pulpal
status
✓if pulp necrosis develops, then
root canal treatment of the
coronal tooth segment to
the fracture is indicated
Root Fracture

71. References:
❖ Books
➢ McDonald, Avery et al: Dentistry for
the Child and Adolescent
• (pages 458-459)
❖ Internet
➢http://www.dentaltraumaguide.org