Traumatic Dental Injuries
ZHU Qi
Wuhan University School of Stomatology
Classification for Injuries to the
Oral Structure —— WHO
873.60 Enamel fracture
873.61 Crown fracture without pulp involvement
873.62 Crown fracture with pulp involvement
873.63 Root fracture
873.64 Crown-root fracture
873.66 Tooth luxation (dislocation)
873.67 Intrusion or extrusion
873.68 Avulsion
873.69 Other injuries
Etiology
Falling while playing and running,16%~25%
Automobile accidents:
Sports activities
Incidence
20%~25% population suffered a dental injury
First two decades,from ages 8 to 12 years
Maxillary central incisor,lateral incisor,
Mandibular incisors.
Examination Ⅰ
History
Chief Complaint
History of Present Illness (injury)
Medical History
Examination Ⅰ
History of Present Illness (injury)
When and Where did the injury happen?
How did the injury happen?
Have you had treatment elsewhere before coming here?
Have you had similar injuries before?
Have you noticed any other symptoms since injury?
What specific problems have you had with your teeth?
Examination Ⅱ
Clinical Examination
Soft Tissues Facial Bones
Teeth Tooth Fracture
Mobility Displacement
Injury to Periodontal ligament and Alveolus
Pulpal Trauma
Examination Ⅲ
Radiographic Examination
Follow-up Evaluation
indispensable in the diagnosis and treatment.
detection, dislocation,root fracture,jaw fracture
after 6 wks,6 m,12 m,yearly for several years
Definition:
Incomplete fracture or crack of
enamel without loss of tooth
structure.
ENAMEL FRACTURE or
CROWN INFRACTION
Diagnosis and Clinic Presentation
Crack or craze line
indirect light or transillumination
UNCOMPLICATED
CROWN FRACTURE
Definition:
Fracture of the enamel only or enamel
and dentin without pulp exposure.
CROWN FRACTURE without
PULP INVOLVEMENT or
Incidence:
1/3 of all dental injuries
Uncomplicated Crown Fracture I
Uncomplicated Crown Fracture II
Diagnosis and Clinic Presentation
Enamel fracture
Enamel/dentin fracture
Treatment
Protect the pulp by sealing the dentinal
tubules by direct application of calcium
hydroxide,Dycal.
Consideration given to function and esthetic,
restoration with a bonded resin technique,
Uncomplicated crown fracture of the maxillary central incisor
CROWN FRACTURE with
PULP INVOLVEMENT or
COMPLICATED
CROWN FRACTURE
Definition:
Crown fractures involving
enamel,dentin,and pulp.
Incidence:
2% ~ 13% of all dental injuries.
Crown fracture with
pulp involvement
Treatment
?Immature teeth,preserve pulps
pulp capping,or pulpotomy
?Mature teeth,pulp extirpation,
root canal therapy,
post/core and crown restoration.
Shallow pulpotomy
CROWN ROOT FRACTURE
Definition:
Crown root fracture involving
enamel,dentin,and cementum;
pulp may or may not be involved.
Incidence:
5% of all dental injuries.
Crown root fracture
Crown root fracture of maxillary central incisor
Treatment
?The same manner as crown fractures
?A periodontal assessment is made
?Extracted or not?
ROOT FRACTURE
Definition:
Fracture of the cementum,dentin,
and pulp.
Incidence:
Less than 3% of all dental injuries.
Diagnosis and Clinic Presentation
?Displacement of the coronal segment
?X-ray examination is extremely important!
Root fracture
Treatment
Apical third,no treatment is necessary
Middle third,repositioning and splint
Coronal third,a poorer prognosis?
communication exist
Treatment of root fracture
Healing Patterns
1,Healing with calcified tissue
2,Healing with interproximal connective tissue
3,Healing with interproximal bone and
connective tissue
4,Interproximal inflammatory tissue
without healing
Healing with calcified tissue
Healing with interproximal connective tissue
Healing with interproximal bone
Healing with interproximal bone
Interproximal inflammatory tissue
LUXATION INJURY
Definition:
Concussion,No displacement,normal mobility,
sensitivity to percussion.
Subluxation,Sensitivity to percussion,increased
mobility,no displacement.
Lateral Luxation,Displacement labially,lingually,
distally,or mesially.
LUXATION INJURY
Definition:
Extrusive Luxation,Displacement in a coronal
direction.
Intrusive Luxation,Displacement in an apical
direction into the alveolus.
Incidence,the most common injury
30% ~40% of all dental injuries.
Diagnosis
Common symptom:
Sensitivity to biting or chewing
Other symptom:
Mobility
Dislocation
bleeding
Treatment
Lateral and Extrusive Luxation:
Repositioning into original position
Splint with an acid-etched technique
Follow-up
Mature tooth,RCT after 3-weeks
Immature tooth,RCT or Not?
Treatment
Intrusive Luxation:
Mature tooth:
Immature tooth:
Reeruption,if not
Orthodontic movement
be repositioned immediately
RCT after 2 weeks
Prognosis
?Pulp necrosis
?Pulp canal obliteration
?Root resorption
Lateral luxation
Lateral luxation
Extrusive luxation
Extrusive luxation
Intrusive luxation
Intrusive luxation
2 weeks
10 days
4 weeks
Primary intrusive luxation
Primary intrusive luxation
6 weeks later
6 month recall
Primary intrusive luxation
16-month recall
16-month recall
AVULSION
Definition:
Complete displacement of the tooth
out of the socket.
Incidence:
1% ~16% of all dental injuries.
Treatment
Treatment success for avulsed teeth is
directly related to the extra-alveolar time
before replantation.
The sooner an avulsed tooth is replanted,
The better the prognosis.
Guideline for avulsions
1,Rinse the tooth in cold running water.
2,Do not scrub the tooth.
3,Replace the tooth in the socket.
4,Bring the patient to the dental office right away
to complete the treatment of replantation,
Selected Clinical Procedures
Splinting Technique
Splinting Technique
Recommende Splint Periods for Various Injuries
Injury Stabilization
Luxations 2 to 8 weeks
Root fractures 8 to 12 weeks
Avulsions 1 week
Alveolar fractures 3 to 4 weeks
Root extrusion technique
?Pretreatment
?Root Canal Treatment
?Orthodontic Treatment
?Periodontal Treatment
?Prosthetic Treatment
Reference
? Andreasen JO Traumatic dental injury,
Copenhagen,Munksgard 1999
? Andreasen JO Textbook and color atlas of
traumatic injury to the teeth,3rd edition,
Copenshagen,Munksgaard,1994
? John Ingle Endodontics 5th edition 2002
? Stephen Cohen Pathways of the pulp,8th edition
2002
? William T,Johnson Color atlas of Endodontics 1st
edition 2002
ZHU Qi
Wuhan University School of Stomatology
Classification for Injuries to the
Oral Structure —— WHO
873.60 Enamel fracture
873.61 Crown fracture without pulp involvement
873.62 Crown fracture with pulp involvement
873.63 Root fracture
873.64 Crown-root fracture
873.66 Tooth luxation (dislocation)
873.67 Intrusion or extrusion
873.68 Avulsion
873.69 Other injuries
Etiology
Falling while playing and running,16%~25%
Automobile accidents:
Sports activities
Incidence
20%~25% population suffered a dental injury
First two decades,from ages 8 to 12 years
Maxillary central incisor,lateral incisor,
Mandibular incisors.
Examination Ⅰ
History
Chief Complaint
History of Present Illness (injury)
Medical History
Examination Ⅰ
History of Present Illness (injury)
When and Where did the injury happen?
How did the injury happen?
Have you had treatment elsewhere before coming here?
Have you had similar injuries before?
Have you noticed any other symptoms since injury?
What specific problems have you had with your teeth?
Examination Ⅱ
Clinical Examination
Soft Tissues Facial Bones
Teeth Tooth Fracture
Mobility Displacement
Injury to Periodontal ligament and Alveolus
Pulpal Trauma
Examination Ⅲ
Radiographic Examination
Follow-up Evaluation
indispensable in the diagnosis and treatment.
detection, dislocation,root fracture,jaw fracture
after 6 wks,6 m,12 m,yearly for several years
Definition:
Incomplete fracture or crack of
enamel without loss of tooth
structure.
ENAMEL FRACTURE or
CROWN INFRACTION
Diagnosis and Clinic Presentation
Crack or craze line
indirect light or transillumination
UNCOMPLICATED
CROWN FRACTURE
Definition:
Fracture of the enamel only or enamel
and dentin without pulp exposure.
CROWN FRACTURE without
PULP INVOLVEMENT or
Incidence:
1/3 of all dental injuries
Uncomplicated Crown Fracture I
Uncomplicated Crown Fracture II
Diagnosis and Clinic Presentation
Enamel fracture
Enamel/dentin fracture
Treatment
Protect the pulp by sealing the dentinal
tubules by direct application of calcium
hydroxide,Dycal.
Consideration given to function and esthetic,
restoration with a bonded resin technique,
Uncomplicated crown fracture of the maxillary central incisor
CROWN FRACTURE with
PULP INVOLVEMENT or
COMPLICATED
CROWN FRACTURE
Definition:
Crown fractures involving
enamel,dentin,and pulp.
Incidence:
2% ~ 13% of all dental injuries.
Crown fracture with
pulp involvement
Treatment
?Immature teeth,preserve pulps
pulp capping,or pulpotomy
?Mature teeth,pulp extirpation,
root canal therapy,
post/core and crown restoration.
Shallow pulpotomy
CROWN ROOT FRACTURE
Definition:
Crown root fracture involving
enamel,dentin,and cementum;
pulp may or may not be involved.
Incidence:
5% of all dental injuries.
Crown root fracture
Crown root fracture of maxillary central incisor
Treatment
?The same manner as crown fractures
?A periodontal assessment is made
?Extracted or not?
ROOT FRACTURE
Definition:
Fracture of the cementum,dentin,
and pulp.
Incidence:
Less than 3% of all dental injuries.
Diagnosis and Clinic Presentation
?Displacement of the coronal segment
?X-ray examination is extremely important!
Root fracture
Treatment
Apical third,no treatment is necessary
Middle third,repositioning and splint
Coronal third,a poorer prognosis?
communication exist
Treatment of root fracture
Healing Patterns
1,Healing with calcified tissue
2,Healing with interproximal connective tissue
3,Healing with interproximal bone and
connective tissue
4,Interproximal inflammatory tissue
without healing
Healing with calcified tissue
Healing with interproximal connective tissue
Healing with interproximal bone
Healing with interproximal bone
Interproximal inflammatory tissue
LUXATION INJURY
Definition:
Concussion,No displacement,normal mobility,
sensitivity to percussion.
Subluxation,Sensitivity to percussion,increased
mobility,no displacement.
Lateral Luxation,Displacement labially,lingually,
distally,or mesially.
LUXATION INJURY
Definition:
Extrusive Luxation,Displacement in a coronal
direction.
Intrusive Luxation,Displacement in an apical
direction into the alveolus.
Incidence,the most common injury
30% ~40% of all dental injuries.
Diagnosis
Common symptom:
Sensitivity to biting or chewing
Other symptom:
Mobility
Dislocation
bleeding
Treatment
Lateral and Extrusive Luxation:
Repositioning into original position
Splint with an acid-etched technique
Follow-up
Mature tooth,RCT after 3-weeks
Immature tooth,RCT or Not?
Treatment
Intrusive Luxation:
Mature tooth:
Immature tooth:
Reeruption,if not
Orthodontic movement
be repositioned immediately
RCT after 2 weeks
Prognosis
?Pulp necrosis
?Pulp canal obliteration
?Root resorption
Lateral luxation
Lateral luxation
Extrusive luxation
Extrusive luxation
Intrusive luxation
Intrusive luxation
2 weeks
10 days
4 weeks
Primary intrusive luxation
Primary intrusive luxation
6 weeks later
6 month recall
Primary intrusive luxation
16-month recall
16-month recall
AVULSION
Definition:
Complete displacement of the tooth
out of the socket.
Incidence:
1% ~16% of all dental injuries.
Treatment
Treatment success for avulsed teeth is
directly related to the extra-alveolar time
before replantation.
The sooner an avulsed tooth is replanted,
The better the prognosis.
Guideline for avulsions
1,Rinse the tooth in cold running water.
2,Do not scrub the tooth.
3,Replace the tooth in the socket.
4,Bring the patient to the dental office right away
to complete the treatment of replantation,
Selected Clinical Procedures
Splinting Technique
Splinting Technique
Recommende Splint Periods for Various Injuries
Injury Stabilization
Luxations 2 to 8 weeks
Root fractures 8 to 12 weeks
Avulsions 1 week
Alveolar fractures 3 to 4 weeks
Root extrusion technique
?Pretreatment
?Root Canal Treatment
?Orthodontic Treatment
?Periodontal Treatment
?Prosthetic Treatment
Reference
? Andreasen JO Traumatic dental injury,
Copenhagen,Munksgard 1999
? Andreasen JO Textbook and color atlas of
traumatic injury to the teeth,3rd edition,
Copenshagen,Munksgaard,1994
? John Ingle Endodontics 5th edition 2002
? Stephen Cohen Pathways of the pulp,8th edition
2002
? William T,Johnson Color atlas of Endodontics 1st
edition 2002
