DENTO ALVEOLAR INJURY

2. Orofacial trauma is involved in 15 % of all
emergency cases and of which 2% is related
to only dentoalveolar trauma.
Frequency of injury
1. Around 1yr:
2. School aged children (8-12yr):
3. 18-23 yrs age: greatest incidence
4. Older age groups:

3.  Automobile injury
 Battered child
 Child abuse
 Epilepsy
 Fall from height
 Sports related injuries
 Associated with management of comatose
patient or patient undergoing general
anesthesia.

4.  Isolated : childhood fall
 Associated with other injury: automobile
accident.
 Direct trauma to teeth: maxillay central
iincisior in patient with classII div I
malocclusion
 Indirect trauma: from blow to chin.
 High velocity impact : crown fracture
 Low velocity impact : supporting structure
fracture

5.  Sharp object: clean crown fractue
 Blunt object: luxation or root fracture.

6.  Dental trauma (single and multiple rooted)
› Primary and permanent dentition:
 Primary in boys than girls
› Impact absorption is more in younger children.
› As they are more resilient the supporting bone
get fractured
 Permanent dentition
› Sharp injuries among older children
› Crown and crown –root fracture is more
common.

7.  Concussion : A traumatic event leads to
damage to the periodontium without
loosening or displacement of the tooth.
 Subluxation. Damage to the periodontium
leads to loosening of the tooth without overt
displacement.

8.  Luxation. This is the term given to dislocation
of the tooth within its socket, leading to
loosening and some degree of displacement.
Luxation can be intrusive, extrusive or lateral
in direction.
 Avulsion: The tooth is completely displaced
from its socket.

9.  Occlusal view
 Lateral view
 90° horizontal angle with central beam
through the tooth.

10.  Class I : simple
fracture of crown
involving enamel
 Class II : extensive
fracture of crown, with
considerable amount
of dentin involved but
no pulp exposure

11.  Class III : extensive
fracture of crown, with
considerable amount of
dentin involved, with
pulp exposure.
 Class IV : traumatized
tooth becomes non vital
(with or without loss of
crown structure).
 Class V : tooth lost due
to trauma.

12.  Class VI : fracture of
root with or without
crown or root structure.
 Class VII :
displacement of the
tooth without crown
and tooth fracture.

13.  Class VIII : fracture of
crown en masse.
 Class IX : fracture of
deciduous teeth.

14.  WHO classification and its application of
international classification of diseases to
dentistry and stomatology, which was further
modified by Anderson who include
› injuries to the teeth,
› supporting structures,
› gingiva, and oral mucosa based on anatomic,
therapeutic and prognostic consideration.

15. A. Crown infraction
B. Uncomplicated crown
C. Fracture
D. Complicated crown
fracture
E. Uncomplicated crown
root fracture
F. Root fracture

16. A. Concussion
B. Subluxation (loosening)
C. Intrusive luxation (central
dislocation)
D. Extrusive luxation
(peripheral dislocation,
avulsion)
E. Lateral luxation
A. Retained root fracture
B. Exarticulation (complete
avulsion)

17. A. Communition of alveolar
socket
B. Fracture of alveolar
socket wall
C. Fracture of alveolar
process
D. Fracture of mandible or
maxilla

18. A. Lacerations of gingiva or oral mucosa
B. Contusion of gingiva or mucosa
C. Abrasion of gingiva or oral mucosa

19.  Crown infraction:
› In complete fracture/
crack of enamel
without loss of tooth
substance.

20.  Uncomplicated crown
fracture:
› Fracture confined to
enamel or involving
enamel or dentine
without exposing the
pulp.

21.  Complicated crown
fracture:
› Involves enamel and
dentine with exposure
of pulp.

22.  Uncomplicated crown
root fracture:
› Fracture involving
enamel dentine and
cementum without
exposure of pulp.

23.  Complicated crown
root fracture:
› Fracture involving
enamel dentine and
cementum with
exposure of pulp.

24.  Root fracture:
› Involves dentine
cementum and pulp

25.  Concussion :
› An injury to the tooth
supporting structure
without abnormal
loosening or
displacement to the
tooth but with marked
reaction to
percussion.

26.  Subluxation
(loosening):
› An injury to the tooth
supporting structure
with abnormal
loosening but without
displacement of tooth.

27.  Intrusive luxation (central dislocation)
› Displacement of tooth into the alveolar bone with
comminution or fracture of the alveolar socket.

28.  Extrusive luxation: (peripheral dislocation/
partial avulsion)
› partial displacement of tooth out of the alveolar
socket.

29.  Lateral luxation :
› Displacement of tooth in a direction other than
axially accompanied by a comminution or
fracture of the alveolar socket.

30.  Retained root fractured:
› Fracture with retention of the root fragment but
loss of crown segment out of the socket.

31.  Exarticulation (complete avulsion):
› Complete displacement of a root out of the
alveolar socket.

32.  Comminution of alveolar socket:
› Comminaution of alveolar socket can occur
together with intrusive and extrusive luxation.

33.  Fracture of the alveolar socket wall:
› Fracture of the alveolar socket is confined to
facial and lingual socket wall.

34.  Fracture of alveolar process:
› Fracture of alveolar process may or may not
involve the alveolar socket.

35.  Fractures of mandible or maxilla:
› A Fractures involving the base of mandible or
maxilla and often the alveolar process may or
may not involve the alveolar socket.

36.  Laceration of gingiva and oral mucosa :
› A shallow or deep wound in the mucosa result
from a tear and is usually produced by a sharp
object.
 Contusion of gingiva or mucosa:
› A bruise is usually produced by impact from a
blunt object and result in sub mucosal
hemorrhage without a break in the mucosa.

37.  Abrasion of gingiva or oral mucosa:
› A superficial wound produced by rubbing or
scrapping of the mucosa, leaving a raw bleeding
surface, constitutes an abrasion of the gingiva or
oral mucosa.

38. Thank
you

40. Section 1. Fractures and luxations of permanent teeth
Section 2. Avulsion of permanent teeth
Section 3. Traumatic injuries to primary teeth

41. Fracture of pe rmanent t eeth:
Infr action
Enamel fr actur e
Enamel - dentin fr actur e
Enamel - dentin - pulp fr actur e
Cr own - r oot fr actur e without pulp exposur e
Cr own - r oot fr actur e with pulp exposur e
Root fr actur e
Alveolar fr actur e

42. Luxationof permanent teeth:
Concussion
Subluxation
Extrusive luxation
Lateral luxation
Intrusive luxation

44. fractures of teeth and alveolar bone
 ENAMEL F RACT URE
 ENAMEL DENT IN F RACT URE
 CRO WN F RACT URE WIT H EXPO SED PULP
 CRO WN - RO O T F RACT URE
 RO O T F RACT URE
 ALVEO LAR F RACT URE

45. Luxation injuries in primary dentition
CO NCUSSIO N
SUBLUXAT IO N
EXT RUSIVE LUXAT IO N
LAT ERAL LUXAT IO N
INT RUSIVE LUXAT IO N
AVULSIO N