How do teeth react to traumatic dental injuries

1. REACTION OF TEETH TO TRAUMATIC
INJURIES
Presented by
Dr. Rasha Hatem
Lecturer of Pediatric Dentistry and Dental Public
Health
Faculty of Oral and Dental Medicine
Cairo University

2. Treatment of Traumatic Dental Injuries in
The Primary Dentition
Primary teeth are more likely to be displaced than
fractured because of:
• The thinner and more elastic alveolar bone.
• Physiological resorption, which reduces the root length.
The effect of injury in the deciduous dentition falls into
two categories:
1) Immediate effect on the primary teeth:
Concussion
Displacement: Intrusion, extrusion or avulsion.
Fracture: Crown-root fracture (very rare).

3. 2) Indirect effect on the unerupted permanent teeth:
Hypoplasia: Turner’s hypoplasia.
Hypomineralization
Dilaceration
I. Treatment of fractured primary teeth
- Enamel and dentin fractures
- Enamel fractures

4. - Fractures involving pulp:
- Traumatized anterior teeth that have become non-vital:
 No treatment is required unless there are signs of a
pathological condition (i.e. pain, abscess and fistula).
 Treatment can be either pulpectomy then filling with
resorbable paste or extraction.
- Fractures of root of primary teeth

5. II. Treatment of displaced primary teeth
The intruded primary tooth will re-erupt spontaneously
[either partially or completely] over a period of few
months.
 Extraction is indicated when the apex of intruded tooth
approaches the permanent tooth germ.
 Infection of the intruded primary tooth e.g. periapical
abscess necessitates its extraction.
1. Concussion:No treatment, just soft diet & follow-up.
2. Intrusion:

6. Complications following intrusion of
primary teeth
2- Gemination: Partial duplication in the part of the affected
tooth formed after injury.
1- Dilaceration:

7. 3-Turner’s hypoplasia: localized small pigmented
hypoplastic area in the permanent successor.
4- Appearance of additional cusps or denticles.

8. 3. Extrusion:
The extruded primary tooth is usually extracted if severely
loose. Repositioning such tooth may result in damage to the
underlying permanent successor. In addition, providing
adequate splint to support the repositioned tooth may be
difficult in a very young child.
4. Avulsion:
Avulsed primary teeth are not replanted to avoid injury to
the underlying permanent successor. The tooth should be
discarded

9. Reactions of tooth to trauma
1. Pulpal hyperemia:
 Follows minor trauma where there is congestion of
blood vessels in pulp chamber which may lead to
pulp necrosis .
 The hyperemic tooth appears reddish in colour as
compared to adjacent teeth.
 The hyperemic tooth may undergo resolution or necrosis
and is treated with root canal therapy.

10. 2. Internal haemorrhage:
• Occurs following trauma which results in hyperemia
and increased blood pressure in the pulp leading to
rupture of capillaries and escape of RBCs with
subsequent breakdown and pigment formation.
• Discoloration may be temporary in mild cases where
reabsorption of RBCs occurs before reaching the
dentinal tubules.
• Discoloration may be permanent in severe cases due
to pigment formation in dentinal tubules.

11. 3. Pulp calcification:
• It is a rapid physiologic repair response of the pulp to
trauma which may continue until the pulp is
completely replaced by calcified tissue. The clinical
crowns appear opaque yellow in colour and show no
response to various pulp tests
• Primary teeth will undergo normal physiologic
resorption while permanent teeth will be indefinitely
retained.

12. 4. Internal resorption:
• It is a destructive process caused by osteoclastic
activity and maybe seen radiographically in pulp
chamber or root canals a few weeks following trauma.
• It may lead to perforation of the root or the crown
may appear with a “pink spot” where vascular pulp
tissue shines through the remaining thin shell of the
tooth.

13. 5. External root resorption:
Occurs following trauma with damage to the
periodontal structures or when trauma causes tooth
displacement. The process usually continues until gross
areas of the root may be destroyed.
• If internal resorption is detected early, the pulp tissue is
extirpated and Ca(OH)2 is placed in the canal to create an
environment unfavourable for root resorption. Repeated
applications of Ca(OH)2 may be necessary until radiographs
confirm cessation of the process. Gutta percha is placed as
the final filling material.

14. 6. Pulpal necrosis:
• Occurs following trauma which causes severance of
apical vessels and decreased blood supply to the pulp.
• A necrosed tooth can be treated with root canal therapy.

15. 7. Ankylosis:
• It is the fusion of alveolar bone and root surface.
• Radiographically:
There is interruption in periodontal membrane space of
ankylosed tooth and continuity of dentin and alveolar bone.
• Clinically:
There is difference in the incisal plane of ankylosed
tooth and the adjacent (submerged)

16. .Treatment:
 In ankylosed primary anterior teeth, extraction is done
followed by a space maintainer.
 In ankylosed permanent anterior teeth, the tooth can be
covered by a jacket crown.