pediatric dentistry

1. By:
Dr : Najma Alamami

2. Outlines :
Introduction
Epidemiology
Etiology
Mechanismofdentalinjuries
Classificationof traumatic injuries .
DiagnosisandExamination
TreatmentofTraumaticDentalInjuries.
reactionofthetoothtotrauma

3. Introduction
↑ traffic accidents & participation in
sports activities have contributed to
making traumatic dental injuries an
emergingpublichealthproblem.

4. Introduction
The emotional impact of such an accident over the child and parents is very
strong.
The dentist must be well informed and capable of an accurate and speedy
diagnosis,followed bydefinitivetherapyleadingtothe finalrestoration.

5. Epidemiology
 Upper anteriorteetharethemostcommonlyaffected bytrauma.
Boys aremore liablethan girls.
Withdeciduous teeth,luxationinjuriesarecommon.
Inpermanentteeth,fractures arecommon.
Avulsion injuriesare3timesmore frequentinboysthaningirlsandoccur in
children 7to9yearsofage .

6. Etiology
 Falling.
 Bicycleinjuries&sportinjuries.
 PatientswithAngleclassII malocclusion.
Mentalretardation, epilepsy .
Developmentaldefectsofenamel &dentin.
Child abuse.

7. Etiology
 Angle class II
malocclusion.
Bicycle injuries & sport
injuries.
Falling.
Child abuse .
Developmental defects of
enamel & dentin.
Mental retardation ,
epilepsy .

8. Mechanismofdentalinjuries
Directtrauma :
directtothetooth.
Indirecttrauma :
transmittedfromthelower
dentalarchtotheupper.

10. 1)ByEllisanddevey(1960):
 ClassI:Simplefracture ofthecrown involvinglittleor nodentin.
 ClassII:Extensive fractureof thecrown involvingconsiderabledentin but notthe dentalpulp.
 ClassIII:Extensive fractureof crowninvolvingconsiderabledentin andexposing the dentalpulp.
 ClassIV:Traumatizedtooth becomes nonvitalwithorwithout lossof crown structure.
 ClassV:Totaltooth loss(avulsion)
 ClassVI:Fractureof root withorwithout lossof crown.
 ClassVII:Displacement of tooth withoutfracture ofcrown orroot.
 ClassVIII:Fracture ofcrown "en masse".
 ClassIX:Traumato deciduous teeth.

11. 1)ByEllisanddevey (1960):
Class III
Class II
Class I:
Class VI
Class V
Class IV
Class IX
Class VIII
Class VII

12. Modified EllisClassificationforcrown fractures
-ClassI:Simplecrown fracture involvinglittleornodentin.
-Class II: Extensivefracture of thecrowninvolvingconsiderable dentinbutnot
thedentalpulp.
-Class III:Extensivefracture ofthecrownwithanexposure ofthe dentalpulp.
-Class IV: Lossoftheentirecrown.

13. 2)W.H.OClassification(1993):
 ClassI:Toothtraumatized withcrownand rootintact.
 Class II:Coronalfracture-pulp notexposed.
 Class III:Coronalfracture-pulp exposed.
 Class IV:Coronalfracture extending subgingivally.
 ClassV:Rootfracturewithorwithoutlossofcrownstructure.
 Class VI:Displacement ofteethwithorwithoutfracture.
 Division(1):PartialDisplacement
 A-Labial,lingualorlateral.
 B-Extrusion.
 C-Intrusion.
 Division(2):CompleteAvulsion
 Class VII:Injuries todeciduous teeth.

14. 3)Andreasen classification (1981)
A. injuriestohard tissuesandpulp.
B. injuriestoperiodontaltissues.
C. Injuriestosupportingbone.
D. Injuriestogingivaandoralmucosa.

16. A)Injuries tohard tissues andpulp.
1)Infraction
incomplete fracture (crack) of the enamel with
outlossoftoothstructure.

17. A)Injuries tohard tissues andpulp.
2) Crownfracture (uncomplicated)
an enamel or an enamel-dentin fracture that does not involve
the pulp.

18. A)Injuries tohard tissues andpulp.
3) Crown fracture ( complicated) :
an enamel-dentin fracture with
pulp exposure.

19. A)Injuries tohard tissues andpulp.
4 ) Crown /root fracture :an enamel, dentin, and
cementum fracture withorwithoutpulp exposure

20. A)Injuriestohardtissuesandpulp
5) Root fracture : a dentin and
cementum fracture involving the
pulp.

22. 1) Concussion : injury to the tooth
supporting structures without abnormal
looseningordisplacementofthetooth.

23. 2)Subluxation
injury to tooth-supporting structures
with abnormal loosening but without
toothdisplacement.

24. 3 ) Lateral luxation : displacement of the tooth in
a direction other than axially. The periodontal
ligament is torn and contusion or fracture of the
supporting alveolarboneoccurs.

25. 4) Intrusion : apical displacement of tooth into
socket, compressing the periodontal ligament and
causes acrushing fracture ofthe alveolarsocket.

26. 5) Extrusion : partial displacement of the tooth
axially from the socket; partial avulsion. The
periodontalligamentusuallyistorn.

27. 6) Avulsion : complete displacement of tooth out of
socket. The periodontal ligament is severed and
fracture ofthe alveolusmay occur.

29. Fractureofmaxillaryormandibularalveolarsocket.
Fractureofmaxillaryormandibular socket wall.
Fractureofmaxillaryormandibular alveolarprocess.

31. Abrasion : superfacial wound in which the epithelial tissue is rubbed or scratched
.
Contusion : is hemorrhage of subcutaneous tissue without laceration of epithelial
tissue .itisusuallycaused bya bluntobject.
Laceration:tearingof tissue usually caused byasharp object.

32. DiagnosisandExamination
Before treating a child with dental trauma
proper medical and dental history
should be obtained followed by clinical
examination.

33. A-Medicalhistory
pointsofspecialconcernare:
-Cardiacdiseases toadminister prophylacticantibiotic therapy.
 Bleeding disorders.
 Allergies tomedication.
 Seizure disorders.
 tetanus prophylaxis:
o Ifthe patienthas not received immunization atall→passiveimmunization
(antitetanic serum) .
o Ifthe child hadalreadyreceived the triplevaccine(DPT) anddidnot receive abooster
doseinthe last5years →tetanustoxoid.

34. A-Medicalhistory
Seriousheadinjuriesmaycausecentralnervoussysteminjurywhichcould
bemanifestedby:
1-Nausea
2-Vomiting,.
3-Disorientation.
4-Lossofconsciousness.
5-Diplopea.
6-Neckstiffnesswhichmight indicatecervicalspineinjury.
Insuchcasespriorityisgiventoreferthepatienttomedicalcarewithout
delay.

35. B-Historyofdentalinjury
Thereare3mainquestionsthatshouldbeasked:
 Whenhastraumaoccurred?
Timeisamajorfactor inthetreatmentplanandprognosis.
 Wherehastraumaoccurred?
Ifthewoundiscontaminatedbysoil,thechildwillneed tetanusprophylaxis.
 Howdidtraumaoccur?
Thiswillshedlightontheseverityoftrauma.

36. c) ClinicalExamination:
After obtaining the history and recording the chief complaint and ruling out
neurologicaltrauma,thefollowingisstarted:
I- Extra - oral examination : starting with facial bones , wounds and bruises , T.M.J ,
and mandibular function. Any stiffness or pain in child's neck may be due to
cervicalspineinjury.

37. c)ClinicalExamination:
II- Intra-oralexamination :
1) Manipulation of teeth and alveolar process to determine mobility. or presence of
cracks orpulpal hyperemia .
2) Percussion cangiveanideaaboutperiodontalmembrane injury.
3) Vitalitytestisnotveryvaluableespeciallyinprimaryteeth.
4) Permanent teeth which may be in a state of shock may not respond to vitality tests.
Thetestcanberedoneafter7-10 daysoftrauma.

38. c)ClinicalExamination:
III- Radiographic Examination:
 maynotreveal anyfindingsatthetimeoftrauma.Followup
radiographsarehelpful.

39. Treatmentof
TraumaticDental
Injuries

40. Emergency treatment ofsofttissueinjury:.
1) Soft tissues → cleanedwithH2O2, warm salineandwater or surface antiseptic.
2) Profuse bleedingintotheoropharynx ornasopharynx →controlled .
3) Anyfragments orremainingtissue tags→removed.
4) Deepwounds→ sutured.
5) Antibiotic → prescribed.
6) Fluidreplacement.

41. Softtissueinjuriesoftheupperlipandtornfrenum.

42. A)Injuriestohardtissuesandpulp.
1) Infraction
Definition : incomplete fracture (crack) of the enamel withoutloss of tooth
structure.
Diagnosis:transillumination→crazelinesapparent .
Treatment : only maintain structural integrity and pulp vitality →
Complications areunusual.

43. A)Injuries tohard tissues andpulp.
2) Crownfracture (uncomplicated)
Definition: an enamel fracture or an enamel-dentin fracture that does not involve the
pulp.
 Diagnosis: Injured lips, tongue, and gingiva should be examined clinically and by
radiographcsfortoothfragments.
Treatment :
o Forsmall fractures, rough marginsandedges→ smoothing
o Forlarger fractures → protection pulp+composite restoration.
o Thept reexaminedafter2weeksandagainafter1month

45. Treatment ofcrown fracture(uncomplicated)
smoothing Composite restoration.

49. REATTACHMENTOFTOOTHFRAGMENT
1) Modifytheinnersurface ofthefragmentonly .Theouterbordersof bothtoothandfragmentshould
bepreserveduntouched.
2) Protectthepulp bycalcium hydroxide.
3) Etchbothtoothandfragment.
4) Apply enamel bondtoboththetoothandthebrokenfragment.
5) Apply compositeresintothefragment portionandsecure itbackinplace.
6) Finishbyfinishingbursordiscsifneeded.

50. (Reattachment of tooth fragment)

52. Bandthetoothtosecureatemporarydressinguntilafinal
restorationispossible
These are used if the fractured margins of the tooth cannot be easily isolated for a
bondingprocedure.
This will maintain contact with the neighboring teeth and
allows pulp vitality testing and the tooth may be restored by the acid etch
composite resin.

53. Stainlesssteelcrown:
 restoration in cases of extensive fracture with
vital pulp exposures or emergency treatment
for patientsin hospital .
 Its does not provide a means for assessing
pulpal response and it has an unpleasant
appearance.

54. A)Injuries tohard tissues andpulp.
3)Crownfracture (complicated)
 Definition:anenamel-dentin fracturewithpulp exposure.
 Treatment :
 Primary teeth : pulpotomy, pulpectomy, and extraction. Decisions are based on life expectancy of
the tooth and vitality of the pulpal tissue.(Direct pulp capping with calcium
hydroxide is not indicated.)
 Permanent teeth : direct pulp capping , partial pulpotomy , full pulpotomy or Pulpectomy ( root
canaltherapy).
 prognosis : depend upon injury to the periodontal ligament , age, size of the pulp exposure , extent
of dentinexposed ,stageof root development.

55. Treatmentof crownfracture( complicated)
direct pulp capping
1)Pt seenwithin 1-2 hours
.
2)Toothvital +small
exposure +Sufficient
crown.
Steps:washing + caoH +
Restoration
Pulpotomy :allowstheapicalportion in immature permanent
tooth(openapex)tocontinuetodevelop(apexogenesis) .
1)Pulpexposureislarge .
2)small pulpexposurebuttheptdidnotseektreatmentuntil
severalhoursordays.
3)insufficientcrowntoholdatemporaryrestoration,
5) In cases of closed apex with pulp
exposure and root fracture..
shallow orpartial pulpotomy :inflammation isnotwidespread +
1to2mmofcoronal pulpremoved +irrgation +control hemorrhage +caoH2.
conventional pulpotomy :inflammation is widespread
All coronalpulp champer removed + irrgation +controlhemorrhage +caoH2
Pulpectomy
Non vital +openapex.( blunderbusscanalorfunnel-
shaped apex)Thelumenofrootcanal islargest at
apexandsmallest inthecervicalarea →
APEXIFICATION
Mature (closedapex)→
RCT

56. Conventional pulpotomy
After 20 months (Root completion)
8 months after initial treatment,
after the class IV crown fracture

57. shalloworpartialpulpotomy
→
→

58. Criteriaforsuccessofpulpotomy:
Completionofrootdevelopment.
Absenceofclinicalsignssuchaspain,mobilityandfistula.
 Absenceofanyradiographicsignsofpathology.
 Some clinicians advise on continuing root canal therapy after the apex has
completelyclosedtoavoidan exaggeratedcalcificresponsethatwilltotallyobliterate
thecanal.

59. (APEXIFICATION)
 therapy to stimulate root growth and apical repair subsequent to pulpal necrosis in permanent
teeth.
 Technique : isolated with a rubber Dam + access opening + instrumentation + irrigation +
drying ofthecanal +caoH2 &CMCP orcaoH2 inamethylcellulose paste+restoration .
 the treatment paste is allowed to remain for 6 months → presence of a “positive stop” →
gutta-percha filling .
 If apical closure has not occurred in 6 months, the root canal is retreated with the calcium
hydroxide paste.

60. (APEXIFICATION)

61. foursuccessfulresultsofApexification treatment
1) continuedclosureofthecanalandapextoanormalappearance.
2) dome-shapedapicalclosurewiththecanalretainingablunderbussappearance.
3) noapparentradiographicchangebutapositivestopintheapicalarea.
4) positivestopandradiographicevidenceofabarriercoronaltotheanatomicapexofthe
tooth.

62. A)Injuries tohard tissues andpulp.
4)Crown/rootfracture :
 Definition:anenamel,dentin,andcementumfracturewithorwithoutpulpexposure.
 Diagnosis: clinically → a mobile coronal fragment with or without a pulp exposure ,Radiographic → a radiolucent
obliquelinethatcomprisescrownandroot .
 Treatment :
o • Primary teeth :the entire tooth should be removed when cannot be restored . unless retrieval of apical fragments may
resultindamageto thesuccedaneoustooth.
o •Permanentteeth:;
 Theemergencytreatment →stabilizethecoronalfragment.
 treatmentalternatives→removethecoronalfragment→asupragingivalrestorationor gingivectomy orextrusion.
 Ifthepulpisexposed,→pulpcapping,pulpotomy,RCT.
Note:Fracturesextending belowthegingivalmarginmaynotberestorable.

64. A)Injuries tohard tissues andpulp.
5)Rootfracture
 Definition: a dentin and cementum fracture involving the pulp .could be vertical, oblique or
horizontal oratapical,middleorcoronal thirds..
 Diagnosis:
o Clinically:amobile coronal fragmentthatmaybedisplaced.
o Radiographic :may reveal 1 or more radiolucent lines that separate the tooth fragments in horizontal
fractures.Multipleradiographicsatdifferentangulationsmayberequired .
 Treatment :
o Primaryteeth: extraction ofcoronalfragmentwithout removing apicalfragmentand observation.
o Permanent teeth: Reposition and stabilize the coronal fragment . to optimize healing of the
periodontal ligamentandneurovascularsupply →Pulpnecrosis .

65. Rootfractures inpermanent teeth:
Apicalfractures:
Havebetterprognosis thanother typesof rootfracture.
ifthetooth hasbeendisplaced,(repositioned+rigidsplintfor2-3months) .R.C.T→
initiatedwhen clinicalandx-ray signsofnecrosis orresorption areapparent.
Middlethirdfractures:
immediate reduction + endodontic treatment + immobilization (a rigid splint for 2-3
months) . If the fragments are not maintained in position, inflammation occurs with
subsequent resorption .

66. Fractureofthecoronalthirdoftheroot
If the facture line is seen to extend more than 4 mm below the gingival attachment
in an oblique fracture, or is below the level of the alveolar crest in a transverse
fracture, thenthe rootshould beextracted.
 A tooth with a short root, unsuitable for supporting a restoration, should also be
extracted.
If the fracture line-extends 1-2 mm. below the gingival margin → gingivectomy +
R.C.T+postandcore andpermanentfullcrown restorations.

68. fourtissuereactionsafterrootfracture:
1) healingwithcalcifiedtissue(consistofdentin,osteodentin,orcementum)
2) healingwithinterpositionofconnectivetissue(cementumwithconnectivetissuefibers).
3) healingwithinterpositionofboneandconnectivetissue.
4) interpositionofgranulationtissue(leastfavorable form) .

69. fourtissuereactionsafterrootfracture:

71. 1)Concussion
 Definition: injury to the tooth-supporting structures with-out abnormal loosening or
displacementofthetooth.
 Diagnosis:
o a tooth tender to percussion without mobility, displacement, or sulcular bleeding and
Radiographicabnormalitiesarenot expected.
 Treatment:
o primary teeth : unless associated infection exists, no pulpal therapy is indicated with minimal
riskforpulpnecrosis .
o maturepermanentteethwithclosed apices may→pulpalnecrosis →followed carefully.

72. 2)Subluxation
 Definition: injury to tooth-supporting structures with abnormal loosening but without tooth
displacement , may or may not have sulcular bleeding. Radiographic abnormalities are not
expected.
 Treatment:
 Primaryteeth:→followedforpathology. shouldreturnto normalwithin2weeks.
 Permanent teeth: Stabilization (flexible splint no more than 2 weeks. ) → relieve any occlusal
interferences.
 permanent teeth (closed apices) may→pulpal necrosis→ followedcarefully.

73. 3 )Lateral luxation
 Definition: displacement of the tooth in a direction other than axially. The periodontal ligament is torn and
contusion or fracture of the supporting alveolar bone occurs. The tooth usually is not mobile or tender to touch.
Radiographic →increase in PL space .
 Treatment :
 Primaryteeth : no occlusalinterference→ allow spontaneous reposition.
o occlusal interference → gently repositioned or slightly reduced if the interference is minor. ( increased risk of
developing pulp necrosis)
o Whenthe injury is severe orthe toothis nearing exfoliation→extraction .
 Permanent teeth: reposition with digital pressure and little force then stabilize the tooth . may need to be
extruded to free itself from the apical lock in the cortical bone plate. Splinting an additional 2 to 4 weeks. In
permanent teeth ( closedapices) → pulp necrosisand pulp canal obliteration .

74. laterallyluxated
Acute trauma tooralsofttissues and primaryteeth.A 2-year-old girl
fellonthefloor.
Clinical appearance 9days aftertrauma. The toothisalmost inits
originalposition,

75. 4)Intrusion
 Definition: apical displacement of tooth into socket, compressing the periodontal ligament and causes a crushing fracture of the
alveolar socket.thetooth appears tobeshortenedor,itmay appear missing.
 Thetooth is notmobile ortendertotouch. Radiographic → PL space isnot continuous.
 If the apex of tooth is displaced labially the tooth can be seen radiographically shorter than its contralateral. If is displaced palatally
thetoothappears elongated.
 Treatment:
• Primary teeth: allow spontaneous reeruption except when displaced into the developing successor. Extraction is indicated. (90% of
intrudedteeth will reeruptspontaneously in2to6months).
incases ofcompleteintrusion Ankylosis may occur.
• Permanentteeth:
o immature teethwith moreeruptivepotential (root½to ²/³formed)→spontaneouseruption(repositionpassively ) .
o In mature teeth, reposition the tooth with orthodontic or surgical extrusion ( actively) → stabilization (splint for 3 to 4 weeks) . and
initiate endodontic treatment within the first 3 weeks of the traumatic incidence. there is considerable risk for pulp necrosis, pulp canal
obliteration, and progressiverootresorption.

76. Intrusiveluxationofrightlateral andcentralincisors.
Crownfracturesareseenonbothintrudedincisorsandtheadjacentleft
centralincisor.

77. 5)Extrusion
 Definition:partialdisplacementofthetooth axiallyfromthesocket;partialavulsion.Theperiodontalligamentusually
istorn.
 Diagnosis:Clinically→thetooth appearselongatedandismobile
Radiographic→ anincreasedperiodontalligamentspaceapically.
 Treatment:
Primaryteeth:
o immaturedevelopingtooth → allow repositionspontaneouslyorrepositionandallowforhealingforminorextrusion
(<3mm).
o severeextrusionormobility,thetooth isnearingexfoliation,thechild’sinabilitytocopewiththeemergencysituation
→extraction
 Permanentteeth:
o repositionwithslowandsteadyapicalpressureandthentostabilizethetooth initsanatomicallycorrectposition. →
Splintforupto 2weeks.
o Inpermanentmatureteeth withclosedapices,thereisconsiderableriskforpulpnecrosisandpulpcanalobliteration.
Theseteethmustbefollowedcarefully.

78. 6)Avulsion
 Definition: complete displacement of tooth out of socket . The periodontal ligament is severed and
fracture ofthealveolusmayoccur.
 Diagnosis: Clinically→ tooth isnot present inthesocket .
 Radiographic→ tooth isnot intruded.
 Treatment :
 Primary teeth:Avulsedprimaryteeth should notbe replanted.
 Permanent teeth: replant→ stabilization ( Flexible splinting for 7- 14 days) + Tetanusprophylaxis
+antibioticcoverage .
 Thetooth hasthebestprognosis ifreplanted immediately.
 Inpermanent avulsedteeth, there isconsiderableriskforpulpnecrosis,root resorption, andankylosis.

79. (Avulsion)
Mediaforavulsed teeth
Ifthetoothcannotbere-plantedwithin5minutes,itshouldbestoredinamedium
:
1) Hank’sBalancedSaltSolution
2) coldmilk.
3) saliva(buccal vestibule),
4) physiologic saline,
5) water → (low osmolality)+(↑20minutes)→ adverseeffect onPDLhealing,
butitisabetterchoice thandrystorage .

80. (Avulsion)
Revascularizationofpulp :
Animmaturetooth(1.0mmapicalopening)hasthepotentialtoestablish
revascularization.
 immatureteethsoakedindoxycyclinesolutionhaveagreaterrateofpulp
revascularization.
 amaturetooth(ie,closedapexorapicalopening<1mm)haslittleorno
chanceofrevascularization.

81. (Avulsion)
(PDL)management–transitionaltherapy:
 tooth → dry environment ( ↑ 60 minutes ) → tooth is replanted →
osseous replacementresorption →ankylosed → lost.
 Toslowdown thisprocess→ remaining PDLshould be removed by gentle
scaling , soft pumice prophylaxis, gauze, or soaking the tooth in 3% citric acid
for 3minutes→sodium fluoride treatmentfor20 minutes.

82. replantingiscontraindicatedin:
1) immunocompromisedhealth .
2) severecongenitalcardiac anomalies.
3) severeuncontrolledseizure disorder.
4) severemental disability.
5) severe uncontrolleddiabetes.
6) compromisedintegrityoftheavulsed toothorsupportingtissues.

83. REACTIONOFTHETOOTHTOTRAUMA
1) Pulpalhyperemia:
Congestion of blood within the pulp chamber a short time after the injury . Tooth is
tendertopercussion.
Itiseithertotallyreversibleormaybeseverecausingnecrosisofthepulp.

84. REACTIONOFTHETOOTHTOTRAUMA
 2)Internalhemorrhage:
 Itiscaused byrupture ofcapillariesandescapeofredbloodcells,withsubsequent breakdownand
pigment formation.
 Inmildcasesthepigments mayreabsorband littlediscolorationoccurs. Inmoreseverecases the
pigments persists forthelifeofthetooth.
 Colorchangesthatoccur weeksormonths →necrotic pulp.
 Discolorationofprimaryteethdoesnotnecessarilymeanthatthetooth isnon-vitalespeciallywhen
thediscolorationoccurs1or2daysafterthetrauma.

85. 2)Internalhemorrhage:

86. REACTIONOFTHETOOTHTOTRAUMA
3)Calcific metamorphosis:(progressivecanalcalcificationordystrophiccalcification)
 Is the condition where the pulp chamber and canal are gradually obliterated by progressive
depositionofdentin.
 Thecrowns of teeth develop ayellowishopaque color.
 Primaryteeth withcalcificmetamorphosis shownormalsheddingandrequirenotreatment.
 Permanent teeth showing signs of calcific changes should be regarded as a potential focus of
infection.RCT shouldbestarted toprevent total canalobliteration.

87. Calcificmetamorphosis:(progressivecanalcalcificationor
dystrophic calcification)

88. REACTIONOFTHETOOTHTOTRAUMA
3) Pulpalnecrosis:
Occurs as a result of strangulation of apical vessels. It develops independent of
the severityofthe blow.
Root canal treatment of primary teeth is indicated if there is no extensive root
resorption orboneloss.
Permanentteethshould be treatedby routineendodontictherapy.

89. Pulpalnecrosis

90. REACTIONOFTHETOOTHTOTRAUMA
4)Internalresorption(PINKSPOT):
Isadestructiveprocess causedbyodontoclasticaction.
It may be observed radiographically in the pulp chamber or root canal after weeks or
monthsoftheinjury.
 If the progression is rapid it may cause perforation of the crown or root. To avoid this, root
canaltreatmentshouldbestarted.

91. Internalresorption(PINKSPOT ):

92. REACTIONOFTHETOOTHTOTRAUMA
5)External (peripheral) rootresorption:
 followsseveretraumawheretheperiodontal membrane hasbeen injured. thepulpnot involved.
 Thelesionoften continues unnoticed untilgrossareasof theroot havebeen destroyed.
 permanent teeth →immediate treatment ( The pulp extirpated → canal irrigated and filled
withcalciumhydroxide).
 Calciumhydroxideapplication mayberepeated tilltheprocess stops →gutta perchafilling.

93. External (peripheral) rootresorption:

94. REACTIONOFTHETOOTHTOTRAUMA
6) Replacementresorption (ankylosis):
 Results after severe injury to the periodontal ligament , with subsequent inflammation of
thefibersand invasionbyosteoclastic cells.
 By time the roots are replaced with bone due to the normal physiologic osteoclastic and
osteoblastic activity.
 Ankylosed anterior primary teeth which interfere with eruption of the successors →
extracted.
 Permanentteeth areonlyremoved iftheadjacent teeththatcontinue toeruptdriftmesially
andcause alossofarchlength.

95. 6) Replacementresorption (ankylosis)

96. Reactionofpermanent toothbudstoinjury
Discoloration
Enamelhypoplasia ( Turnertooth)
Crown orrootdilacerations
Odontoma likemalformation
Development of reparative dentin to protect the pulp if the ameloblasts are
destroyedduring earlyenamelformation
Partialortotalinterruption ofrootformation
Ectopic eruption

97. Crown malformation following intrusion of
tooth 61 at the age of 2 years irregular root
formation of the neighbouring teeth, (a)
radiological and (b) postoperative findings.

98. (b) Circular enamel hypoplasia
following subluxation of the teeth 51,
61 and 62 at the age of 3.4 years.
(a) Enamel hypoplasia following
intrusion trauma at the age of 2.8
years.

99. Enamelhypoplasia( Turnertooth)

100. Anysplintshouldbe:
1) Atraumaticandpassive.
2) Allowforvitalitytestingandendodonticaccess.
3) Easytoapplyandremove.
4) Intreatingboneorrootfractureitshouldberigid.
5) Intreatingperiodontalligamentinjuryitshouldbeflexible.

101. D, Titanium trauma splint
A, Button with stainless steel
ligature and acrylic caps B, Orthodontic archwire.
C, Fiber-filled acrylic