2. Relevance of the topic
• Injury to the teeth is a fairly common dental problem that most
often occurs in children. According to statistics, traumatic injuries of
the teeth are detected in 41-50% of preschool children and up to 33%
of school children. Children under 6 years old learn to walk, fall from
heights, slides, swings , etc. School-age children go in for sports
(hockey, karate, football), play outdoor games, skateboard and
rollerblade. These are all situations that increase the risk of injury to
the tooth.
• Acute dental injuries arise from simultaneously acting causes. Often,
patients, especially children, do not seek help immediately, but after a
long time, which makes it difficult to diagnose and treat such lesions.
The type of injury is associated with the force of the blow, its
direction, and the place of application. The age of the patient, the
condition of the teeth and periodontium play an important role.
• Currently, there is more than one classification system for dental
injuries, but the WHO approach is the most common.
3. Classification of dislocations and
fractures
Currently, there is more than one classification system for dental injuries,
but the WHO approach is the most common. Based on it, dental injuries
are represented by 8 classes:
• I -class - bruises of the teeth, which are later accompanied by cracks in
the enamel;
• II -class - fractures of uncomplicated form;
• III -class - complicated fracture of the apex of the tooth - damage to the
crown ;
• IV -class - complete fracture of the apex of the tooth;
• V -class - longitudinal fractures that affect the root and crown of the
tooth
• VI -class - fracture of the roots of the tooth;
• VII- class - incomplete dislocation;
• VIII- class - complete dislocation.
4. Dislocation of teeth
• Dislocation of the tooth is a traumatic injury to the tooth, as a
result of which its connection with the hole is broken.
• Tooth dislocation occurs most often as a result of a blow to the
crown of the tooth. More often than others, the frontal teeth on
the upper jaw and less often on the lower jaw are exposed to
dislocation. Dislocations of premolars and molars occur most
often with the careless removal of adjacent teeth using an
elevator.
5. Incomplete dislocation
• With incomplete dislocation, part of the periodontal fibers is
torn. Fibers that have retained continuity are usually stretched
to one degree or another.
• Incomplete dislocation is characterized by a change in the
position of the crown of the tooth in the dentition and the root
in relation to the walls of the alveolus.
Pic.1. Incomplete dislocation
6. Complete dislocation
• With complete dislocation, there is a rupture of the tissues of the
entire periodontium and the circular ligament of the tooth. This leads
to the tooth falling out of the alveolus under the action of the applied
force or the own weight of the tooth. The neurovascular bundle is
always torn. Fracture of the edge of the alveolus may occur.
Sometimes the tooth is held in the alveolus by single remaining
fibers of the circular ligament of the tooth or due to the adhesive
properties of two wet surfaces: the root of the tooth and the wall of
the alveolus
Pic.2 . Complete dislocation
7. Impacted dislocation
• With an impacted dislocation, the root of the tooth is embedded deep into the
alveolar process and the body of the jaw. This can occur when hitting the cutting
edge of the tooth in the direction of its vertical axis. Impacted dislocation is
characterized by a complete rupture of periodontal fibers and, as a rule, a rupture of
the neurovascular bundle.
Pic.3. Impacted dislocation
10. Treatment of dislocations
Treatment for an incomplete dislocation includes:
• R reposition of the tooth;
• Immobilization with fiberglass tape in combination with a
light-cured composite material for 4 weeks or fixation with a
kappa or a smooth brace splint;
• Hygiene of the cavity and sparing diet;
• About review in 1 month;
• when establishing the death of the pulp - its extirpation and
canal filling .
11. Treatment for a complete dislocation includes:
• With a complete dislocation of the tooth, its replantation is
possible (no later than three days after the injury),
• extirpation and canal filling;
• replantation;
• Immobilization for 4 weeks with a kappa or a smooth splint-
bracket, fiberglass tape in combination with a light-cured
composite material ;
• mechanically sparing diet .
12. Treatment for impacted dislocation includes:
• Reposition and immobilization for 4 weeks with a kappa or a
smooth brace, fiberglass tape in combination with a light-cured
composite material;
• If reposition is not possible, tooth extraction
13. Replantation
• Replantation is the return of a tooth to its own socket.
Distinguish between immediate and delayed tooth replantation.
• With a single visit, a tooth is prepared for replantation, its root
canal is sealed, and the actual replantation is carried out,
followed by splinting .
• In delayed replantation, the avulsed tooth is washed, immersed
in saline with an antibiotic, and placed temporarily (until
replantation) in the refrigerator. After a few hours or days, the
tooth is trepanned, sealed and replanted.
14. Tooth fractures
The causes of a tooth fracture are mainly mechanical injuries
resulting from a blow or fall. The anterior teeth of the upper jaw
are more susceptible to fractures than the teeth of the lower jaw,
often fractures of the teeth are combined with their incomplete
dislocations .
Tooth fractures are :
• by type: with opening of the pulp chamber and without
opening;
• by type: transverse, longitudinal and comminuted ;
• by location: in the region of the crown, in the region of the
neck of the tooth and root.
15. Pic.4 . Fracture with opening of the pulp chamber
Pic.5. Fracture without opening the pulp chamber
Pic.6. Cracks in enamel and dentin
Pic.7 . Fracture (chip) of the crown in the enamel zone
Pic.8. Chipped crown in the enamel area
Pic.9 . Fracture of the crown in the zone of enamel and den
16. Pic.10. Fracture of the neck of the
tooth
Pic.11. Fracture of the root or root apex
17. Pic.12. Schematic representation of individual types of tooth fracture:
a - at the level of enamel and dentin without and with opening of the tooth
cavity, b - at the level of the neck of the tooth, c - transverse, at the level of
the upper third of the root, d - longitudinal, e - transverse, at the level of
the middle third of the root
18. Treatment of dental
fractures
• The tactics of treatment in relation to such teeth are decided
collegially by dentists: therapists, surgeons, orthopedists.
19. Conclusion
The study made it possible to draw the following conclusions:
• Fractures and dislocations of teeth are most common in childhood. Most
often, such a pathology is observed in the frontal section of the upper jaw. The
mechanism of injury is most often associated with the physical activity of
children.
• Timely and correct treatment avoids the occurrence of a defect with
malocclusion, biting function, aesthetic defect, complications in the form of
an inflammatory process.
• Immobilization, as the main stage in the treatment of injured teeth in children,
must meet the following requirements: the splint must be harmless to the
body, exclude the mobility of injured milk and permanent teeth, both erupted
and in the process of eruption, not interfere with other therapeutic measures,
must be atraumatic .
• The tactics of treating a fracture or dislocation of a tooth in children should be
determined on an individual basis, depending on the clinical and radiological
picture, the age of the patient, the level and quality of oral hygiene.
