classification of traumatic injury of oral tissues and teeth.

1. CLASSIFICATION OF
TRAUMATIC INJURY

2. CONTENT
• Dental trauma
• Etiology
• Mechanism of dental trauma
• classification of anterior teeth trauma by sweets
• Ellis and Davey classification
• Bennett’s classification
• Modified Ellie’s classification
• Gracia godoy’s classification
• David classification
• WHO classification
• Classification by hargreaves
• Andreasen classification

3. DENTAL TRAUMA
• Dental trauma refers to trauma (injury ) to teeth or periodontium gums periodontal ligaments alveolar bone
and nearby soft tissues such as lips tongue etc.
• Injury can be defined as an interruption in the continuity of tissue
• Result of this process can either be tissue repair where the continuity is restored but the healed tissue differs in
anatomy and function or tissue regeneration
• Dental tissues are unique in comparison to most other tissues in the body due to their ability to completely
regenerate.
• Injury and its sequelae in some important structure of teeth are :-

4. • Dental follicle :- traumatic injury can be transmitted easily from the primary to permanent dentition. It has
been shown in experiments that when parts of dental follicle are removed an Ankylosis is formed between
tooth surface and the crypt
• Cervical loop :-cervical loop is highly resistant to trauma. Only profound contusion due to intrusion of primary
incisors result in total arrest odontogenesis
• Inner enamel epithelium:-in case of total loss of ameloblast in secretory phase no regenerative phase
potential exist. In case of partial damage enamel Matrix formation and maturation may be affected. If there
total loss of ameloblasts during the maturation stage hypomineralized enamel will Develop.
• Reduced enamel epithelium:- minor injury to the reduced enamel epithelium is repaired with a thin
squamous epithelium where as, Large area of destruction results in ankylosis and tooth Retention.
• Enamel and enamel matrix :- trauma to primary tooth may cause contusion of permanent matrix.
Ameloblastoma will also be destroyed there by arresting enamel maturation and resulting in permanent
hypomineralized enamel defect.
• HERS :-chronic trauma to HERS, such as orthodontic intrusion of immature teeth often leads to fragmentation.
An acute trauma to the epithelial root sheet transmitted indirectly for example:-by intrusion of a primary
tooth can damage HERS and leads to partial or complete arrest of root development.

5. • Gingival and periosteal complex:- the gingiva attachment is often torn during luxation and displacement injuries. In
injuries to the underline bone firstly the cortical bone plate loses an important part of its vascular supply and
secondly the cellular cover of bone provided by the innermost layer of periosteum is partially or totally removed.
• Periodontal ligament : cementum complex:- following a severe dental injury the periodontal ligament must respond
to a variety of injury these includes-temporary compressive, tensile or sharing stress which results in hemorrhage,
edema rupture or Contusion of the periodontal ligament.
• Dentin pulp complex :- a deviation in the composition of the organic structure of dentin may lead to fracture.
(Dentinogenesis imperfecta). Furthermore, the exposure of dentinal tubules during trauma leads to bacterial
invasion with a resultant permanent or transitory inflammation reaction in the Pulp.
Two basic response determine pulpal wound healing response- general features of the pulpal wound healing
response is replacement of damaged tissue with newly formed Pulpal tissue along the pulpodentinal border.

6. ETIOLOGY
• Falls in infancy
• Child abuse -battered child syndrome
• Sports injuries
• Horse riding
• Automobile injury
• Mental retardation and epilepsy
• Drug related injuries
• Development defects of enamel and dentin like
Dentinogenesis imperfecta.

7. MECHANISM OF DENTAL TRAUMA INJURIES
1. Direct trauma- occurs when tooth itself is stuck example against table or
chair.
2. Indirect trauma-when lower dental arch is forcefully closed against upper
dental arch example blow to chin.
3. Extent of trauma can be assessed by four factors given by hallet in 1954
• Energy of impact:- energy is equals to mass multiply by velocity. Hence if
the impacting object either has more mass or has high velocity the impact
will be more
• Resilience of impacting object:- This can be either hard or soft. More injury
is bounded to occur in the case of former and less in case of later.
• Shape of impacting object:- the nature of wound depends upon whether
the object is sharp or blunt .
• Direction of impacting force:-type of fracture will directly depend on
direction

8. CLASSIFICATION OF ANTERIOR TEETH TRAUMA BY
SWEETS (1955)
• It is mainly based on the anatomy and morphology of the tooth structure.
• The disadvantage of this classification is that no stress has been laid on
injuries to supporting structures soft tissues and bones.
• It indicated more towards permanent teeth then primary teeth.

9. CLASSIFICATION OF ANTERIOR TEETH BY SWEETS
1955
1. Class 1 A simple of crown exposing no
dentation.
2. Class 2. A parallel of crown involving little
dentin.
3. Class 3. Extensive fracture of crown
involving more dentin but no pulp exposure.
4. Class 4. Extensive fracture of crown
exposing pulp.
5. Class 5 complete fracture of crown
exposing pulp.
6. Class 6 Fracture of root with or without
loss of crown structure.
7. Class 7. Tooth loss as a result of trauma.

10. ELLIS AND DAVEY CLASSIFICATION 1960
• Class 1 simple fracture of crown involving only enamel with little or no dentin.
• Class 2 extensive fracture of crown involving considerable dentin but not exposing dental pulp.
• Class 3 extensive fracture of crown involving considerable dentin and exposing dental pulp.
• Class 4 the traumatized tooth that becomes non vital with or without loss of crown structure.
• Class 5 total tooth loss-avulsion.
• Class 6 Fracture of root with or without loss of crown.
• Class 7 displacement of tooth with neither crown nor root fracture.
• Class 8 fracture of crown en masse and its displacement.
• Class 9 tramatic injuries of primary teeth.
• . According to Cohen –cracked tooth
• . According to mathewson - cyclic Dislocation of tooth

13. BENNETT’S CLASSIFICATION
• Bennett’s classification is according to injuries to peridontium and Alveolus considering the
anatomy and morphology of the teeth which can be applied partially for primary and
permanent teeth.
• Class 1. Traumatized tooth
• 1a. Tooth is firm in Alveolus.
• . 1b. Tooth is subluxation in Alveolus
• Class 2. Coronal fracture.
• 2a. Fracture of enamel.
• 2b. Fracture of enamel and dentin.
• Class 3. Coronal fracture with pulp exposure.
• Class 4. Root fracture.
• 4a. Without coronal fracture
• 4b. With coronal fracture
• class 5. Avulsion of tooth.

14. MODIFIED ELLIS CLASSIFICATION (BY MCDONALD ,
AVERY AND LYNCH 1983)
• Class 1 simple fracture of crown involving little or no
dentin
• Class 2 extensive fracture of crown involving
considerable dentin but not the dental pulp
• Class 3 extensive fracture of the crown involving
considerable dentin and exposing the pulp
• Class 4 loss of entire crown

15. GARCIA-GODOY’S CLASSIFICATION 1984
• It is a numerically descriptive classification that holds good for the primary and permanent teeth
• It is based on andreasen’s modification of World health organisation classification
• Class 0 enamel crack
• Class 1 enamel fracture
• Class 2 enamel dentin fracture without pulp exposure
• Class 3 enamel dentin fracture with pulp exposure
• Class 4 enamel dentin cementum fracture without pulp exposure
• Class 5 enamel dentin cementum fracture with pulp exposure
• Class 6 root fracture
• Class 7 concussion
• Class 8 luxation
• Class 9 lateral displacement
• Class 10 intrusion
• Class 11 exclusion
• Class 12 avulsion

18. DAVID CLASSIFICATION 1988
• It is simple and clear classification
• Description of the incisal injuries to supporting
tissue and soft tissue has not been given
• Class 1 enamel chip of
• Class 2 enamel + dentin involvement
• Class 3 pulpal involvement
• Class 4 displacement

19. WHO CLASSIFICATION 1993
• 873.60 enamel fracture
• 873.61 enamel and dentin fracture without pulp exposure
• 873.62 enamel and dentin fracture with pulp exposure
• 873.63 root fracture
• 873.64 crown root fracture
• 873.66 concussion luxation
• 873.67 intrusion and extrusion
• 873.68 avulsion
• 873.69 soft tissue injuries

21. Injury to the soft tissue

22. CLASSIFICATION BY HARGREAVES 1999
• It is a classification on basis of the type of injury to individual tooth and injuries to the
supporting tissues and alveolar bone
• Trauma by type of injury to individual teeth
• Description
1. Fracture of enamel only
2. Fracture of involving dentin
3. Fracture involving dental pulp
4. Displacement or excessive mobility no fracture
5. Displacement or excessive mobility and fracture of enamel
6. Displacement or excessive mobility and fracture of dentin
7. Displacement or excessive mobility fracture to dental pulp
8. Displacement but no other sign of injury
9. Tooth lost because of trauma luxation

23. ANDREASEN’S CLASSIFICATION 1981
1. Injuries to hard dental tissues and pulp
2. Injuries to periodontal tissues
3. Injuries to supporting bone
4. Injuries to gingiva and oral mucosa

24. INJURIES TO HARD DENTAL TISSUES AND PULP
• Enamels infraction- incomplete fracture crack of enamel without loss of tooth substance
• Enamel fracture uncomplicated crown fracture - a fracture with loss of tooth substance confined to
enamel only
• Enamel dentin fracture uncomplicated crown fracture- a fracture with loss of tooth substance confined
to enamel dentin but not involving pulp
• Complicated crown fracture- fracture involving enamel and Dentin and also exposing Pulp
• Uncomplicated crown root fracture- Fracture involving enamel Dentin and Cementum but not exposing
pulp
• Complicated crown root fracture -fracture involving exposing dentin and cementum and also exposing
pulp
• Root fracture a fracture iinvolvin dentin cementum and pulp . They also be classified according to
displacement of coronal fragment

26. INJURIES TO PERIODONTAL TISSUE
• Concussion and injury to supporting structure without abnormal loosening or displacement of tooth but
with marked reaction to percussion
• subluxation and injury to the tooth supporting structures with abnormal loosening but without
displacement of tooth
• Extrusive luxation (peripheral dislocation and partial avulsion ) partial displacement out of its sockets.
• Lateral luxation displacement of tooth in any other direction other than axial. Accompanied by fracture
of alveolar socket
• intrusive luxation (Central dislocation): displacement of tooth into alveolar socket accompanied by
fracture of alveolar socket
• Avulsion ( exarticulation) Complete displacement out of its socket.

28. INJURIES TO THE SUPPORTING BONE
• Comminution of mandibular and maxillary alveolar socket : Crushing and compression of the alveolar
socket found mostly with intrusive and lateral luxation.
• Fracture of maxillary Or mandibular socket wall :A Fracture confined to facial or lingual socket wall.
• Fracture of maxillary or mandibular alveolar process: A fracture involving the base of mandible or
maxilla and often the alveolar process . May or may not involved alveolar socket

30. INJURY TO GINGIVA OR ORAL MUCOSA
• Laceration of gingiva or oral mucosa : shallow or Deep wound in the mucosa resulting from a tear
usually produced by sharp object
• Contusion of gingiva or oral mucosa : A bruise usually produced by impact with blunt object and not
accompanied by a break in mucosa , but usually causing submucosal hemorrhage.
• Abrasion of gingiva or oral mucosa : superficial wound produced by rubbing or scraping of mucosa
leaving a raw bleeding surface.

32. ZERMAN CAVALLERI G CLASSIFICATION 1995
• Dental trauma was divided into the following categories based on anatomic morphological aspects and injuries to supporting
tissues
• It is indicated more towards the permanent Dentition then primary dentition.
1. Fracture of enamel including enamel Chipping
2. Fracture of enamel dentin without pulpal involvement
3. Fracture of enamel Dentin with pulpal involvement
4. Fracture of root
5. Crown root fracture without palpal involvement
6. Crown root fracture with palpal involvement.
7. Concussion
8. subluxation
9. Intrusive laxation
10. Extrusive luxation
11. Lateral luxation
12. avulsion

33. SUB GINGIVAL FRACTURE CLASSIFICATION BY
HEITHERSAY AND MORILE
• They classified sub gingival fractures based on the level of tooth fracture in relation to various
horizontal plains of periodontium
• Class 1 fracture line does not extend below the level of attached gingiva
• Class 2 fracture line below the level of attached gingiva but not below the level of alveolar crest
• Class 3 fracture line extends below the level of alveolar crest
• Class 4 fracture line is within the coronal third of root but below the level of alveolar crest

35. HARGREAVES AND CRAIG CLASSIFICATION 1970
• Class 1 no fracture or fracture of enamel only with or without displacement of tooth
• Class 2 fracture of crown involving both enamel and dentin without exposing of pulp with or without
displacement of tooth
• Class 3 fracture of crown exposing the bulb with or without displacement of tooth
• Class 4 fracture of root with or without coronal fracture with or without displacement of tooth
• Class 5 total displacement of tooth

37. AL MAJED CLASSIFICATION 2001
• Classified the maxillary incisors for dental trauma
• This classification is applicable to both primary and permanent dentition
• It is based on anatomic consideration with the therapeutic and prognostic consideration
• Code 0 no trauma
• Code 1 discoloration
• Code 2 fracture involving enamel
• Code 3 fracture involving enamel and dentin
• Code 4 fracture involving enamel Dentin and pulp
• Code 5 missing due to trauma
• Code 6 acid etch composite restoration
• Code 7 permanent replacement including crown denture bridge pontic
• Code 8 temporary restoration
• Code 9 assessment could not be made when the tooth was either missing or badly broken by dental
case

38. CLASSIFICATION OF SPINAS 2002
• It is an easy to use classification of dental crown lesion that helped to gather data easily to choose the right
materials to improve communication among practitioners including by electronic means
• It consist of 4 classes ABCD and three subclasses b1 C1 D1
1. class A: All the simple enamel lesions which involve a mesial Or distal crown angle or only the incisal edges
2. Class B :all the enamel dentin lesions which involves a mesial or distal angle and the incisal edge. When a
Pulp exposition exists defined as a subclass b1
3. Class C : all the enamel dentin lesions which involves the incisal edge at least a third of the crown surface in
case of pulp exposure defined as sub class c1
4. Class D :all the enamel dentin lesion which involves a mesial or distal crown angle and the incisal or palatal
surface with root cement involvement crown route fracture in case of pulpal exposure exists as sub class D1.

39. ROCHA MJC CLASSIFICATION 2001
• This classification is based on the type of injury of the dentition and due to consideration to the coronal fractures radicular
fractures and the injuries to the supporting tissue have been laid.
1. Type of crown fracture
• Enamel fracture
• radicular fracture
• Crown fracture with pulp exposure
• Crown fracture without pulp exposure
• Coronoradicular fracture with pulp exposure
2. Type of luxation
• Subluxation
• Intrusive luxation
• Avulsion
• Concussion
• Lateral luxation
• Extrusive luxation

40. ACCORDING TO THE INTERNATIONAL CLASSIFICATION
OF DISEASE 1992
1. Injury to the hard dental tissue and pulpal enamel infraction- N502.50
2. Enamel fracture( uncompleted crown fracture) N502.50
3. Enamel dentin fracture (uncomplicated ,crown fracture) N502.51
4. Complicated crown fracture N502.52
5. Complicated crown root fracture N502.54
6. Root fracture N502.53
7. Injuries to periodontal tissue (concussion) N503.20
8. Subluxation N503.20
9. Extrusive relaxation (peripheral dislocation ,partial avulsion )N503.20
10. Lateral luxation N503.20
11. Intrusive luxation (Central dislocation) N503.20

41. ACCORDING TO THE INTERNATIONAL CLASSIFICATION
OF DISEASE 1992
• Avulsion ( exarticulation) N502.22
• Comminution of mandibular or maxillary N502.40 & N502.60
• Fracture of mandibular or maxillary alveolar socket wall N502.40 &N502.60
• Fracture of mandible or maxilla N502.61 & N502.42
• Laceration of Gingiva or oral mucosa S01.50
• Contusion of gingiva or oral mucosa S00.50
• Abrasion of Gingiva or oral mucosa S00.50

42. CLASSIFICATION OF DENTAL TRAUMA OF PRIMARY
TEETH BY FRIED AND ERICKSON 1995
• classification of hard tissue fractures
1. class 1 simple fracture of enamel only
2. Class 2 fracture involving enamel and dentin
3. Class 3 fracture extends farther into tooth with a small pulpal exposure
4. Class 4 fracture involves significant amount of pulpal exposure
5. Class 5 complete loss of tooth
6. Class 6 fracture of root
• trauma Affecting the periodontium
1. Concussion sensitivity of tooth to trauma without abnormal losing or mobility
2. Subluxation Loosening of Tooth without mobility
3. Luxation displacement of traumatized teeth

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