This document provides information on dental trauma, including definitions, causes, diagnosis, classification, and treatment. It begins with defining dental injury as damage limited to the teeth and supporting alveolar structures. Boys are more likely to experience dental trauma than girls. Causes include traffic accidents, falls, seizures, and sports injuries. Diagnosis involves examining the history, clinically examining soft tissues and teeth, and obtaining radiographs. Injuries are classified based on their severity and specific treatments are outlined for each class.

1. Dr. Mohammad A. Barayan

2. : Definition
Injury which is limited to the teeth
and supporting structures of the
.alveolus
N.B Boys are three times more
.at risk than girls
: Causes
.Traffic Accident -1
.Falls -2
.During Epileptic seizures -3
.Sport injuries -4

3. D iagnos is
Clinical
History Radiographic
examination Vitality test
Examination

4. Personal history (1
medical history (2
Previous dental history (3
( when ,how ,whereHistory of trauma ( (4

5. ? When did the accident occur (1
Theshorter the time between accident and
treatment thebetter. prognosis
? where did the accident occur (2
If the accident occurred indirty place prophylactic tetanus
is indicated
? how did the injury occur (3
Direct force under the chin → → condylar fracture
Direct force to teeth→ → Crown F, Root F, displacement

6. Extraoral Examination
Laceration ;Abrasions ;Contusions on the head and
neck can be noted visually
Anyasymmetries including deviation in mouth
.opening
Intraoral Examination
( .. Soft tissue ( tongue ; gingiva
Teeth ( displacement ; mobility ; tooth fracture ;
( colour change

7. Vitality test just following traumatic
injury often given false negative
response
Types of vitality test
Thermal pulp test (1
cold test
heat test
(2Electrical pulp test
Cavity test (3

8. *s o f t t is s u e in ju r ie s
1- Determination of child immunization
status:-
•If the child had received a primary
immunization activated with booster injection
of toxoid .
•Unimmunized child can be protected by
tetanus antitoxin.
2- Adequate debridment of the wound

9. stage of root formation -1
presence of root fractur -2
periapical radiolucencies -3
injury of the supporting periodontal membrane -4
(degree of intrusion or extrusion o the tooth)
size of the pulp -5
N. B. If a jaw fracture is suspected extaoral
radiographs indicated (panoramic and lateral
( oblique views

10. :Ellis classification
:Class I
crack or fracture of E only
:Class II
fracture of E , D with out pulp exposure
:Class III
fracture of E , D with pulp exposure
:Class IV
Fracture line passes beneath the gingival margin
:Class V
Root fracture
a( vertical b( horizontal
((apical , middle , cervical

11. : Class I
a crack of the -1 enamel
without loss of tooth
. structure
Do not require immediate
.treatment
fracture of enamel only -2
smoothing the sharp edge
regular vitality test ,
radiograph

12. : Class II
Immediate treatment of the crown is
:required to
(1protect the pulp
.restore the esthetics and function (2
Cover the expose of the dentine by a
layer of calcium hydroxide to
.reparative dentine formation
.A- Reattachment of tooth fragment
B- Acid-etch composite resin
restoration

13. : Class III
The treatment depends on many
:factors such as
.vitality of the exposed pulp (1
.Size of the exposure (2
.Time elapsed since the exposure (3
.Degree of root maturation (4
Restorability of the fractured (5
.crown
The main objective of treatment is to
. maintain the vitality of the tooth

14. Small exposure Large exposure
Early Late Early Late
Open Close open closed open closed open Closed
pulpoto pulpecto Pulpoto pulpecto Pulpe
my my my my ctomy
Direct pulp
capping pulpec
pulpecto pulpecto Apexifi tomy
my my cation

15. : Apexification

16. : Class IV
Treatment usually involve removing
. the loose fragment
tooth can be extruded -1
orthodontically
crown lengthening to -2
gain access to placement of
.restoration

17. : Class v
Horizontal Root fracture (1
When the fracture occur near the
apical 1/3, the prognosis is more
favourable than the middle or cervical 1/3
: because
more alveolar support (1
immobilization of the tooth is much easier (2
: Treatment of root fracture depends upon
Condition of the pulp (1
amount of mobility or the level of the (2
fracture line

18. A( apical 1/3 root fracture(
reduction , splinting the tooth (1
the tooth should be checked(2
periodically for vitality and
.radiograph

19. B( middle 1/3 root(
: fracture
reduction , splinting the tooth (1
the patient recall 2-3 months ,(2
checked the vitality ,radiograph
if the tooth non vital and no(3
healing the following treatment is
:performed
a( R C T of both fragments
b( apical fragment removed
surgically
c( intraradicular pin to stabilize

20. : C( cervical 1/3 root fracture(
reductin , splinting the tooth(1
recall the patient periodically and checked(2
the vitality and radiograph
if there is radiolucent and pulp necrosis the(3
following treatment is performed
a( extraction the tooth
b( removed the apical fragment
and endo-osseous
implant placed
c( orthodontic extrusion
d( if the fracture is 1-2mm
infrabony remove the
coronal segment and
osteoplasty to expose the root

21. 2) vertical root fracture :
• usually the prognosis is not favorable
• treatment of V R F :
1)extraction of the tooth
2)using co2 laser and ND:YAG laser beam

22. Concussion *
• A mild blow to the tooth resulting in mild
sensitivity requires little or no treatment
• Need only regular vitality test

23. subluxation*
• Mobility of the tooth without displacement
• Tooth may be sensitive to percussion
• If mobility is extensive splint the tooth
using the acid –etch splinting technique.
• Regular vitality test and radiograph

24. • 1) lateral luxation
• 2) intrusive luxation
• 3) extrusive luxation
• 4) avulsion

25. 1( Lateral luxation :
• Displacement of the tooth in any
direction other than the axial one
• If the patient comes immediately
after trauma reposition, splinting
• Once the tooth have solidified in
their position orthodontic
treatment is required

26. 1( Intrusion:
• Displacement the tooth into the socket
A) primary tooth:
will re-erupted over a period of few
months. If the intruded tooth is in
contact with underlying permanent tooth
should be remove
B) permanent tooth:
• a) immediate surgical repositioning ,
splinting
• b) orthodontic extrusion
• c) incomplete root formation the tooth
will erupt spontaneously

27. 2( Extrusion :
• Partially displacement the tooth out of the socket .
A) primary tooth: Treatment usually extracted
B) permanent tooth :
• reposition and splinting
• If the vitality of tooth is lost start root treatment
immediately placing calcium
• hydroxide in the canal for 6-12 month followed
permanent filling.

28. 3( Avulsion:
• Complete displacement of the tooth
from the socket .
• There are tow important factors to be
consider in cases of avulsion
• 1)time between the injury and treatment
• 2)condition under which the tooth have
been restored
• The tooth must be kept moist to
prevent damage to the fibers of PDL

29. • In many cases the initial patient contact is by
phone
• The tooth should be handled by the crown
• The tooth should be placed in suitable storage
medium (milk, unsalted water, lens solution )or
in buccal vestibule or under the tongue .
• At the dental office :
• a) information about tetanus immunization
should be obtained
• b) replantation , splinting for 1_2weeks but in
immature apices 2-3weeks
• c) calcium hydroxide should be placed
• d) RCT

30. • Small fracture through the alveolar
process.
there may be concomitant injuries
(crown, root fracture and soft tissue) managed by referral
to an oral and maxillofacial surgery .
• Treatment: redaction , splinting

31. : Types of splinting
1) acid_etched composite splinting
2) Interdental wiring
3) ( vacuum_formed plastic) splint
4) arch bare splint
• More rigid and the longer the stabilization,
the more root resorption , ankylosis that
can be expected .

32. Stabilization periods for dentoalveolar injury
Dentoalveolar injury Duration of
immobilization
Mobile tooth (1 days 10 _ 7
Tooth displacement (2 weeks 3 _ 2
Root fracture(3 months 4 _ 2
Avulsion (4 days 10 _ 7
Alveolar fracture (5 weeks 6 _ 4