2. Incidence & Gender predilection
Prevalence : 9.8%
Age: peak incidence at 2- 4 y and 8 – 11 year.
Sex : males more than females ( after 9 y).
Teeth : anterior
7. Modified Ellis and Davey classification
(1970)
Class I [enamel fracture]
Class II [enamel and dentin without pulp
involvement]
Class III [fracture enamel and dentin with pulp
involvement]
Class VI [fracture crown enemas]
Class V [root fracture]
10. History
Medical Dental
Medical History : (vaccination State)
Dental History: Previous teeth trauma
Examination
Extra Oral Intra oral
Extra Oral: Neuralgic involvement, Laceration,
Asymmetries , TMJ involvement
Intra Oral: 1) Soft tissue
2) Hard tissue (vitality test)
11. Radiographic examination
• Relation od displaced 1ry
tooth to its successor
• Root Fx
• Jaw / alveolar process Fx
• Proximity of pulp tissue to
the Fx
• Maturity of the tooth
• Displacement of tooth
into/out of its socket
12. Treatment:
Diagnosis:
Extra Oral
Intra Oral – soft
tissue
Intra oral – Hard
tissue
Treatment:
Intra oral – Hard
tissue
Intra Oral – soft
tissue
Extra oral
13. Infraction
Primary dentition:
No treatment + follow up
permanent:
No treatment + follow up
Long term + wide crack =
discoloration [require
sealing]
Sensitivity [more than 2
weeks] [require sealing]
14. Uncomplicated crown fracture Ellis class I ,II
Uncomplicated
crown
fracture
Enamel
No treatment required
Roundation of the
edges + flouride
application
composite restoration
Enamel + dentin
Shallow [away from
the pulp]
composite restoration
Deep [near the pulp]
indirect pulp capping
Fragment
restoration
15. Complicated crown fracture –Ellis Class III –
[ enamel + dentin + pulp]
Pulp
treatment
Vital
open apex
large
early
partial pulpotomy
complete pulpotomy
late
Small
early direct pulp capping
late
Partial pulpotomy [3-5
mm]
complete pulpotomy
[till the CEJ]
closed apex
large
early RCT
late RCT
small early direct pulp capping
late RCT
Apexogenisis
Apexogenisis
According to clinical judgement:
Pulpotomy or apexification.
17. Ellis class IV
Corwen
amputation
Subgingival +
supra bony
retraction cord
Pulp ttt +
restoration
Subgingival +
infra bony
if less than
2mm
osteotomy +
gingivectomy
if more than
2mm
orthodontic
extrusion
18. Root fracture
A. Vertical [ extraction]
B. Horizontal :
Apical fracture( Most favorable )
No ttt required
Middle root fracture, (repositioning
and splint for 4 – 6 w)
Coronal fracture:
Splinting 3-4 months [low success
rate]
If not successful:
remove coronal part, and then
extrude.
Internally splint both fragments
Extract both fragments
19. Concussion
Trauma absorbed by PDL
causing edema within the PDL
but no rupture of the fibers.
Diagnosis:
Tender to percussion [periodontal
cells are affected]
No mobility
No displacement
Treatment:
Relife the occlusion.
Soft dite for 7 days
Follow up for any signs of tooth
necrosis
20. Subluxation
No displacement just looseness-
periodontal cells breakdown =
hemorrhage from gingival crevice.
Splint [1-2 weeks] + soft diet + out of
occlusion
Chlorohexidine MW twice daily
Follow up
21. Lateral luxation [ any direction but
apical]
Primary tooth or
permeant:
Repositioning + splint
[2-3 weeks]
Soft diet for 2 – 3 w
Antibiotic and MW
22. Intrusion
In primary:
Leave to re erupt
**Inform the parents about possibility of ankyloses ,
necrosis or damage for permanent successor
23. Intruded
permanent
tooth
Open apex
Allow to erupt for 2-
4w
No eruption occurs
Surgical extrusion +
splint for 1w + endo ttt
Orthodontic extrusion
over 3-4 w
Closed apex
Surgical traction
Orthodontic traction
Intrusion
RCT if
needed
24. Extrusion
If primary = Reposition and splint with
composite
If permanent replace and splint 2-3w
Follow up
25. Avulsion
Tell the guardian to :
make sure it is a permanent tooth (primary teeth should not
be replanted).
Find the tooth and pick it up by the crown
Avoid touching the root.
If the tooth is dirty, wash it briefly (10 seconds) under cold
running water and reposition it. Try to encourage the
patient / parent to replant the tooth.
If this is not possible, place the tooth in a suitable storage
medium, e.g. a glass of milk
Seek emergency dental treatment immediately.
26. Avulsion
Extra oral dry time less
than 60 min. The tooth
has been kept in
physiologic storage
media or osmolality
balanced media (Milk,
saline, saliva or Hank’s
Balanced Salt Solution)
.
Clean the root surface.
Administer local anesthesia
Irrigate the socket with saline.
Replant the tooth slowly.
Suture gingival lacerations if
present.
Verify normal position of the
replanted tooth both, clinically
and radiographically.
Apply a flexible splint for up to
2 weeks.
Administer systemic
antibiotics.
Initiate root canal treatment 7-
10 days after replantation and
before splint removal.
27. Extra oral dry
time
exceeding
60 min or
other
reasons
suggesting
non-viable
cells
Avulsion Remove attached non-viable
soft tissue with gauze.
Root canal treatment can be
performed prior to replantation,
or it can be done 7-10 days later.
Administer local anesthesia
Irrigate the socket with saline.
Replant the tooth slowly.
Suture gingival lacerations if
present.
Stabilize the tooth for 4 weeks
using a flexible splint.
Administer systemic antibiotics.
