This document summarizes the treatment of traumatic dental injuries in primary and permanent teeth. It discusses that primary teeth are more likely to be displaced than fractured due to thinner bone and root resorption. The effects of injury can be immediate on primary teeth through displacement like intrusion or extrusion, or indirect on permanent teeth through conditions like hypoplasia. Treatment depends on the specific injury and may include repositioning displaced teeth, extraction, or pulp therapy and fillings for fractures. Complications from injuries can include pulp necrosis, discoloration, resorption, or ankylosis. Prompt treatment is important to prevent further issues.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
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2. College of Dentistry
Pedodontic II
Management of Traumatic Injuries in
Children - 4 -
Dr. Hazem El Ajrami
Master Degree in Orthodontic & Pedodontic
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3. Treatment of Traumatic Dental Injuries
(Primary Dentition)
Primary teeth are more likely to be displaced
than fractured because of:
The thinner and more elastic alveolar bone.
Physiological resorption, which reduces the
root length.
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4. The effect of injury in the deciduous dentition
falls into two categories:
Immediate effect on the primary teeth:
Displacement: Intrusion, extrusion or
avulsion.
Fracture: Crown-root fracture (very rare).
Indirect effect on the unerupted permanent
teeth:
Hypoplasia: Turner's hypoplasia.
Hypomineralization.
Dilaceration.
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5. Treatment of fractured primary teeth:
Enamel fractures: smooth sharp edges,
Enamel and dentin fractures: acid etch
composite.
Fractures involving pulp: pulp therapy or
extraction.
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6. Traumatized anterior teeth that have become
non-vital: no treatment is required unless there
are signs of a pathological condition (i.e. pain,
abscess and fistula). Treatment can be either
pulpectomy then filing with resorbable paste or
extraction.
Fractures of root of primary tooth: extraction.
N.B.
Children below 4 years of age are usually
treated under general anesthesia.
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7. Treatment of displaced primary teeth:
Intrusion:
In almost all instances of intrusion,
reassurance and observation is required. Most
intruded primary teeth will re-erupt over a
period of few months. Only if there is clear
evidence that the intruded tooth is in contact
with the underlying successor consideration
should be taken for removing the intruded
tooth. Infection is unusual complication, in
which the intruded tooth should be extracted.
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8. • Extrusion:
The extruded primary tooth is usually
extracted if severely loose.
Repositioning such tooth may result in
damage to the underlying permanent
successor. In addition, providing adequate
splint to support the repositioned tooth may be
difficult in a very young child.
• Avulsion:
Avulsed primary teeth are not replanted.
The tooth should be discarded.
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9. Reaction of the tooth to trauma:
Pulp Hyperemia:
A trauma of even a so-called minor
nature is immediately followed by a condition
of pulpal hyperemia. The hyperemic condition
with a single outlet of veins leads to an
increased danger of strangulation of the
vessels.
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10.  Congestion of the blood within the pulp
chamber a short time after the injury can often
be detected in the clinical examination (the
coronal portion of the tooth will often appear
reddish as compared with the adjacent teeth).
The color change may be evident for several
weeks after the accident and is often indicative
of a poor prognosis.
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11. Internal Hemorrhage:
The dentist will occasionally observe
temporary discoloration of a tooth after injury.
Hyperemia and increased pressure may cause
the rupture of capillaries and the escape of red
blood cells with subsequent breakdown and
pigment formation. The extravasated blood
may be reabsorbed before gaining access to the
dentinal tubules, color change is noticeable
and it is temporary in nature. In more severe
cases there is pigment formation in the
dentinal tubules.
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12. • The change in color is evident within 2 to 3
weeks after injury, and the reaction is
reversible to a degree that the crown of the
injured tooth retains some of the discoloration
for an indefinite period of time.
• Discoloration that becomes evident for the first
time months or years after an accident,
however, is evidence of a necrotic pulp.
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13. Calcific Metamorphosis (Dystrophic
Calcification):
Calcific metamorphosis is a degenerative
pathologic process that ultimately leads to
obliteration of the pulp chamber and root canal.
The reaction is considered to be a physiologic
repair response of the pulp and once initiated, it
may continue until the pulp is completely
replaced with a dentine like calcified tissue.
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14. • Such teeth, their clinical crowns may have a
yellowish, opaque color and will not show any
response to various pulp tests. Primary teeth will
undergo normal physiologic resorption, and
permanent teeth will often be retained
indefinitely.
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15. Inflammatory resorption:
Inflammatory resorption can occur
externally and/or internally (pink spot). It
commonly arises following luxation injuries
when the periodontal ligament is inflamed and
the pulp is necrotic. Odontoclastic activity can
occur so rapidly that the teeth are destroyed in
a matter of weeks.
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16. • Immediate treatment of inflammatory resorption
is essential. As soon as this process is detected
radiographically, the pulp tissue in the tooth is
thoroughly extirpated. Copious irrigation with
sodium hypochlorite assists in the dissolution of
organic debris in the canal. In permanent teeth,
calcium hydroxide is placed in the canal; here
the objective is not to induce apical closure but
to create an environment unfavorable for the
resorption process.
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17. • Depending upon the severity of the
inflammatory resorption, calcium hydroxide
may need to be retained in the tooth for 6-24
months. Repeated applications may be
necessary if the resorption progresses. When
radiographs confirm that the process is not
continuing, gutta percha is placed as the final
filling material.
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18. Replacement Resorption (Ankylosis):
Replacement resorption occurs most
commonly following severe luxation injuries
like avulsion or intrusion, in which periodontal
ligament cells are destroyed. Alveolar bone
directly contacts cementum of the involved
tooth and becomes fused with it.
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19. • Then as the bone undergoes its normal,
physiologic, osteoclastic, and osteoblastic
activity, the root is resorbed or replaced with
bone, which may cause a mechanical lock or
fusion between alveolar bone and root
surfaces. Clinically ankylosed tooth appear at a
lower incisal plane than its adjacent teeth, as
they continue to erupt while the ankylosed
tooth remain fixed to surrounding structures.
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20. • This type of resorption cannot be treated once
the tooth is firmly immobilized by the process.
In young children with rapid bone turnover,
teeth are completely resorbed in 3-4 years. In
adults, the process may take up to 10 years.
Replacement resorption can be prevented only
by prompt and appropriate treatment of
luxation injuries.
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21. Pulp Necrosis:
• Little relationship exists between the type of
injury to the tooth and the reaction of the pulp
and supporting tissues. A severe blow to a
tooth causing displacement often results in
pulp necrosis; the blow may cause a severance
of the apical vessels, in which case the pulp
undergoes autolysis and necrosis.
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22. • In a less severe type of injury the hyperemia
and slowing of blood flow through the pulpal
tissue may cause eventual necrosis of the pulp.
In some cases the necrosis may not occur until
several months after the injury.
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23. Thank You
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