TRAUMATIC DENTAL INJURIES ARE THOSE INVOLVING THE TEETH ,THE ALVEOLAR PORTION OF MAXILLA AND MANDIBLE AND THE ADJACENT SOFT TISSUES.

1. BY- Dr. Prathamesh Fulsundar

2. TRAUMATIC DENTAL INJURIES
TDI -ARE THOSE INVOLVING THE TEETH ,THE
ALVEOLAR PORTION OF MAXILLA AND
MANDIBLE AND THE ADJACENT SOFT TISSUES

3. ALARMING STATISTICS
• Constitute 5-9% of total injuries
• Prevalence of TDI in primary dentition -11-30%
• Prevalence of TDI n permanent dentition -5-30%
• Boys to girls ~ 2:1
• Age - 6-18 years
• Teeth involved:
11and 21 -37%
31 and 41 -18%
32 and 42 -6%
12 and 22 -3%

4. Etiology
• Falls due to incomplete
coordination.
• Sports activities.
• Road accidents.
• Domestic violence and abuse
• Fights and assaults
• Mental retardation, epilepsy.
• Developmental defect in
enamel and dentine.
• Class II Division 1
Malocclusion
• Overjet 3-6mm or more

5. Peoples’ attitude towards TDI
• Mostly affect milk teeth hence not an issue
• Little knowledge regarding different types of injury
• Go and see family doctor in such injury
• Dentist charge a lot of money
• Knocked out teeth is a waste
• If stored –wrap in tissue or cotton
• No psychological impact on children of fractured
teeth

6. INJURIES TO THE
HARD TISSUES AND
PULP
Enamel infraction
Enamel fracture
Enamel dentin
fracture
Complicated crown
fracture
Uncomplicated
crown-root fracture
Complicated crown-
root fracture
Root fracture
INJURIES TO
PERIODONTAL
TISSUES
Concusion
Subluxation
Extrusive
luxation
Lateral luxation
Intrusive
luxation
Avulsion
INJURIES TO
SUPPORTING
BONE
Comminution
of jaws alveolar
socket wall
Fractures of
jaws alveolar
socket wall
Fracture of jaws
alveolar process
Fracture of
mandible or
maxilla
INJURIES TO
GINGIVA AND
ORAL MUCOSA
Laceration
Contusion
Abrasion
INTERNATIONAL CLASSIFICATION OF DISEASES(1992)

7. EMERGENCY MANAGEMENT AT THE
SITE OF INJURY
FRACTURED
TOOTH
Look for the broken piece
Hold the crown and not
the root
Place the piece in a cup
with patient’s saliva or cold
milk
NEVER PUT THE TOOTH IN
WATER
Take the piece and visit
dentist immediately
MOBILE/DISPLACED
TOOTH
Ask the patient to gently
close the mouth and bring
the teeth together slowly
and carefully
If the displacement is
minor the tooth will move
to the normal position
If the patient cannot bite
down do not force closure
See the dentist
immediately
KNOCKED OUT
TOOTH
Look for the tooth
Hold the crown only ,do not
touch the root
Rinse the permanent tooth in
tap water for only 10 seconds
Put it back in socket
If cannot ,then place in saliva
or cold milk
NEVER PUT THE TOOTH IN
WATER
Go to the dentist
immediately

8. MANAGEMENT OF TDI
INJURIES TO THE HARD TISSUES AND PULP
ENAMEL
INFRACTION
ENAMEL
FRACTURE
ENAMEL DENTIN
FRACTURE
COMPLICATED CROWN FRACTURE
In case of marked
infractions, etching
and sealing with
resin to prevent
discoloration of the
infraction lines.
Otherwise, no
treatment is
necessary.
Contouring or
restoration
with composite
resin
depending on
the extent and
location of the
fracture.
•If a tooth fragment is
available, it can be bonded to
the tooth.
• Otherwise perform a
provisional treatment by
covering the exposed dentin
with glass- Ionomer or a more
permanent restoration using a
bonding agent and composite
resin, or other accepted
dental restorative materials
• If the exposed dentin is
within 0.5mm ofthe pulp
(pink, no bleeding) place
calcium hydroxide base and
cover with a material such as
a glass ionomer.
•In young patients with immature, still developing
teeth, it is advantageous to preserve pulp vitality
by pulp capping or partial pulpotomy. Also, this
treatment is the choice in young patients with
completely formed teeth.
● Calcium hydroxide is a suitable material to be
placed on the pulp wound in such procedures.
● In patients with mature apical development,
root canal treatment is usually the treatment of
choice, although pulp capping or partial
pulpotomy also may be selected.
● If tooth fragment is available, it can be bonded
to the tooth.
● Future treatment for the fractured crown may
be restoration with other accepted dental
restorative materials.

9. INJURIES TO THE HARD TISSUES AND PULP
UNCOMPLICATED CROWN-
ROOT FRACTURE
COMPLICATED CROWN-ROOT
FRACTURE
ROOT FRACTURE
Emergency treatment
● As an emergency treatment a temporary
stabilization of the loose segment to adjacent
teeth can be performed until a definitive
treatment plan is made.
Emergency treatment
● As an emergency treatment a temporary
stabilization of the loose segment to adjacent
teeth.
● In patients with open apices, it is
advantageous to preserve pulp vitality by a
partial pulpotomy. This treatment is also the
choice in young patients with completely
formed teeth. Calcium hydroxide compounds
are suitable pulp capping materials. In patients
with mature apical development, root canal
treatment can be the treatment of choice.
● Reposition, if displaced, the
coronal segment of the tooth as
soon as possible.
● Check position radiographically.
● Stabilize the tooth with a flexible
splint for 4 weeks. If the root
fracture is near the cervical area of
the tooth, stabilization is beneficial
for a longer period of time (up to 4
months).
● It is advisable to monitor healing
for at least one year to determine
pulpal status.
● If pulp necrosis develops, root
canal treatment of the coronal tooth
segment to the fracture line is
indicated to preserve the
tooth.
Non-Emergency Treatment Alternatives
● Fragment removal and gingivectomy (sometimes ostectomy)
Removal of the coronal fragment with subsequent endodontic treatment and restoration with a post-
retained crown. This procedure should be preceded by a gingivectomy and sometimes ostectomy with
osteoplasty. This treatment option is only indicated in crown-root fractures with palatal subgingival
extension.
● Orthodontic extrusion of apical fragment
Removal of the coronal segment with subsequent endodontic treatment and orthodontic extrusion of the
remaining root with sufficient length after extrusion to support a post-retained crown.
● Surgical extrusion
Removal of the mobile fractured fragment with subsequent surgical repositioning of the root in a more
coronal position.
●Root submergence
An implant solution is planned, the root fragment may be left in situ.
●Extraction
Extraction with immediate or delayed implant-retained crown restoration or a conventional bridge.
Extraction is inevitable in very deep crown-root fractures, the extreme being a vertical fracture

10. INJURIES TO PERIODONTAL TISSUES
CONCUSION SUBLUXATION LATERAL LUXATION
Crushing injury to apical
vasculature and periodontal
ligament with inflammatory edema
and without abnormal loosening or
displacement
Injury to tooth supporting structure
with abnormal loosening but
without displacement of teeth
clinically.
Displacement of tooth in any
direction other than axial
● No treatment is needed.
● Monitor pulpal condition
for at least one year.
Normally no treatment is
needed, however a flexible
splint to stabilize the tooth
for patient comfort can be
used for up to 2 weeks.
● Reposition the tooth digitally
or with forceps to disengage it
from its bony lock and gently
reposition it into its original
location.
● Stabilize the tooth for 4
weeks using a flexible splint.
● Monitor the pulpal
condition.
● If the pulp becomes
necrotic, root canal treatment
is indicated to prevent root
resorption.

11. INJURIES TO PERIODONTAL TISSUES
EXTRUSIVE LUXATION INTRUSIVE LUXATION AVULSION
● Reposition the tooth by
gently re-inserting It into
the tooth socket.
● Stabilize the tooth for 2
weeks using a flexible
splint.
● In mature teeth where
pulp necrosis is anticipated
or if several signs and
symptoms indicate that the
pulp of mature or immature
teeth became necrotic, root
canal treatment is
indicated.
Teeth with incomplete root formation
● Allow eruption without intervention
● If no movement within few weeks,
initiate orthodontic repositioning.
● If tooth is intruded more than 7mm,
reposition surgically or orthodontically.
Teeth with complete root formation:
● Allow eruption without intervention if
tooth intruded less than 3mm. If no
movement after 2-4 weeks, reposition
surgically or orthodontically before
ankylosis can develop.
● If tooth is intruded 3-7 mm, reposition
surgically or orthodontically.
● If tooth is intruded beyond 7mm,
reposition surgically.
● The pulp will likely become necrotic in
teeth with complete root formation. Root
canal therapy using a temporary filling
with calcium hydroxide is recommended
and treatment should begin 2-3 weeks
after repositioning.
● Once an intruded tooth has been
repositioned surgically or orthodontically,
stabilize with a flexible splint for 4 weeks.
•The tooth is placed in saline
•If contaminated ,the root surface is
cleansed with stream of saline
•The socket is examined for evidence
of fracture.The alveolus is also
cleansed with a flow of saline to
remove contaminated coagulum
•Tooth to be reimplanted using slight
digital pressure with light pressure.
The reimplanted tooth should fit
loosely in the alveolus
•Suture gingival laceration
•Apply splint for 1 week only as
prolonged splinting of replanted tooth
causes root resorption
•Proper repositioning can now be
evaluvated by the occlusion of tooth
•Verify position radiographically
•Tetanus prophylaxis is important
•If apical foramen is closed then
perform endodontic therapy after one
week prior to removal of splint

12. Case I

13. Case II

14. Case III