This document discusses the classification, assessment, and management of dental injuries involving traumatic injuries to teeth. It begins with an overview of various classification systems for dental injuries. It then discusses the general assessment of traumatic dental injuries, including patient history, clinical examination, and radiographic evaluation. The document focuses on specific injury types like crown fractures, root fractures, and luxation injuries. It provides details on pulp testing and the endodontic and restorative treatment of traumatized teeth. Classification systems help categorize injuries to determine appropriate treatment and prognosis. A thorough clinical and radiographic examination is important for assessing traumatic dental injuries. Management depends on the specific type and severity of injury.

1. Traumatic
injuries of
teeth …

2. General aspects
Crown fracture
Crown root fracture
Root fracture

3. Contents
Introduction
Classification
general aspects
- history of presenting illness
- clinical examination

4. - Mechanical stimulation
- Thermal tests
- Electrometric tests
- Laser doppler flowmetry
- Radiographic examination
Crown fractures
Crown root fractures
Root fractures

5. Endodontic management of traumatized
teeth
Orthodontic management of traumatized
teeth
Conclusion
References

6. Introduction
Traumatic dental injuries usually imply
wound healing
processes in the periodontium, the pulp and
sometimes
associated soft tissue.
The outcome of these determines the
final healing of such injuries

7. The general response of soft
and mineralized tissues to surgical and
traumatic injuries is
a sensitive process, where even minor
changes in the treatment
procedure may have an impact upon the
rate and
quality of healing

8. Epidemiology
Dental trauma is common in childhood &
adolescent
Incidence of dental trauma is 31-40% of
boys & 16-30% of girls at 5 years of age
Incidence of dental trauma is 12-33% of
boys & 4-19% of girls at 12 years of age
Boys are affected almost twice as often as
girls in both the dentitions

9. Classification
-Classification by Rabinowitch(1956)
- Classification by Ellis and Davey(1960)
- Classification by WHO 1978
- Andreasen’s modification of WHO
classification 1981
- Classification by Garcia Godoy(1981)
- modification of Ellis classification by
Mc Donald,Avery and Lynch(1983)
- Classification by Ulfohn(1985)
- Classification by Heithersay and Marde
- Classification by Hargreaves and Craig
- Currently recommended classification by WHO
modified by Andreasen and Andreasen

10. I. Classification by Rabinowitch 1956
Injuries to primary teeth
- Fracture of enamel, or slightly into dentine
- Fractures into dentine
- Fractures into the pulp
- Fractures of the root
- Comminuted fractures
- Displaced teeth

11. II. Classification by Ellis and Davey 1960
- Class I – simple fracture of crown involving
only enamel
- Class II- extensive fracture of crown with
considerable amount of dentine, with no pulp
exposure
- Class III- extensive fracture of crown, with
dentinal involvement and pulp exposure
- Class IV- traumatized tooth becomes non vital
with or without loss of crown structure

12. - Class V – tooth lost due to trauma
- Class VI- fracture of root with or without
crown fracture
- Class VII – displacement of the tooth
without crown or root fracture
- Class VIII – fracture of the crown en
masse
- Class IX- fracture of deciduous teeth

13. III. WHO Classification 1978
873.60- enamel fracture
873.61- crown fracture involving enamel, dentine
without pulpal involvement
873.62- crown fracture with pulpal involvement
873.63- root fracture
873.64- crown root fracture
873.66- luxation
873.67- intrusion or extrusion
873.68- avulsion
873.69- other injuries like soft tissue
lacerations

14. IV. WHO classification modified by
Andreasen 1981
873.64- uncomplicated crown root fracture
without pulp exposure
873.64 – complicated crown root fracture
without pulp exposure
873.66- concussion- injury to tooth
supporting structure without loosening or
displacement of tooth

15. 873.66- subluxation – an injury to tooth
supporting with abnormal loosening or
displacement of tooth
873.66- lateral luxation, displacement of
tooth in a direction other than maxillary and
accompanied by fracture of alveolar socket

16. V. Classification by Garcia and
Godoy(1981)
Class I- enamel fracture
Class II- enamel and dentine fracture
Class III- enamel and dentine fracture with
pulp exposure
Class IV- enamel, dentine and cementum
fracture

17. Class V- root fracture
Class VI – concussion
Class VII- luxation
Class VIII- extrusion
Class IX- avulsion – total displacement

18. VI. Modification of Ellis classification by Mc
Donald, Avery,Lynch (1983)
Class 1: simple fracture of crown involving
little or no dentine
Class 2: extensive fracture of crown involving
considerable dentine but not dental pulp
Class 3: extensive fracture of crown with
pulp exposure
Class 4: loss of entire crown

19. VII. Classification by Ulfohn(1985)
a. Fracture of enamel
b. Fracture of the crown with indirect pulp
exposure through the dentine
c. Fracture of crown with direct pulp
exposure

20. VIII. Classification by Heithersay and Marde
Class I- fracture line does not extent below
the level of attached gingiva
Class II- fracture line extends below attached
gingiva, not below alveolar craest
Class III- fracture line extends below alveolar
crest
Class IV- fracture line is within coronal third
of root but below level of alveolar crest

21. Class I: no fracture /fracture of enamel only
with or without displacement of tooth
Class II: fracture of crown involving enamel,
dentine without pulp exposure, with/without
tooth displacement
Class III: Fracture of crown exposing pulp,
with/without displacement of tooth
Class IV: fracture of root with/ without
coronal fracture, with/without displacement
of tooth
Class V: total displacement of tooth
IX. Classification by Hargreaves and
Craig

22. X. Classification currently recommended
by WHO modified by Andreasen and
Andreasen
Soft tissues
Lacerations – 873.69
Contusion-N 902.0
Abrasions-N 910.00

23. Tooth fractures
N 873.60- enamel fracture
N873.61- crown fractures- uncomplicated
(no pulp exposure)
N873.62-crown fractures-
complicated(with pulp exposure)
N873.64-crown root fractures
N873.63- root fractures

24. Luxation injuries
873.66- tooth concussion
873.66- subluxation
873.66- extrusive luxation
873.66- lateral luxation
873.67- intrusive luxation
873.68- avulsion

25. Facial skeletal injuries
Alveolar process- maxilla/mandible
Body of the maxillary/ mandibular bone
Temporomandibular joint

26. Classification according to J O
Andreasen & F M Andreasen
Injuries to hard dental tissues and pulp
Injuries to the periodontal tissues
Injuries to the supporting bone
Injuries to gingiva or oral mucosa

27. General aspects in dental injury
History
Clinical examination
Mechanical stimulation
Thermal tests
Electrometric tests
Laser doppler flowmetry
Radiographic examination

28. History
Delirium
Time elapsed b/n injury and treatment
Place of accident
Nature of accident

29. Previous treatment
Multiple injuries
Medical history
Cerebral involvement

30. Spontaneous pain
Reaction to thermal stimuli
Pain during mastication

31. Clinical examination
Extraoral wounds
Injury – oral mucosa, gingiva
Crown – extent of fracture, pulp
exposure, change of colour

32. Displacement of teeth
Occlusion
Mobility of teeth , alveolar fragments
Palpation of alveolar process

33. Tenderness of teeth
Pulp sensibility test

34. Mechanical stimualtion
Exposed dentine – probe – sensibility
Test cavity
Exposed pulp – cotton pledeget soaked
in saline

35. Thermal test
Heated gutta percha
Ethyl chloride
Ice
Carbon dioxide snow
Dichlor- difluormethane

36. Electric pulp test
Current is carried ionically through the
electrolytes of tooth
- Teeth wity temporary crown- dist b/n
crown and electrode-1mm or else thermal
pulp test with carbon dioxide
snow
- Stage of eruption
- Teeth orthodontic treatment

37. Laser doppler flowmetry
Laser beam – coronal aspect of pulp
Reflected light scattered by RBCs- Doppler
frequency shift
Scattered light- detected and processed to
yield a signal

38. Laser doppler flowmetry
Laser beam – coronal aspect of pulp
Reflected light scattered by RBCs- Doppler
frequency shift
Scattered light- detected and processed to
yield a signal

39. -
Disadvantages
Blood pigment – interferes with laser light
transmission
Equipment – refinement
Expensive

40. -
Radiographic examination
Stage of root formation
Injuries affecting root, periodontal
structures
Root fractures – fracture line runs parallel to
central beam

41. -
Displacement –
Lateral, extrusive luxations- widening of PDL
space
Intrusive – blurred PDL
Differing angulations - necessary

42. -
Steep occlusal exposure – root fractures,
lateral luxations with oral displacement of
crown
Extraoral r/g- direction of dislocation of
Intruded primary incisors
Bone fractures – intraoral r/g unless fracture
is confined to facial/ lingual bony plate

43. -
Jaw fractures – extraoral r/g – mandatory

44. Crown fractures …

45. Classification based on anatomic,
therapeutic and prognostic
considerations
1.Enamel infraction
2.Enamel fracture
3.Enamel dentine fracture
4.Complicated crown fracture
* Permanent dentition – 26- 76% of
dental injuries

47. Etiology
- falls
- contact sports
- automobile accidents
- foreign bodies striking the teeth
- Ocupational hazard

48. Infractions
- Cause
- Patterns
- Visualization
- Associated injuries

49. Fractures
- Single tooth involveemnt
- Max incisors
- Incisal edge, facial surface
- Concomitant luxation injuries
- Fracture of unerupted permanent teeth

50. Fractures
- Single tooth involveemnt
- Max incisors
- Incisal edge, facial surface
- Concomitant luxation injuries
- Fracture of unerupted permanent teeth

51. - Examination – cleansing the area with water
spray
- Pulp exposure
- Dentine sensitivity
- Pulp sensibility test

54. Radiographic examination
- Size of pulp, root development
- Record
- Verify hard tissue barrier over exposed pulp

55. Pathology
Infractions
- ground sections : dark lines parallel
to enamel rods
Fractures
- dentine exposure
- 20,000- 45,000 tubules

56. - Bacterial penentration
- Fluid movement
. Pulpal blood flow
. Neurogenic stimulation
- Inflammation of pulp

57. Treatment
Enamel infraction
- No treatment
- Multiple lines – seal with unfilled resin

58. Enamel dentine fractures
- Smoothing fracture lines
- Combined with orthodontic extrusion
of fractured tooth
- Restoration

59. - Maintain anatomy and occlusion
crown
- Reattachment
- Temporary crown ?? – risk of leakage

62. Treatment strategy
- Use of dentine bonding agents : should
exposed dentine be lined ?
- Ca(OH)2 lining
- Microleakage

63. - Dentine bonding agent
- Pulpal response ??
** hard setting Ca(OH)2 liner/ GIC +
dentine bonding agent - hermetic seal

64. Complicated crown fractures/ enamel
dentine crown fractures with pulp exposure
- Treatment of exposed pulp
- Provisional treatment of crown fractures
. Stainless steel crowns
. Composite resin- moulded using acrylic
crowns
. Splints

65. Definitive management of crown fractures
Previously – cast semi permanent
restorations
• Composite restorations
• Reattachment
• Full coverage crown
• Laminate veneers

67. Composite resin
- Microfilled /macrofilled /hybrid composites
- Maxillomandibular relation
- Support for centric, protrusive and
protrusive lateral functions

68. • Highly polishable hybrids – 0.04microns
microparticles, 1-3 micron macroparticles
• Heavy filled microfilled composites – 0.04
microns
• Semi polishable hybrids- 1-3 microns

69. Shade selection – utmost importance
Customized composite shade guide

70. Pulp protection
Dentine exposure – changes in the pulp ?
Lining the deepest part of fracture with hard
setting Ca(OH)2 followed by resin bonding
Splint – prior to application of splint, pulp
dentine protection

71. Primary teeth
• Sharp edges
• F varnish

72. Preparation
Bevel – not placed
Chamfer/shoulder
Bullet nosed diamond
Cervically – 1mm beyond fractured enamel and
Depth – half of enamel thickness

73. Chamfer – not too shallow
Functions
- Removes acid resistant enamel
- Resin lap joint
- Finish line
- Prism orientation

74. Acid etching
4 important considerations
1. Method
2. Time
3. Concentration
4. Type of acid used

75. Bonding resins
- Allows clinician –manipulate the composite
material
- Air inhibited layer – tight bond b/n
the composite and the bonding resin

76. Insertion of composite material
Setting against a matrix – smooth finish
Resin crown form
Odus Pella and Interberg crown forms

77. Points to bear in mind :
- Minimum labial finishing after
composite polymerizing
- Composite excess should not extend > 1mm
- Vent holes , air escape

78. • Crown matrix adapted
• Wooden wedge
• Crown form compressed labiolingually

79. Polymerising composite material
Factors
- Time of application
- Plane of direction of light source
- Distance b/n light and composite
- Shade of composite
- Nature of filler particle
- Temperature

80. Caution exercised to avoid
“Skin effect”
Undercuring

81. Finishing
Labial margin – thin tapered carbide bur
White line
Finishing knife, interproximal finishing knives
Abrasive strips
White stone

82. Disc contouring
Aluminium oxide disks
Superfine disc – hybrid composite
Paste polishing
Paste and rubber cup
Abrasive points and Prisma Gloss

83. Occlusion – verified , microfilled composite-
cohesive failure is seen
Light filled on heavy filled composite
resin sandwich technique

84. Reattachment
of the
original crown
fragment …

85. 1) It is a conservative procedure
2) Appears more natural than any other
composite.
3). color stability (Busato et al, 1998).

86. 4) Total chairside time for re-attachment
of incisal edge is less than constructing
a composite resin incisal
edge(Cavalleri and Zerman, 1995).
5) The method is much more economical.

87. [I;
Techniques
1.Placement of a circumferential bevel
before are attaching the fragment
(Simonsen, 1979 and Burke,
1991 andWalker, 1996).
2. Placement of an external chamfer at
the fracture line
after bonding(Baratieri, 1994).
3. Use of a v-shaped enamel notch.

88. 4. Placement of an internal groove
( Walker, 1996 and Baratieri, 1994).
5. Leaving a superficial overcontour of
Restorative material over the fracture
line (Reis et al, 2001 and
Badami et al, 1995).
Indian J.Sci.Res. 6(2) : 163-170, 2015
Chaudhary et al

89. Adv- restoring fracture with material
that abrades the same way as the opposing
teeth
Minimal chair time
Prior to advent of DBA, reattachment was
done with acid etching

90. Bonding using DBA – bond strength –
50-60 % of intact teeth
Remaining dentine thickness – min 0.2mm
Gluma Dentine bonding system
Most important aspect – retrieval of the
fragment

91. Treatment strategy
Depends on distance b/n pulp and fracture
surface
If small- fracture surface – covered with hard
setting Ca(OH)2, provisional restoration
Liner placement on enamel- removal of
temporary restoration

92. Interim period – fragment kept moist
If distance b/n pulp and fracture
surface is more – reattachment at
the time of injury
Temporary restoration – not eugenol
Due to complexing action of eugenol
with calcium in sound dentine

93. **
The purpose of this study was to determine the
effects of various drying and wetting storage
periods on the fractured fragment and to
reach a final conclusion as to which rehydration
period is both better and more practical under
clinical conditions.

95. Results -Compared to a 30-minute period, a
24-hour rehydration of the tooth fragment
before treatment seems to salvage enough
moisture to result in an increase in reattachment
strength.
Operative Dentistry, 2012, 37-5, 501-508
F Shirani et al

111. Esthetics following reattachment
- Discoloration
- Light cured composite , double chamfer
preparation

112. Fragment retention
– questionable
- Nowadays treated as a method to
maintain esthetics until a final treatment
option is planned

113. Laminate veneers …

114. Fracture strength – increased , prep limited
to enamel
Better esthetic results
Good material adaptation
Minimal plaque retention
Strength and survival- improved

115. Patient selection
- If composite build up is done – at least 2
weeks should elapse before initiating
preparation and impressions for ceramic veneer
- Dimensional stability of composite

116. Prognosis
Permanent teeth
Follow up after trauma
- Pulp sensibility – lowered imm after injury
- 1-8 weeks
- Pulp testing done without removing temp restn

117. Enamel infractions
- Isolated infractions – risk if pulp necrosis
less
Enamel fractures
- Risk of pulp necrosis – 0.2-1.0%

118. - Enamel dentine fractures without pulp
Involvement
- risk- 1-6%
- Stage of root development
• Constricted apices – greater risk
• Extent of periodontal injury

119. • Extent and location of fracture
horizontal, proximal superficial fractures - >>
Deep proximal fractures
• Effect of treatment
• Time interval

123. CROWN ROOT
FRACTURES

124. A fracture involving enamel, dentine
and cementum
Complicated/ uncomplicated
Etiology – direct trauma

125. Clinical presentation
Fracture starts incisal to marginal gingiva-
oblique course
Coronal aspect – held by PDL fibers
Slightly displaced fragments

126. Single/ multiple fracture line
Pain

127. Radiographic presentation
Imperceptible
Fracture line perpendicular to central beam

130. Pathology
Pulpal inflammation
Proliferation of gingiva
Osteodentine deposition ?

131. Treatment
Emergency – stabilization of coronal
fragment
Definitive treatment – initiated soon
Multiple fractures, removal of loose
fragments , coverage with glass ionomer
cement

132. Incomplete fractures of immature permanent
teeth- amenable to orthodontic extrusion,
Pulp capping, restoration

133. Definitive therapy includes
1. Removal of coronal fragment and
supragingival restoration
2. Surgical exposure of fracture surface
3. Orthodontic extrusion of apical fragment
4. Surgical extrusion of apical fragment

138. Surgical exposure of fracture site

141. Orthodontic extrusion

142. Surgical extrusion

143. Surgical extrusion

144. Surgical extrusion

145. Surgical extrusion

149. Root fractures

150. Fractures involving dentine,cementum and pulp
and relatively uncommon among dental traumas
0.5- 7 % of injuries affecting permanent
dentition
Mechanism – frontal impact – compression
zones labially and lingually

151. Histologic level – injury to periodontal ligament,
stretching or laceration of pulp at fracture
level
Clinical findings
Max central incisors, 11-20 years
Uncommon in younger individuals

152. Associated with alveolar fractures
Slightly extruded tooth , lingual direction
Site of fracture – tooth mobility
Diagnosis entirely based on radiograph

153. Radiographic findings
Fracture line – at optimal angle for
radiographic disclosure
Visible only if central beam directed within a
maximum range of 15-20 degree of fracture
plane
If ellipsoid radiolucent line – seen ,
two additional r/g should be taken

154. One with increased angulation – 15 degree
Second – negative angulation of 15 degree to
original
Usually missed, later revealed – due to devpt
of haemorrhage or granulation tissue b/n
fragments / resorption

156. The aim of this study was to investigate
the accuracy of cone-beam computed
tomography (CBCT) in the
diagnosis of vertical root fractures in a tooth
with gutta-percha and prefabricated posts
The CBCT scans revealed a high accuracy in
the diagnosis of vertical root fractures; the
accuracy did
not decrease in the presence of gutta-percha.
.

157. The presence of prefabricated posts also had
little effect on the accuracy
of the system, which was, of course, not
statistically significant

160. Fracture line –
Single line – usual finding
Direction varies
Apical/mid root fractures – facio oral
direction in an incisal direction
Cervical fractures – more horizontal

161. Fractures at the apical third – detected with
steep occlusal exposure
Teeth with incomplete root formation –
‘green stick fracture’
Seen as – break in continuity of root canal
wall/ root surface of immature root
Can also heal by hard tissue formation

162. Pathology
Root fracture healing
Initiated at the site of pulpal and
Periodontal involvement- two types of
wound healing response
Occur independantly

163. Healing with calcified tissue
Interposition of connective tissue
Interposition of bone and connective tissue
Interposition of granulation tissue

165. Healing with calcified tissue
Uniting callus of hard tissue
Dentine, osteodentin, cementum
Inner part – dentine , outer- cementum
First layer- cellular, atubular
Later – normal tubular dentin

166. Cementum deposition – preceded by
resorptive processes
Discontinuous layer interspersed with
connective tissue derived from PDL
Widening of root canal space- internal
surface resorption, followed by hard tissue
formation
Limited peripheral rounding of fracture
edges

167. Partial pulp canal obliteration confined to
apical fragment
C/E
- Normal mobility
- Normal percussion to percussion,
decreased response to pulp sensibility
testing

168. Seen in cases of concussion, subluxation
No dislocation of coronal fragment
Immature root formation

171. Interposition of connective tissue
Moderately injured pulp
Pulp revascularization >> healing
Periodontal ligament cells – dominate healing
Connective tissue b/n fragments

172. Connective tissue fibres – running // fracture
surface
New apical foramen – formed at fracture level
Peripheral rounding of fracture edges
Slight ingrowth of bone
PDL space around apical fragment

173. r/g
Rounding of fracture edges
Radiolucent line
external, internal surface resorption & pulp
canal obliteration

175. c/p
Teeth – firm/ slightly mobile
Weak pain- percussion
Sensibility test- normal

176. Post resorptive mineralization – ankylosis
Follow up

177. Interposition of bone and connective tissue
b/n fragments
Bone into root canal
Result of trauma prior to completed alveolar
Process, coronal fragment continues to erupt

179. r/g
Bony bridge b/n fragments with periodontal
space around pulp canal obliteration
c/p
Teeth – firm
React normally to pulp test

180. Interposition of granulation tissue
Histologically- granulation tissue
Coronal pulp – necrotic – inflammatory
changes , Often, communication b/n gingival
crevice & fracture line
Apical – contain vital pulp

181. r/g
Widening of fracture line, rarefaction of
alveolar bone
c/p
Coronal fragment – loose, extruded,
sensitive to percussion
Fistulae labial mucosa

182. Negative pulpal sensibility
Fixation of orthodontic bands prior to
advent of acid etching – was a cause for
pulp necrosis

183. Treatment
Reduction of displaced coronal fragment and
firm immobilization
Digital manipulation – repositioning
Socket wall fracture ?
Radiographic evaluation

191. Immobilization – rigid splint
(acid etch resin splint)- passively applied
2-3 months – fixation period
Immature teeth with incomplete root
fractures – heal by hard tissue union
If splinted/ not – teeth monitored
radiographically and for pulp sensibility

192. Proximity of cervical fracture line to
the gingival crevice – poor chance of healing
Consider – removal of coronal fragment,
orthodontic/surgical extrusion
Fracture at cervical third of root –
conservative management
Good oral hygiene- permanent fixation of
coronal fragment to adjacent teeth

193. If tooth – unsalvagable- extraction
With great caution- with little / no
sacrifice to labial bone
Preserve the marginal socket wall
Another option – preservation of apical
fragment containing vital pulp

194. Primary teeth with root fractures without
dislocation – preserved
Coronal fragment – usually removed inorder
to prevent pulp necrosis
Never apical fragment is removed – damage

195. Pulpal healing
Survival following root fracture >> than
luxation injury
Periodontal ligament contributes to
revascularization
Escape of pulpal edema through fracture
Minimizing pressure

196. Fracture reduces the impact to the
apical area
Close c/l and r/g follow ups
Extrusion of coronal fragment, tenderness
to percussion
r/g signs of pulp necrosis – seen after 2
months

197. Factors contributing to necrosis
- Displacement of coronal fragment
- Forceful application of splints
- Non splinting
- Teeth with completed root formation

200. Factors affecting type of healing
Presence of restorations
Presence of marginal periodontitis
- Interposition of connective tissue

201. Management of pulp necrosis
- Apical fragment – vital
- Coronal fragment – root filled
If fracture line is in cervical third of root,
pulp necrotic – intraradicular splinting –
uniting fragments and serving as root filling

206. Using metal endodontic implants
Implant – shifts the fulcrum to more
apical position

207. Pulp canal obliteration
Common finding
Partial pulp canal obliteration – fracture
region & apical region
Can extend into 1-2 mm of coronal fragment
Complete obliteration

208. Both types – progress at the same rate
Well advanced – 9-12 months
Approach full density – 1-2 years
Obliteration of
Apical segment –healing with calcified
tissue
Apical and coronal – connective tissue

209. Other criteria
Resorption of bone at the level of fracture
Loss of sensibility
Loosening of coronal fragment

210. Root resorption
60% cases
Detected within 1 year after injury
Should be differentiated from resorption
of bone at the level of root fracture
Types
External surface resorption

211. External inflammatory resorption
External replacement resorption
Internal surface resorption
Internal tunneling resorption

213. Endodontic management of
traumatized teeth …

214. Crown fractures with pulp exposure
- Pulp – lacerated, exposed
- Healing does not occur
- Bacteria
- Hemorrage , inflammation

215. Crown fractures with pulp exposure
- Pulp – lacerated, exposed
- Healing does not occur
- Bacteria
- Hemorrage , inflammation

216. Proliferative/destructive changes
Treatment goals
Preservation of vitality
Hard tissue barrier

217. • Pulp capping
• Pulpotomy
• Pulpectomy

218. • Factors
- Maturity of root formation
- Luxation injury
- Age
- Surgical procedure
- Wound dressing

219. Pulp capping
24 hrs
Small exposure
Caoh
1* and 2* contamination

220. Treatment
Caoh
GIC
Temporary crown

221. Pulpotomy
Removal of damaged / inflamed
tissue – clinically healthy pulp
Time
Exposure size

222. Partial / cervical pulpotomy
Treatment
Diamond bur, contrangled handpiece
Cooling , no pressure
2mm below exposure site

223. Hemostasis
Caoh , cotton pellet
GIC, ZnOE
Complications – pulp canal
obliteration, pup necrosis

224. Pulpectomy
Complete removal of pulp
Interim caoh dressing

225. Clinical evaluation of pulp healing
Histological techniques
Criteria
No c/l symptoms
r/g
Root devpt- immature

226. Sensitivity to electrical stimulation
Follow up at 3 yrs
Hard tissue barrier – clinical probing

227. Root fractures
25 % - pulp necrosis
Apical fragment – vital
Diagnosis- pulp sensibility, color
change
Widening of space b/n fragments

228. Changes- periradicular bone
3 months after injury
Splinting – mandate
Internal surface/ tunneling
resorption – healing
External inflammatory root
resorption - necrosis

229. Treatment
Endodontic treatment
Coronal fragment – RCT
Both fragments – necrotic –
treatment
Not treatable – surgical removal

230. Orthodontic treatment of root
fractured teeth

231. Crown , crown root fracture
- Extrusion
- Heithersay 1973,
- Ingber 1976

233. Coronal shift of marginal gingiva
Stretching & readjusting of
periodontal fibres
To avoid relapse – fibrotomy
Before retention period
3-5mmduring 3-4 weeks
Resorption - rare

234. Root fractures
Depends upon the type of healing
that has occurred

235. Prevention
Children , professional players
Mouth guards
-

236. Conclusion
management of traumatic dental
injuries can be both demanding and
challenging that requires immediate
Intervention as they are accompanied by
the emotional factors of the patient
The successful treatment requires
often a multidisciplinary approach involing
Different specialities

237. References
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Canada: BC Decker; 2002:795.
2. Malmgren O, Malmgren B, and Frykholm A. Rapid orthodontic
extrusion of crown root and cervical root fractured teeth. Endod Dent
Traumatol 1991;7(2):49-54.
3. Ehrmann EH. Restoration of a fractured incisor with exposed
pulp using original tooth fragment: report of case. JADA 1989;
118(2):188-185.
4. Morse DR, O’Larnic J, Yesilsoy C. Apexification: review of the literature.
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239. Thank you…