Begins immediately when the patient enters the office . Hematoma in the fioor of the moth indicate mand F . If ther is more than 2 teeth alveolar F should be suspected . Non vital tooth often appear dis colored
All traumatized teeth should be take a x-ray
There are more than 2 classification for classifyng dental trauma but the ellis classifictaion is the most famous and used
If the patient came immediately after the trauma (vitality t ,x-ry) very important to provide the basis for comparison of subsequent examination if the patient came very late (no apparent effect or dest calcification or necrosis or resoption )
If you tack x_ray immediately following the trauma may be not see the R F , tack anther x-ray after 1-2 weeks . If the F segments close proximity and the pulp remain vital callus may reunite the two segments
Reduce the occ surface . Digital pressure , composite splint .
Often hemorrhage around the gingival margin . Toled don’t use the affected tooth , reduce the occlusion
The root displaced on the opposite direction to the crown . There is mobility and tender to percussion . X-ray widening in PDL . The prognosis for tooth retention is fair and for pulp retention it is poor
The crown appear short . Discontanus PMS . . Almost pulp is necrosis especially in mature apex . Tender to percussion no mobility . External R resoripion, loss of marginal bony support complcation of surgical reposition
The crown appear long . Mobility
Primary tooth: usually the treatment is extraction
we can used the Composite with orthodontic wire or heavy nylon suture
Injury which is limited to the
teeth and supporting
structures of the alveolus.
INCIDENCE Boys are
three times more at risk than
1- Traffic Accident.
3- During Epileptic seizures.
4- Sport injuries.
examination Vitality test
1) Personal history
2) medical history
3) Previous dental history
4) History of trauma (when ,how ,where )
11((TIME OF OCCURENCETIME OF OCCURENCE??
TheThe shortershorter the time between accident andthe time between accident and
treatment thetreatment the betterbetter prognosisprognosis..
22((TIME OF OCCURENCETIME OF OCCURENCE??
If the accident occurred inIf the accident occurred in dirty placedirty place prophylactic tetanusprophylactic tetanus
is indicatedis indicated
33((TIME OF OCCURENCETIME OF OCCURENCE??
Direct force under the chin →Direct force under the chin → →→ condylar fracturecondylar fracture
Direct force to teethDirect force to teeth → →→ → Crown F, Root F, displacementCrown F, Root F, displacement
Laceration ; Abrasions; Contusionson thehead
and neck can benoted visually
Any asymmetriesincluding deviation in mouth
Soft tissue( tongue; gingiva.. )
Teeth ( displacement ; mobility ; tooth fracture;
Vitality test just following traumatic injury
often given false negative response
Types of vitality test
1) Thermal pulp test
2) Electrical pulp test
3) Cavity test
1- Determination of child immunization
•If the child had received a primary immunization
activated with boosterinjection of toxoid .
•Unimmunized child can be protected by tetanus
2- Adequate debridment of the wound
1- stage of root formation
2- presence of root fractur
3- periapical radiolucencies
4- injury of the supporting periodontal membrane
(degree of intrusion or extrusion o the tooth)
5- size of the pulp
N. B. If a jaw fracture is suspected extaoral
radiographs indicated (panoramic and lateral
oblique views )
Ellis classificationEllis classification::
crack or fracture of E only
fracture of E , D with out pulp exposure
fracture of E , D with pulp exposure
Fracture line passes beneath the gingival margin
a) vertical b) horizontal
(apical , middle ,
Class IClass I::
1-a crack of the enamelwithout
loss of toothstructure.
Do not require immediate treatmentDo not require immediate treatment..
22--fracture of enamel onlyfracture of enamel only
smoothing the sharp edgesmoothing the sharp edge
regularvitality test ,regularvitality test ,
Class IIClass II::
Immediate treatment of the crown is
1(protect the pulp
2(restore the esthetics and function.
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
Class IIIClass III::
The treatment depends on manyThe treatment depends on many
factors such asfactors such as::
1)vitality of the exposed pulp.
2)Size of the exposure.
3)Time elapsed since the exposure.
4)Degree of root maturation.
5)Restorability of the fractured
The main objective of treatment is toThe main objective of treatment is to
maintain the vitality of the toothmaintain the vitality of the tooth..
Small exposure Large exposure
Early Late Early Late
Open Close open closed open closed open Closed
Treatment usually involve removing
the loose fragment.
11--tooth can beextrudedtooth can beextruded
22--crown lengthening tocrown lengthening to
gain accessto placement ofgain accessto placement of
Class vClass v::
11((HORIZONTAL ROOT FRACTUREHORIZONTAL ROOT FRACTURE
When the fracture occur near theWhen the fracture occur near the
apical 1/3, the prognosis is moreapical 1/3, the prognosis is more
favourable than the middle or cervical 1/3favourable than the middle or cervical 1/3
1)more alveolar support
2)immobilization of the tooth is much easier
Treatment of root fracture depends upon:
1(Condition of the pulp
2(amount of mobility orthe level of the fracture
(A) APICAL 1/3 ROOT
11((reduction , splinting thetoothreduction , splinting thetooth
22((thetooth should becheckedthetooth should bechecked
periodically for vitality andperiodically for vitality and
))B) MIDDLE 1/3 ROOTB) MIDDLE 1/3 ROOT
11((reduction , splinting the toothreduction , splinting the tooth
22((the patient recall 2-3 months ,the patient recall 2-3 months ,
checked the vitality ,radiographchecked the vitality ,radiograph
33((if the tooth non vital and no healingif the tooth non vital and no healing
the following treatment is performedthe following treatment is performed::
a) RC Tof both fragmentsa) RC Tof both fragments
b) apical fragment removedb) apical fragment removed
c) intraradicularpin to stabilizec) intraradicularpin to stabilize
both segmentsboth segments
))C) CERVICAL 1/3 ROOT FRACTUREC) CERVICAL 1/3 ROOT FRACTURE
11((reductin , splinting the toothreductin , splinting the tooth
22((recall the patient periodically andrecall the patient periodically and
checked the vitality and radiographchecked the vitality and radiograph
33((if there is radiolucent and pulp necrosisif there is radiolucent and pulp necrosis
the following treatment is performedthe following treatment is performed
a) extraction the tootha) extraction the tooth
b) removed the apical fragment andb) removed the apical fragment and
endo-osseous implantendo-osseous implant
c) orthodontic extrusionc) orthodontic extrusion
d) if the fracture is 1-2mmd) if the fracture is 1-2mm
infrabony remove theinfrabony remove the
coronal segment andcoronal segment and
2)VERTICAL ROOT FRACTURE :
usually the prognosis is not favorable
treatment ofV R F :
1)extraction of the tooth
2)using co2 laser and ND:YAG laser beam
A mild blow to the tooth resulting in mild
sensitivity requires little or no treatment
Need only regular vitality test
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
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
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
B) permanent tooth:
a) immediate surgical repositioning ,
b) orthodontic extrusion
c) incomplete root formation the tooth
will erupt spontaneously
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
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
The tooth must be kept moist to
prevent damage to the fibers of PDL
In many cases the initial patient contact is by
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
Small fracture through the alveolar
there may be concomitant injuries
(crown, root fracture and soft tissue) managed by referral to an
oral and maxillofacial surgery .
Treatment: redaction , splinting
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 .