• Examination and diagnosis

Consider traumatic injuries as emergency,

• To relieve pain.
• Reduce psychological stress.
• Facilitate reduction of # or avulsion.
• For good prognosis.
When did injury occurred ?

• Time interval between injury and treatment started.

• Alter possible prognosis and line of treatment specially in cases of
re-implantation, pulp exposure, bone# and severe soft tissue
injuries.

Where did injury occurred ?

• For tetanus prophylaxis.

• How did injury occurred ?

• Direction of blow which tells possible structure affected.

• Object in mouth like pacifier labial displacement of teeth.

• Young child and women with multiple soft tissue injury at

deferent stage of healing improper history child abuse.
Treatment else where ?

• Storage of avulsed teeth.

• Medication taken.
• Re-implantation and immobilization considered.

History of previous injury ?

• Sustained repeated injury influence pulp vitality test.

• Affects healing capacity of pulp and PDL.
General health and medical history ?

• Allergic reaction
• Epilepsy
• Bleeding disorder
• Differs emergency and later treatment
Examination

• Color change of traumatized tooth noted occurs in post injury period.

• Deranged occlusion
• Abnormal mobility
• Palpation of alveolar process
• Percussion
• Vitality test
• Radiographic examination
 Management of patient

• Emergency management
A- Airway with cervical spine control

B- Breathing and ventilation

C- Circulation and hemorrhage control

D- Disability neurological states

• Central nervous system injury
 Classification based on tissue and site

All injuries to the face may be divided into two basic

groups,

• Injuries to soft tissues

• Injuries to bone
• Rabinowitch Classification (1956)

• Fractures of the enamel

• Fractures into the dentin

• Fractures into the pulp

• Fractures of the root

• Comminuted fractures

• Displaced teeth
 Ellis and Davey Classification (1960)

• Class 1 - Simple fracture of the crown involving little or no

dentin.

• Class 2 - Extensive fracture of the crown involving

considerable dentin, but not the dental pulp.
• Class 3 - Extensive fracture of the crown involving
considerable dentin and exposing the dental pulp.

• Class 4 - The traumatized teeth that become non-vital with

or without a loss of crown structure.

• Class 5 - Teeth lost as a result of trauma

• Class 6 - Fracture of the root with or without a loss of the crown
structure.

• Class 7 - Displacement of a tooth without fracture of the crown or

root.

• Class 8 - Fracture of crown en masse and its replacement.

• Class 9 - Traumatic injuries to primary teeth.
Modification of Ellis classification by McDonald, Avery and
Lynch (1983)

• Class 1 - Simple fracture of the crown involving little or no

dentin.

• Class 2 - Extensive fracture of the crown involving considerable

dentin, but not the dental pulp.
• Class 3 - Extensive fracture of the crown
with an exposure of the dental pulp.

• Class 4 - Loss of the entire crown.

 WHO Classification (1992)

• Adapted from WHO Geneva 1992.

• Based on anatomy, therapeutic and prognostic
consideration.

• It is applied to both primary and permanent teeth.

• Code numbers used according to the International
classification of diseases 1992
Injuries to the hard dental
tissues and pulp

Enamel infraction N
502.50: An incomplete
fracture (crack) of the
enamel without loss of
tooth substance.
Injuries to the hard dental
tissues and pulp

Enamel infraction N
502.50: An incomplete
fracture (crack) of the
enamel without loss of
tooth substance.
Enamel fracture
(Uncomplicated crown
fracture) N 502.50: A
fracture with loss of tooth
substance confined to
enamel.
Enamel - dentin fracture
(Uncomplicated crown
fracture) N 502.51: A
fracture with loss of tooth
substance confined to
enamel and dentin but not
involving pulp.
Complicated crown
fracture N 502.52

A fracture involving
enamel and dentin and
exposing the pulp.
Uncomplicated crown root
fracture N 502.54

A fracture involving enamel,

dentin and cementum but
not involving the pulp.
Complicated crown root
fracture N 502.54

A fracture involving enamel,

dentin and cementum and
exposing pulp.
Root fracture N
502.53: A
fracture involving
dentin, cementum and
the pulp.
Injuries to the periodontal
tissues

Concussion N 503.20: An
injury to the tooth
supporting structures
without abnormal loosening
or displacement of the
tooth.
Subluxation N 503.20

An injury to the tooth

supporting structures with
abnormal loosening but
without displacement of
the tooth.
Subluxation N 503.20

An injury to the tooth

supporting structures
with abnormal loosening
but without displacement
of the tooth.
Extrusive luxation
(peripheral
dislocation, partial
avulsion) N 503.20

Partial displacement of
the tooth out of its
socket.
Lateral luxation N 503.20

Displacement of the tooth in

a direction other than
axially. This is accompanied
by fracture of the alveolar
socket.
Intrusive luxation (central
dislocation) N 503.21:
Displacement of the tooth
into the alveolar bone. This
injury is accompanied by
fracture of the alveolar
socket.
Exarticulation (complete
avulsion) N 503.22

Complete displacement
of the tooth out of its
socket.
Injuries of the supporting bone

Comminution of alveolar
socket (mandible N 502.60,
maxilla N 502.40): Crushing and
compression of the alveolar
socket. intrusion and lateral
luxation.
Fracture of the alveolar
socket wall

(mandible N 502.60,
Maxilla N 502.40)

A fracture contained to the

facial or lingual socket wall.
Fracture of the alveolar
process

(Mandible N 502.60, Maxilla

N 502.40)

A fracture of the alveolar

process which may or may not
involve the alveolar socket.
Fracture of mandible and maxilla

(Mandible N 502.61, Maxilla N 502.42)

A fracture involving the base of the mandible or maxilla

and often the alveolar process (jaw fracture). The
fracture may or may not involve the alveolar socket.
Injuries to gingival or oral
mucosa

Laceration of gingival or
oral mucosa N S01.50: A
shallow or deep wound in
the mucosa resulting from a
tear and usually produced
by a sharp object.
Contusion of gingival or
oral mucosa N S00.50

A bruise usually produced

by an impact from a blunt
object and not accompanied
by a break of the continuity
in the mucosa, causing sub-
mucosal hemorrhage.
Abrasion of gingiva or
oral mucosa N S00.50

A superficial wound
produced by rubbing or
scraping of the mucosa
leaving a raw bleeding
surface.
BY ANDREASEN
Classification of trauma in injury of hard
tissues and pulp.
• This is based on W.H.O. classification.
• 873.60  Incomplete fracture.
• 873.61  Uncomplicated crown fracture.
• 873.62  Complicated crown fracture.
• 873.64  Uncomplicated crown and root
fracture.
• 873.64  Complicated crown and root
fracture.
• 873.63  Root fracture.
Injuries to the periodontal tissues:
• 873.66  Concussion.
• 873.66  Subluxation (loosening).
• 873.67  Intrusive luxation (central dislocation).
• 873.67  Extrusive luxation (peripheral
dislocation, partial avulsion).
• 873.66  Lateral luxation.
• 873.68  Exarticulation (Avulsed tooth).
Injuries to the supporting bone:
• Mandible No. 802.20, maxilla No. 8.2.40 –
comminution of alveolar socket.
• Mandible No. 802.20, Maxilla No. 802.40 –
Failure of alveolar socket wall.

• Mandible No. 802.20, Maxilla No. 802.40 –

Fracture of alveolar process.

• Mandible No. 802.21, Maxilla No. 802.42 –

Fracture of mandible / maxilla.
Injuries to Gingiva/ Oral mucosa:
• 873.69  Laceration of gingiva/oral
mucosa.
• 920.X0  Contusion of gingiva/oral
mucosa.
• 910.00  Abrasion of gingiva or oral
mucosa.
• BASRANI CLASSIFICATION
• Crown fractures.
– Fracture of enamel.
– Fracture of enamel and dentin.
• Without pulp exposure.
• With pulp exposure.
• Root fractures.
• Crown root fractures.
BY ULFOHN
• His classification is based on clinical endodontics and
does not reveal the extent of fracture or amount of
dentin exposed.
• He based his classification on 3 aspects:
• Clinical state of the pulp.
• Pulp and dentin as one organ.
• Determination of treatment.
• Crown fractures:
– Of enamel.
– With indirect pulp exposure through dentine.
– With direct pulp exposure.
ETIOLOGY
• Iatrogenic injuries in new
born

• Fall in infancy

• Child physical abuse

• Automobile / bicycle Accident

• Drug related /Mental
retardation

• Dentinogenesis imperfecta
• Contact sports
Management of infraction and
fracture of enamel
• Smoothening of rough edges.

• Composite resin using acid-etch

technique
Treatment of enamel and
dentine Fracture
• Most effective method is placement of a protective
material over exposed dentin to allow the pulp to
form a protective barrier e.g. Ca(OH)2 placement
(Dycal).
• The fracture site must be covered with a
restoration material such as acid-etch composite
restoration.
• Because of the extent of fracture and because of
esthetics reason – crown may be required.
• Re-attachment of fractured fragments can also be
done
 Treatment of fracture with
pulpal involvement
• Depends on maturity of the tooth.

Incomplete Root Formation

Complete root formation
PULP CAPPING
PULPECTOMY
APEXIFICATION
ENDODONTIC TREATMENT
PULPOTOMY

APEXOGENESIS
Treatment guideline for
avulsed tooth with open
apex Avulsed Tooth Immature Pulp
• Open apex – 2 mm
•

No Dry Storage Time Dry Storage Time

Repositioning of avulsed tooth with complete
root formation

Tooth and socket are cleaned with saline

Prepare socket
Reposition tooth

Splinting is done