Luxation tooth injuries

LUXATION TOOTH INJURIESBY-DR. PARAS ANGRISH

Injuries to periodontal tissues

Concussion

Subluxation

Intrusive luxation

Extrusive luxation

lateral luxation

Exarticulation

Prognosis of pulp after luxation injuries

Type of luxation injury Pulp death

concussion 4%

sub-luxation 12%

lateral luxation 77%

extrusive luxation 55 – 98%

intrusive luxation 100%

Barnett et al ‘02

Luxation injuries

Largest group – 30 to 44%

Includes

1. Concussion

2. Subluxation

3. Extrusive luxation

4. Lateral luxation

5. Intrusive luxation

6. Avulsion

CONCUSSIONDescription An injury to the tooth-supporting structures

without increased mobility or displacement of

the tooth, but with pain to percussion.

Visual signs Not displaced.

Percussion test Tender to touch or tapping.

Mobility test No increased mobility.

Pulp sensibility test Usually a positive result.The test is important in

assessing future risk of healing complications.

A lack of response to the test indicates an

increased risk of later pulp necrosis.

Radiographic findings No radiographic abnormalities, the tooth is in-

situ in its socket.

Radiographs recommended As a routine: Occlusal, periapical exposure

and lateral view from mesial or distal aspect

of the tooth in question. This should be done in

order to exclude displacement.

Diagnosis

Concussion - Treatment Guidelines

Treatment objectives•Usually there is no need for treatment.

Treatment•Monitor pulpal condition for at least 1 year.

Patient instructions•Soft food for 1 week.Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene. Brushing with a soft brush and rinsing with chlorhexidine 0.1 % is beneficial to prevent accumulation of plaque and debris.

Follow-up•Clinical and radiographic control at 4 weeks, 6-8 weeks and 1 year.

SUBLUXATION

An injury to the tooth supporting structures

resulting in increased mobility, but without

displacement of the tooth. Bleeding from the

gingival sulcus confirms the diagnosis

ETIOLOGY

DIAGNOSTIC SIGNS

Description An injury to the tooth supporting structures resulting in increased mobility, but without displacement of the tooth. Bleeding from the gingival sulcus confirms the diagnosis

Visual signs Not displaced.

Percussion test Tender to touch or tapping.

Mobility test Increased mobility.

Pulp sensibility test Sensibility testing may be negative initially indicating transient pulpal damage. Monitor pulpal response until a definitive pulpal diagnosis can be made.

There will be a positive sensibility test result in about half the cases. The test is important in assessing future risk of healing complications. A lack of response at the initial test indicates an increased risk of later pulp necrosis.

Radiographic findings Usually no radiographic abnormalities.

Radiographs recommended As a routine: Occlusal, periapical exposure and lateral view from the mesial or distal aspect of the tooth.

TREATMENT OBJECTIVE

Usually no need for treatment.

TREATMENT

A flexible splint to stabilize the tooth for patient comfort can be used for up to 2 weeks.

PATIENT INSTRUCTIONS

Soft food for 1 week.

Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene. Brushing with a soft brush and rinsing with chlorhexidine 0.1 % is beneficial to prevent accumulation of plaque and debris.

FOLLOW-UP

Clinical and radiographic control at 4 weeks, 6-8 weeks and 1 year.

EXTRUSION

Partial displacement of the tooth out of its socket. An injury to the tooth

characterized by partial or total separation of the periodontal ligament

resulting in loosening and displacement of the tooth. The alveolar socket

bone is intact in an extrusion injury as opposed to a lateral luxation injury. In

addition to axial displacement, the tooth will usually have an element of

protrusion or retrusion. In severe extrusion injuries the retrusion/protrusion

element can be very pronounced. In some cases it can be more

pronounced than the extrusive element.

ETIOLOGY

DIAGNOSTIC SIGNS

Definition Partial displacement of the tooth out of its alveolar socket.

An injury to the tooth characterized by partial or total separation of the periodontal ligament resulting in loosening and displacement of the tooth. The alveolar socket bone is intact in an extrusion injury as opposed to a lateral luxation injury. Apart from axial displacement, the tooth will usually have an element of protusion or retrusion. In severe extrusion injuries the retrusion/protrusion element can be very pronounced. In some cases it can be more pronounced than the extrusive element.

Visual signs Appears elongated.

Percussion test Tender.

Mobility test Excessively mobile.

Sensibility test Usually lack of response except for teeth with minor displacements. The test is important in assessing risk of healing complications. A positive result to the initial test indicates a reduced risk of later pulp necrosis.

In immature, not fully developed teeth, pulpal revascularization usually occurs. In mature teeth pulp revascularization sometimes occurs.

Radiographic findings Increased periapical ligament space.

Radiographs recommended As a routine: Occlusal, periapical exposure and view from the mesial or distal aspect of the tooth.

TREATMENT

The exposed root surface of the displaced tooth is cleansed with saline before repositioning.

Reposition the tooth by gently re-inserting it into the tooth socket with axial digital pressure (local anesthesia is usually not necessary).

Stabilize the tooth for 2 weeks using a flexible splint.

Monitoring the pulpal condition is essential to diagnose associated root resorption.

Open apex: Revascularization can be confirmed radiographically by evidence of continued root formation and pulp canal obliteration and usually a return to a positive pulp response to sensibility testing.

Closed apex: A continued lack of pulp response to sensibility testing should be taken as evidence of pulp necrosis together with periapical rarefaction and sometimes crown discoloration.




FOLLOW-UP

Clinical and radiographic control and splint removal after 2 weeks. Clinical and radiographic control at 4 weeks, 6-8 weeks, 6 months, and 1 year.

LATERAL LUXATION

Displacement of the tooth other than axially. Displacement is accompanied by comminution or fracture of either the labial or the palatal/lingual alveolar bone.

Lateral luxation injuries, similar to extrusion injuries, are characterized by partial or total separation of the periodontal ligament. However, lateral luxations are complicated by fracture of either the labial or the palatal/lingual alveolar bone and a compression zone in the cervical and sometimes the apical area. If both sides of the alveolar socket have been fractured, the injury should be classified as an alveolar fracture (alveolar fractures rarely affect only a single tooth). In most cases of lateral luxation the apex of the tooth has been forced into the bone by the displacement, and the tooth is frequently non-mobile.

ETIOLOGY

DIAGNOSTIC SIGNS

Description Displacement of the tooth other than axially. Displacement is accompanied by comminution or fracture of either the labial or the palatal/lingual alveolar bone.

Lateral luxation injuries, similar to extrusion injuries, are characterized by partial or total separation of the periodontal ligament. However, lateral luxations are complicated by fracture of either the labial or the palatal/lingual alveolar bone and a compression zone in the cervical and sometimes the apical area. If both sides of the alveolar socket have been fractured, the injury should be classified as an alveolar fracture (alveolar fractures rarely affect only a single tooth). In most cases of lateral luxation the apex of the tooth has been forced into the bone by the displacement, and the tooth is frequently non-mobile.

Visual signs Displaced, usually in a palatal/lingual or labial direction.

Percussion test Usually gives a high metallic (ankylotic) sound.

Mobility test Usually immobile.

Sensibility test Sensibility tests will likely give a lack of response except for teeth with minor displacements.

The test is important in assessing risk of healing complications. A positive result at the initial examination indicates a reduced risk of future pulp necrosis.

Radiographic findings Widened periapical ligament space best seen on occlusal or

TREATMENT OBJECTIVE

To reposition and splint a displaced tooth to facilitate pulp and periodontal ligament healing.

TREATMENT

Rinse the exposed part of the root surface with saline before repositioning.

Apply a local anesthesia

Reposition the tooth with forceps or with digital pressure 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. 4 weeks is indicated due to the associated bone fracture.

Monitoring the pulpal condition is essential to diagnose root resorption. If the pulp becomes necrotic, root canal treatment is indicated to prevent infection related root resorption.

In immature developing teeth, revascularization can be confirmed radiographically by evidence of continued root formation, initiation of pulp canal obliteration and usually a return to a positive response to sensibility testing.

In fully formed teeth, a continued lack of response to sensibility testing (i.e. exceeding 3 months) should be taken as evidence of pulp necrosis together with periapical radiolucency and sometimes crown discoloration.

Splint removal: after the fixation period (4 weeks) resin can be removed. If non-composite resin is used it can be peeled off with a dental scaler. If composite is used i should be removed with a bur. The tooth must be supported with digital pressure during this procedure.




FOLLOW-UP

Clinical and radiographic control after 2 weeks. Clinical and radiographic control and splint removal after 4 weeks. Clinical and radiographic control at 6-8 weeks, 6 months, 1 year and yearly for 5 years.

INTRUSION - INTRUSIVE LUXATION

Displacement of the tooth into the alveolar bone. This injury is accompanied by comminution or

fracture of the alveolar socket.

ETIOLOGY

INTRUSION - DIAGNOSTIC SIGNS

Description Displacement of the tooth into the

alveolar bone. This injury is

accompanied by comminution or

fracture of the alveolar socket.

Visual signs The tooth is displaced axially into the

alveolar bone.

Percussion test Usually gives a high metallic

(ankylotic) sound.

Mobility test The tooth is immobile.

Sensibility test Sensibility test will likely give negative

response.

In immature, not fully developed

teeth, pulpal revascularization may

occur.

Radiographic findings The periodontal ligament space may

be absent from all or part of the root.

The cemento-enamel junction is

located more apically in the intruded

tooth than in adjacent non-injured

teeth, at times even apical to the

marginal bone level.

Radiographs recommended As a routine: Occlusal, periapical

exposure and lateral view from the

mesial or distal aspect of the tooth in

question. If the tooth is totally intruded

a lateral exposure is indicated to

make sure the tooth has not

TREATMENT

Tooth intrusion is associated with a potential risk of tooth loss due to progressive root resorption (ankylosis or infection related resorption). The following three methods are only partly evidence based.

Spontaneous eruptionThis is the treatment of choice for permanent teeth with incomplete root formation with minor or moderate intrusion. In teeth with mature root development it is only recommended for teeth with minor intrusion.This treatment seems to lead to fewer healing complications than orthodontic and surgical repositioning. If no movement within a few weeks, initiate orthodontic or surgical repositioning before ankylosis can develop.

Orthodontic repositioningThis treatment may be preferred for patients coming in for delayed treatment. This treatment method enables repair of marginal bone in the socket along with the slow repositioning of the tooth.

Surgical repositioningThis treatment technique is preferable in the acute phase. Intrusion with major dislocation of the tooth (more than 7 mm) may be an indication for surgical repositioning.

Common for all treatmentsEndodontic treatment can prevent the necrotic pulp from initiating infection-related root resorption. This treatment should be considered in all cases with completed root formation where the chance of pulp revascularization is unlikely. Endodontic therapy should preferably be initiated within 3-4 weeks post-trauma. A temporary filling with calcium hydroxide is recommended

Degree of

intrusionRepositioning

Spontaneous Orthodontic Surgical

OPEN APEX

Up to 7 mm x

More than 7

mmx x

CLOSED APEX

Up to 3 mm x

3-7 mm x x

More than 7

mmx



Good healing following an injury to the teeth and oral tissues depends, in part, on good oral

hygiene. Brushing with a soft brush and rinsing with chlorhexidine 0.1 % is beneficial to prevent

accumulation of plaque and debris.

FOLLOW-UP

Control after 2 weeks. Splint removal and control after 4 weeks, 6-8 weeks, 6 months, 1 year and

yearly for 5 years

Sequalae to luxation injury

Yellow discoloration

Grey discoloration

Resorption – 5 to 15%

Incomplete root formation

Primary teeth – pulp space obliteration by

calcification

Avulsed Permanent Teeth

Incidence

0.5% to 16% of

traumatic injuries

Main etiologic

factors

Fights

Sports injuries

Automobile

accidents


Maxillary central incisor

Most commonly avulsed

tooth

Mandibular teeth

Seldom affected

Most frequently involves

a single tooth


Most common age - 7 to

11

Permanent incisors

erupting

Loosely structured PDL


Associated injuries

Fracture of alveolar

socket wall


Associated injuries

Fracture of alveolar

socket wall

Injuries to the lips

and gingiva

Management of the

Avulsed Tooth

What tissue should

be our primary

concern?

Pulp?

Management of the

Avulsed Tooth

What tissue should

be our primary

concern?

Pulp?

Socket?

Management of the

Avulsed Tooth

What tissue should

be our primary

concern?

Pulp?

Socket?

PDL?

Management of the

Avulsed Tooth

Ultimate goal

PDL healing without

root resorption

Management of the

Avulsed Tooth

Ultimate goal

PDL healing without

root resorption

Most critical factor

Maintaining an

intact and viable

PDL on the root

surface

Periodontal Ligament

Responses

Surface Resorption

Replacement Resorption (Ankylosis)

Inflammatory Resorption

Andreasen JO, Hjorting-Hansen E.

Replantation of teeth II. Histological study of 22 replanted anterior teeth in humans.

Acta Odontol Scand 1966;24:287-306.


Responses

Surface resorption

Superficial

resorption cavities

Mainly in

cementum

Complete repair of

PDL


Responses

Replacement resorption (Ankylosis)

Direct union of bone and root

Resorption of root -Replacement with bone

Direct result of loss of vital PDL


Responses

Inflammatory

resorption

Resorption of

cementum and

dentin

Inflammatory reaction

in the periodontal

ligament

Etiology

Inflammatory

resorption

Surface resorption

of cementum

exposing dentinal

tubules

Etiology

Inflammatory

resorption

Surface resorption

of cementum

exposing dentinal

tubules

Pulp necrosis

Etiology

Inflammatory

resorption

Surface resorption of

cementum exposing

dentinal tubules

Pulp necrosis

Toxic products from

the pulp provoke an

inflammatory

response in the PDL


Responses

Surface resorption


Responses Surface resorption



Responses Surface resorption


Inflammatory resorption

Treatment Considerations

Extraoral time

Extraoral environment

Root surface manipulation

Management of the socket

Stabilization

Extraoral Time

Shorter time = Better prognosis*

< 30 min 10% resorption

> 90 min 90% resorption


Replantation of teeth I. Radiographic and clinical study of 110 human teeth replanted after accidental loss.


Extraoral Time

Shorter time = Better prognosis*

< 30 min 10% resorption

> 90 min 90% resorption

*depending on storage medium


Replantation of teeth I. Radiographic and clinical study of 110 human teeth replanted after accidental loss.


Extraoral Environment

Viability of PDL cells is

critical

Storage Media

Tap Water

Dry

Saliva

Saline

Andreasen JO.

Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after

replantation of mature permanent incisors in monkeys.

Int J Oral Surg 1981;10:43-53.

Poor results

Storage Media

Tap Water

Dry

Saliva

Saline

Andreasen JO.

Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation

of mature permanent incisors in monkeys.

Int J Oral Surg 1981;10:43-53.

Good protection for 2 hrs

Poor results

Milk As A Storage Medium

Physiologic

osmolality

Markedly fewer

bacteria than

saliva

Readily available

Storage Media - Milk vs. Saliva

Storage for 2 hrs

Periodontal healing almost as good as immediate replantation

Blomlof L, et al.

Storage of experimentally avulsed teeth in milk prior to replantation.

J Dent Res 1983;62:912-6.

Storage Media - Milk vs. Saliva

Storage for 2 hrs Periodontal healing almost as good as

immediate replantation

Storage for 6 hrs Saliva extensive replacement resorption

Milk healing almost as good as immediate replant

Blomlof L, et al.

Storage of experimentally avulsed teeth in milk prior to replantation.

J Dent Res 1983;62:912-6.

Cell Culture Media

Eagle’s Medium

Hank’s Balanced Salt Solution

Hank’s Balanced Salt Solution

Proper pH and osmolality

Reconstitutes depleted cellular

metabolites

Washes toxic breakdown products from

the root surface

Organ Transplant Storage Media

Viaspan

Dramatically prolongs the storage of human

organs

Expensive

Not readily available

Storage Media Comparison

Viaspan

Complete healing after 6 and 12 hrs

Good for extended storage periods (72 and 96 hrs)

Trope M, Friedman S.

Periodontal healing of replanted dog teeth stored in Viaspan, milk and Hank’s balanced salt solution.

Endod Dent Traumatol 1992;8:183-8.

Storage Media Comparison

Viaspan

Complete healing after 6 and 12 hrs

Good for extended storage periods (72 and 96 hrs)

Hank’s balanced salt solution

Healing results similar to Viaspan

Trope M, Friedman S.

Periodontal healing of replanted dog teeth stored in Viaspan, milk and Hank’s balanced salt solution.


Recommended Storage Media

1. Socket

(immediate

replantation)

2. Cell culture

medium

3. Milk

4. Physiologic saline

5. Saliva

Root Surface Manipulation

Attempt to retain PDL cell viability

Do not curette root surface

Avoid caustic chemicals

Van Hassel HJ, Oswald RJ, Harrington GW.

Replantation 2. The role of the periodontal ligament.

J Endodon 1980;6:506-8.


Extraoral dry time determines handling


Extraoral dry time < 1 hr

PDL healing is still possible

Handling recommendations

Keep root moist

Do not handle root surface

Gentle debridement


Extraoral dry time > 1 hr

Loss of PDL cell viability

inevitable

Treatment recommendations

Remove tissue tags

Soak in accepted dental fluoride solution for 20 min

Fluoride Treatment

1.0-2.4% topical

fluoride solution

Sodium fluoride

(Andreasen)

Stannous fluoride

(Krasner)

20 minute soak

Management of the Socket

Remove contaminated coagulum

in socket

Irrigate with sterile saline


Examine socket If fracture is evident

Reposition fractured bone with a blunt

instrument


Replant using light digital pressure

Stabilization

Splint

Definition a rigid or flexible device used to support,

protect, or immobilize teeth, preventing further injury

Types

• Acid etch composite

• Cross-suture

Acid Etch Composite Splints

Interproximal composite


Composite with arch wire


Composite with monofilament nylon


Functional Splint

20-30 lbmonofilament nylon

Bonded with composite

Allows physiologic movement

Antrim DD, Ostrowski JS.

A functional splint for traumatized teeth.

J Endodon 1982;8:328-31.

Cross-Suture Splint

Indications

No adjacent teeth

to splint to

Unmanageable

traumatized

children

Cross-Suture Splint

Splinting Time

Effect of splinting time

7 days

30 days

Nasjleti CE, Castelli WA, Caffesse RG.

The effects of different splinting times on replantation of teeth in monkeys.

Oral Surg 1982;53:557-66.

Splinting Time

Recommended time

7 to 10 days

Nasjleti CE, Castelli WA, Caffesse RG.

The effects of different splinting times on replantation of teeth in monkeys.

Oral Surg 1982;53:557-66.

Pulpal Prognosis

Stage of root development

Dry storage time

Storage media

Antibiotics

Stage of Root Development

Mature roots (< 1.0 mm)

Revascularization 0%

Kling M, et al. Endod Dent Traumatol 1986;2:83-9.

Andreasen JO, et al. Endod Dent Traumatol1995;11:51-8.

Stage of Root Development

Mature roots (< 1.0 mm)

Revascularization 0%

Immature roots (> 1.0 mm)

Revascularization 18-34%

Kling M, et al. Endod Dent Traumatol 1986;2:83-9.

Andreasen JO, et al. Endod Dent Traumatol1995;11:51-8.

Revascularization

Loss of blood

supply to pulp

Revascularization – Day 4

Coronal pulp

Extensive ischemic

injury

Revascularization – Day 4

Coronal pulp

Extensive ischemic

injury

Apical pulp

Initial

revascularization

Revascularization – 4 Weeks

Pulp status

Revascularization

Reinnervation

New odontoblastic

layer

Revascularization

Typical sequela

Pulp canal

obliteration

Dry Storage Time

As dry storage time increases

Pulp survival decreases

Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM.

Endod Dent Traumatol 1995;11;59-68.

Storage Media

Nonphysiologicstorage

Minimal chance of pulp revascularization



Storage Media

Nonphysiologic storage

Minimal chance of pulp revascularization

Physiologic storage

HBSS, milk, saline, saliva

Improved chance of pulp revascularization



Pulpal Prognosis - Antibiotics

Systemic

antibiotics

Pulp

revascularization is

not increased

Cvek M, Cleaton-Jones P, Austin J, Lowni J, Kling M, Fatti P.


Pulpal Prognosis - Antibiotics Systemic antibiotics

Pulp

revascularization is

not increased

Topical antibiotics

Beneficial effect

Cvek M, Cleaton-Jones P, Austin J, Kling M, Lowni J, Fatti P.



Topical Doxycycline

Decreased microorganisms

in pulpal lumen

Increased pulp

revascularization




Recommendation

Topical Doxycycline

1 mg in 20 ml physiologic

saline

5 minute soak



Endodontic Rationale

Mature root - 4 weeks

Very limited

revascularization

Endodontic Rationale

Mature root - 4 weeks

Very limited

revascularization

Ischemic coronal pulp

with great risk of infection

!!!

Endodontic Rationale – Mature

Root

Pulpectomy 7-14 days

Endodontic Rationale – Mature

Root

Calcium hydroxide placement

Endodontic Rationale –

Mature Root

Calcium hydroxide

Antibacterial

Increases pH in dentin

Favors mineralization over resorption

Tronstad L, Andreasen JO, et al.

pH changes in dental tissues after root canal filling with calcium hydroxide.

J Endodon 1981;7:17-21.

Endodontic Rationale –

Mature Root

Treatment recommendation

Ca(OH)2 therapy for as long as

practical, usually 6-12 months

Treatment of the Avulsed Permanent Tooth.

Recommended Guidelines of the American Association of Endodontists, 1995.

Specific Treatment Regimen

Specific Treatment Regimen

Root Development

Closed apex

Open apex

Extraoral Dry Time

One hour or less

More than one

hour

Treatment of the Avulsed Permanent Tooth.

Recommended Guidelines of the American Association of Endodontists, 1995.

Treatment Flowchart

< 1 hr > 1 hr

Extraoral Dry Time

Apex MaturityClosed Open Open or Closed

Pulpectomy7-14 days

Observe

Option:

Extraoral RCT

Pulpectomy 7-14 days

Emergency Treatment

Replantation technique

Local anesthetic, if

necessary

Radiograph to verify

position

Check occlusion

Physiologic splint

Emergency Treatment

Additional

Considerations

Analgesics

Emergency Treatment

Additional

Considerations

Analgesics

Chlorhexidine

Emergency Treatment

Additional Considerations

Analgesics

Chlorhexidine

Tetanus

Refer to physician for tetanus prophylaxis prn

Rothstein RJ, Baker FJ.

Tetanus: Prevention and treatment.

J Am Med Assoc 1978;240:675-6.

Emergency Treatment

Additional Considerations

Analgesics

Chlorhexidine

Tetanus

Antibiotics

Antibiotics

Penicillin

500 mg qid for 4-7 days

Andreasen JO.

Atlas of replantation and transplantation of teeth.

Philadelphia: W.B. Saunders Co., 1992;57-92.

Antibiotics

Tetracycline vs. amoxicillin in a replacement resorption model

Tetracycline had better anti-resorptive properties

Sae-Lim V, Wang CY, Choi GW, Trope M.

The effect of systemic tetracycline on resorption of dried replanted dogs’ teeth.


Antibiotics

Tetracycline vs. amoxicillin in an inflammatory root resorption model

Tetracycline had better anti-bacterial properties

Sae-Lim V, Wang CY, Trope M.

Effect of systemic tetracycline and amoxicillin on inflammatory root resorption of replanted dogs’ teeth.


Antibiotics

Recommendation

“Tetracycline could be considered as an alternative to amoxicillin after avulsion injuries.”


Effect of systemic tetracycline and amoxicillin on inflammatory root resorption of replanted dogs teeth.


Tetracycline Use In Young Children

Tetracycline staining

Not a problem since avulsed maxillary anteriorshave already erupted and are not susceptible to staining

At worst, posterior teeth might be stained

Remote possibility with 7-10 day prescription


Effect of systemic tetracycline and amoxicillin on inflammatory root resorption of replanted dogs’ teeth.


Avulsion Sequelae

Closed Apex

Extraoral dry

time 1 hour or

less

Avulsion Sequelae

Closed Apex

Extraoral dry time

more than 1 hour

Avulsion Sequelae

Open Apex

Extraoral dry

time 1 hour or

less

Avulsion Sequelae

Open Apex

Extraoral dry time

more than 1 hour

Avulsion Management

Be prepared -

Dental Trauma Kit

Immerse tooth in a

physiologic storage

medium to “buy time”

Determine extraoral dry

time

Follow AAE AND IADT

Guidelines

REFERENCES

- Essentials of traumatic injuries to the teeth

J.O.Anderasen and F.M. Anderasen

-Treatment planning for traumatized teeth

- Mitsuhiro tsukiboshi

-cohen’s pathways of the pulp

tenth edition

- Ingle’s –Endodontics 6th edition

- Storage Media For Avulsed

Teeth: A Literature ReviewBrazilian Dental Journal (2013) 24(5): 437-445

- Transport media for avulsed teeth:

A review Aust Endod J 2012; 38: 129–136

- A proposal for classification of tooth

fractures based on treatment needJournal of Oral Science, Vol. 52, No. 4, 517-529,

2010

Assessment of pulp vitality: a review

International Journal of Paediatric Dentistry 2009;

19: 3–15

STUDY OF STORAGE MEDIA FOR AVULSED

TEETH Brazilian Journal of Dental Traumatology

(2009) 1(2): 69-76

Fracture resistance of tooth

fragment reattachment: effects of

different preparation techniques and

adhesive materials Dental

Traumatology 2010; 26: 9–15;

Luxation tooth injuries

Health & Medicine

Transcript of Luxation tooth injuries