Tooth Trauma.ppt

7/17/2019 Tooth Trauma.ppt

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Traumatic InjuriesTraumatic Injuries

to the Anterior Teethto the Anterior Teeth

Presented by:Presented by:

Dr. Navroop KaurDr. Navroop Kaur

MDS (PedodonticsMDS (Pedodontics


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IntroductionIntroduction Traumatic episodes! dependin" on the ener"y o# the impact!Traumatic episodes! dependin" on the ener"y o# the impact!

can resu$t in injuries %hich may ran"e in severity #romcan resu$t in injuries %hich may ran"e in severity #rom

ename$ #ractures to comp$e& denta$ injuries invo$vin" theename$ #ractures to comp$e& denta$ injuries invo$vin" the

pu$p and the periodontium.pu$p and the periodontium.The e&tent o# injury is in#$uencedThe e&tent o# injury is in#$uenced

by the severity o# the traumatic event! direction o# #orceby the severity o# the traumatic event! direction o# #orce

a"ainst the teeth and supportin" structures and the type o#a"ainst the teeth and supportin" structures and the type o#

impact'b$unt or sharp.impact'b$unt or sharp.The injury may remain $imited to theThe injury may remain $imited to the

denta$ tissues or may invo$ve the supportin" structuresdenta$ tissues or may invo$ve the supportin" structures

inc$udin" the periodonta$ $i"ament and the a$veo$ar bone.inc$udin" the periodonta$ $i"ament and the a$veo$ar bone.

Majority o# denta$ injuries occur une&pected$y durin" dai$y $i#eMajority o# denta$ injuries occur une&pected$y durin" dai$y $i#e

activities and most$y invo$ve the anterior teeth! thus a##ectin"activities and most$y invo$ve the anterior teeth! thus a##ectin"

their #unction.their #unction.


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Incidence-Incidence- In the deciduous dentition! thereIn the deciduous dentition! there

are ) ne% cases o# denta$ trauma every year.are ) ne% cases o# denta$ trauma every year.There is an increase in incidence o# traumaticThere is an increase in incidence o# traumatic

injuries #rom * year o# a"e %ith a pea+ o# *,)injuries #rom * year o# a"e %ith a pea+ o# *,)

at - years o# a"e because by * year o# a"eat - years o# a"e because by * year o# a"e

most o# the chi$dren $earn to %a$+ and by themost o# the chi$dren $earn to %a$+ and by the

a"e o# three they can indu$"e in ridin" a bicyc$ea"e o# three they can indu$"e in ridin" a bicyc$e

tricyc$e ma+in" them prone to #a$$s and injuries.tricyc$e ma+in" them prone to #a$$s and injuries.


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/tio$o"y0 Traumatic injuries/tio$o"y0 Traumatic injuries Motor incontro$0Motor incontro$0 especia$$y at 10- years o# a"e $eads toespecia$$y at 10- years o# a"e $eads to

#a$$s and co$$isions and hence increased incidence o##a$$s and co$$isions and hence increased incidence o#

denta$ trauma.denta$ trauma.

Medica$ ai$ments0Medica$ ai$ments0 $i+e iso$ated convu$sions and$i+e iso$ated convu$sions and

epi$epsy a$so predispose a chi$d to traumatic injuriesepi$epsy a$so predispose a chi$d to traumatic injuries

especia$$y comp$icated cro%n #ractures.especia$$y comp$icated cro%n #ractures.

2ontact sports02ontact sports0 injuries due to contact sports areinjuries due to contact sports are

"enera$$y seen in o$der a"e "roup %hen chi$dren start"enera$$y seen in o$der a"e "roup %hen chi$dren start

to indu$"e in outdoor sports activities.to indu$"e in outdoor sports activities.


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Automobi$e accidents0Automobi$e accidents0 injuries due to roadinjuries due to roadside accidents may be seen in chi$dren o#side accidents may be seen in chi$dren o#

any a"e "roup but most common in teena"eany a"e "roup but most common in teena"e

chi$dren and especia$$y in boys.chi$dren and especia$$y in boys.

3i"hts03i"hts0 common$y $eads to comp$e& oro0common$y $eads to comp$e& oro0

ma&i$$o#acia$ injuries a$on" %ith associatedma&i$$o#acia$ injuries a$on" %ith associated

denta$ trauma %hich may be $u&ation injuriesdenta$ trauma %hich may be $u&ation injuries

or cro%n #ractures.or cro%n #ractures.


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Risk factors-Risk factors- *.*.Anteroposterior mo$ar re$ation0Anteroposterior mo$ar re$ation0 StudiesStudies

have reported that increased preva$ence o# denta$ traumahave reported that increased preva$ence o# denta$ trauma

is seen in chi$dren %ith An"$e4s 2$ass II div I ma$occ$usionis seen in chi$dren %ith An"$e4s 2$ass II div I ma$occ$usion

and a$so in chi$dren %ith an An"$e4s 2$ass I mo$ar re$ation.and a$so in chi$dren %ith an An"$e4s 2$ass I mo$ar re$ation.

1. 5ip incompetency01. 5ip incompetency0 5ips #orm a natura$ barrier a"ainst5ips #orm a natura$ barrier a"ainst

trauma to the teeth. 6eduction o# cushionin" e##ect in thetrauma to the teeth. 6eduction o# cushionin" e##ect in the

presence o# incompetent $ips predisposes to denta$presence o# incompetent $ips predisposes to denta$

trauma.trauma.

--. Incisa$ overjet0. Incisa$ overjet0 2hi$dren %ith "reater than mm overjet2hi$dren %ith "reater than mm overjet

are considered to be *. times more susceptib$e thanare considered to be *. times more susceptib$e than

chi$dren %ith an overjet o# $ess than mm. The incidencechi$dren %ith an overjet o# $ess than mm. The incidence

increases to t%o#o$d %hen the overjet is "reater than 7increases to t%o#o$d %hen the overjet is "reater than 7

mm.mm.


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Traumatic Injuries to the TeethTraumatic Injuries to the Teeth

Classification of traumatic injuries to anterior teeth- Ellis and Davey (1970Classification of traumatic injuries to anterior teeth- Ellis and Davey (1970

Cl-1Cl-10 Simp$e #racture o# cro%n invo$vin" on$y ename$ %ith $itt$e or no dentin.0 Simp$e #racture o# cro%n invo$vin" on$y ename$ %ith $itt$e or no dentin.

Cl-!Cl-!0 /&tensive #racture o# cro%n invo$vin" considerab$e dentin but not e&posin"0 /&tensive #racture o# cro%n invo$vin" considerab$e dentin but not e&posin"

denta$ pu$p.denta$ pu$p.

Cl-"Cl-"0 /&tensive #racture o# cro%n invo$vin" considerab$e dentin and e&posin"0 /&tensive #racture o# cro%n invo$vin" considerab$e dentin and e&posin"pu$p.pu$p.

Cl-#Cl-#0 Traumati8ed tooth %hich becomes non0 vita$ %ith %ithout $oss o# cro%n0 Traumati8ed tooth %hich becomes non0 vita$ %ith %ithout $oss o# cro%n

structure.structure.

Cl-$Cl-$0 Tooth $oss0 avu$sion.0 Tooth $oss0 avu$sion.

Cl-%Cl-%0 6oot #racture %ith %ithout $oss o# cro%n structure.0 6oot #racture %ith %ithout $oss o# cro%n structure. Cl-7Cl-70 Disp$acement o# tooth %ithout #racture o# cro%n or root.0 Disp$acement o# tooth %ithout #racture o# cro%n or root.

Cl-&Cl-&0 3racture o# cro%n en masse and its disp$acement.0 3racture o# cro%n en masse and its disp$acement.

Cl-9Cl-90 Traumatic injuries o# primary teeth0 Traumatic injuries o# primary teeth


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Traumatic Injuries to the TeethTraumatic Injuries to the Teeth

2$inica$ e&amination02$inica$ e&amination0 Medica$ history0Medica$ history0Assess the need #or S9/Assess the need #or S9/

prophy$a&is. Determine i# the chi$d has aprophy$a&is. Determine i# the chi$d has a

b$eedin" disorder! or is immune compromised.b$eedin" disorder! or is immune compromised.6ecord any current medications. uestion the6ecord any current medications. uestion the

parent about a$$er"ies to medications.parent about a$$er"ies to medications.

Determine i# the chi$d4s tetanus immuni8ationDetermine i# the chi$d4s tetanus immuni8ation

is up0to0date. Determine i# the chi$d $ostis up0to0date. Determine i# the chi$d $ostconsciousness due to the injury.consciousness due to the injury.


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Denta$ and trauma history0Denta$ and trauma history0 The c$inician shou$d determine ho%!The c$inician shou$d determine ho%!

%hen and %here the injury occurred.%hen and %here the injury occurred.

;hen= is important! because the

pro"nosis #or the injured tooth %orsens %ith every minute o#pro"nosis #or the injured tooth %orsens %ith every minute o#

de$ay in treatment. ;>here= is important! because it mayde$ay in treatment. ;>here= is important! because it may


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Intra ora$ e&amination0Intra ora$ e&amination0 /ach tooth shou$d be/ach tooth shou$d bee&amined #or dama"e or mobi$ity.e&amined #or dama"e or mobi$ity.

The $abia$ mucosa! ma&i$$ary #renum! "in"iva$The $abia$ mucosa! ma&i$$ary #renum! "in"iva$

tissues! and ton"ue shou$d be e&amined #ortissues! and ton"ue shou$d be e&amined #or

bruisin" or $acerations.bruisin" or $acerations.

6adio"raphic e&amination6adio"raphic e&amination

Photo"raphic documentationPhoto"raphic documentation

@ita$it testin 0@ita$ity testin"0 6ecent$ traumati8ed teeth #ai$ to6ecent$y traumati8ed teeth #ai$ to


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/$$is c$ass * #racture/$$is c$ass * #racture

/$$is c$ass * #ractures can be o# t%o types0/$$is c$ass * #ractures can be o# t%o types0

*. 2ro%n in#ractions0 In#raction $ines are*. 2ro%n in#ractions0 In#raction $ines are

visua$i8ed easi$y %ith trans0 i$$umination andvisua$i8ed easi$y %ith trans0 i$$umination and

their presence indicates a si"ni#icant #orce!their presence indicates a si"ni#icant #orce!hence the status o# the pu$pa$ and supportin"hence the status o# the pu$pa$ and supportin"

periodonta$ structures shou$d be eva$uated.periodonta$ structures shou$d be eva$uated.

'reatment-'reatment- Sea$in" the in#raction $ine %ith anSea$in" the in#raction $ine %ith an

un#i$$ed resin #o$$o%in" an acid etch techniBueun#i$$ed resin #o$$o%in" an acid etch techniBue

may prevent stains #rom becomin" an estheticmay prevent stains #rom becomin" an esthetic

prob$em.prob$em.


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! Enamel fractures- )ana*ement-! Enamel fractures- )ana*ement-a.a. Recontourin*-Recontourin*-6econtourin" o# the6econtourin" o# the

injured or adjacent opposin" tooth mayinjured or adjacent opposin" tooth maybe done. 6econtourin" e$iminates thebe done. 6econtourin" e$iminates the

sharp ename$ ed"es associated %ithsharp ename$ ed"es associated %ith

minor injuries and prevents $aceration o#minor injuries and prevents $aceration o#


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Ellis class ! fracturesEllis class ! fractures

The tooth shou$d be e&amined #or minor pu$pThe tooth shou$d be e&amined #or minor pu$p

e&posures. @ita$ity testin" shou$d be done immediate$ye&posures. @ita$ity testin" shou$d be done immediate$y

and re"u$ar$y at periodic reca$$ visits #or a minimumand re"u$ar$y at periodic reca$$ visits #or a minimum

time period o# si& months and symptoms $i+e therma$time period o# si& months and symptoms $i+e therma$

sensitivity and pain on mastication shou$d be noted.sensitivity and pain on mastication shou$d be noted.

Intra ora$ peri apica$ radio"raph o# the tooth shou$dIntra ora$ peri apica$ radio"raph o# the tooth shou$d

revea$ an intact periodonta$ $i"ament space and so$idrevea$ an intact periodonta$ $i"ament space and so$id

cortica$ bone associated %ith the tooth.cortica$ bone associated %ith the tooth.


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2$inica$ mana"ement2$inica$ mana"ement

*.*. Indirect +ul+ ca++in* and com+ositeIndirect +ul+ ca++in* and com+osite

resin ,uild u+-resin ,uild u+-I# the thic+ness o# remainin"I# the thic+ness o# remainin"

dentin is %ithin ,. mm o# the denta$ pu$p!dentin is %ithin ,. mm o# the denta$ pu$p!

app$ication o# hard settin" ca$cium hydro&ideapp$ication o# hard settin" ca$cium hydro&idecement as a $iner over the e&posed dentina$cement as a $iner over the e&posed dentina$

tubu$es and restoration %ith a compositetubu$es and restoration %ith a composite

resin is done.resin is done.

1.1. Reattachment of the fractured se*mentReattachment of the fractured se*ment


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ELLIS CLASS II FRACTURE

BEVEL MARGINBEFORE

COMPOSITERESTORATION

APPLICATION OF CALCIUM HYDROXIDE

FOLLOWED BY ACID ETCHING ANDCOMPOSITE RESTORATION


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Reattachment procedure


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EI. C/.. " R/C'RE.EI. C/.. " R/C'RE.

/$$is c$ass - #ractures are de#ined as cro%n #ractures/$$is c$ass - #ractures are de#ined as cro%n #ractures

invo$vin" ename$! dentin and pu$p.invo$vin" ename$! dentin and pu$p.

6adio"raphic eva$uation and sensitivity testin" is mandatory6adio"raphic eva$uation and sensitivity testin" is mandatory

Sensitivity testin" is usua$$y not indicated initia$$y sinceSensitivity testin" is usua$$y not indicated initia$$y since

vita$ity o# the pu$p can be visua$i8ed c$inica$$y.vita$ity o# the pu$p can be visua$i8ed c$inica$$y.

Clinical mana*ement-Clinical mana*ement-

A. Teeth %ith immature root apices and vita$ pu$pa$A. Teeth %ith immature root apices and vita$ pu$pa$

e&posures reBuire:e&posures reBuire:

*. Pu$p cappin"0*. Pu$p cappin"0 Ca++in* of the +ul+Ca++in* of the +ul+is to be done on$y #oris to be done on$y #or

sma$$ e&posures that can be treated immediate$y a#ter thesma$$ e&posures that can be treated immediate$y a#ter the

injury.injury.


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1. Partia$ pu$potomy or1. Partia$ pu$potomy or

-. Pu$potomy dependin" on the individua$ case0-. Pu$potomy dependin" on the individua$ case0

Studies indicate that it may be sa#e to proceed %ithStudies indicate that it may be sa#e to proceed %ith

sha$$o% pu$potomies up to * %ee+ post #racture.sha$$o% pu$potomies up to * %ee+ post #racture.A#ter that! it is Buestionab$e in mature! #u$$y #ormedA#ter that! it is Buestionab$e in mature! #u$$y #ormed

teeth. A$thou"h in youn"! deve$opin" teeth %ithteeth. A$thou"h in youn"! deve$opin" teeth %ith

%ide0open apices! pu$potomy can be tried even%ide0open apices! pu$potomy can be tried even

%hen the tooth has been e&posed #or more than a%hen the tooth has been e&posed #or more than a

%ee+.%ee+.


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TREATMENT PLAN FOR ELLIS CLASS3 FRACTURES


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2 ractured cro3n 3ith mature a+e4-2 ractured cro3n 3ith mature a+e4- InIn

case o# teeth %ith c$osed ape&! vita$ pu$pcase o# teeth %ith c$osed ape&! vita$ pu$p

procedures are per#ormed accordin" toprocedures are per#ormed accordin" to

individua$ case. I# on #o$$o% up! si"ns o# #ai$ureindividua$ case. I# on #o$$o% up! si"ns o# #ai$ureo# therapy are seen! #or instance! periapica$o# therapy are seen! #or instance! periapica$

radio$ucency! pain or tenderness on percussionradio$ucency! pain or tenderness on percussion

is seen! e&tirpation o# pu$p and conventiona$is seen! e&tirpation o# pu$p and conventiona$

endodontic treatment are carried out.endodontic treatment are carried out.


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ELLIS CLASS 3 FRACTURE MANAGEMENT

REMOVAL OF CORONAL PULP

APPLICATION OFCALCUM

HYDROXIDEPULPOTOMYPROCEDURE


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EI. C/.. # R/C'RE.EI. C/.. # R/C'RE.

In /$$is c$ass #racture! the tooth becomes non vita$In /$$is c$ass #racture! the tooth becomes non vita$

%ith %ithout $oss o# tooth structure.%ith %ithout $oss o# tooth structure.

)ana*ement of Ellis class # fracture-)ana*ement of Ellis class # fracture- depends ondepends on

the status o# root comp$etion o# the tooth.the status o# root comp$etion o# the tooth.

In case of a tooth 3ith an incom+lete5 o+en a+e4In case of a tooth 3ith an incom+lete5 o+en a+e4

and a non vital +ul+6 the +rocess of a+e4ification isand a non vital +ul+6 the +rocess of a+e4ification is

used to induce the com+letion of the root a+e4used to induce the com+letion of the root a+e4

In case of a tooth 3ith mature a+e4In case of a tooth 3ith mature a+e4 and a necroticand a necrotic

pu$p the $ine o# treatment ispu$p the $ine o# treatment is +ul+ectomy and+ul+ectomy and

o,turation of the canalo,turation of the canal


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TREAMENT PLAN FOR ELLIS CLASS 4 FRACTURES


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/ In case of a tooth 3ith an incom+lete5 o+en/ In case of a tooth 3ith an incom+lete5 o+ena+e4 and a non vital +ul+a+e4 and a non vital +ul+ T%o treatment optionsT%o treatment options

can be considered in such cases.can be considered in such cases.

*. Ape&i#ication procedure is used to induce ape&*. Ape&i#ication procedure is used to induce ape&

comp$etion0 can be done in one ormu$tip$e visitscomp$etion0 can be done in one ormu$tip$e visitsdependin" on the materia$ used.dependin" on the materia$ used.

)aterials for a+e4ification)aterials for a+e4ification00

*. ca$cium hydro&ide*. ca$cium hydro&ide

1. MTA1. MTA


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APEXIFICATION PROCEDURE

Discolored o !i"#l "oo"$% #ccess o&ei'( )or*i'

le'"$ +e#s,re+e" #d CA-OH./ &l#ce+e"


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! Revasculari8ation of the +ul+- Indications! Revasculari8ation of the +ul+- Indications00Pu$p revascu$ari8ation is indicated as aPu$p revascu$ari8ation is indicated as a

procedure in cases %ith immature permanentprocedure in cases %ith immature permanent

teeth %here disin#ection o# the cana$ can beteeth %here disin#ection o# the cana$ can be

achieved.achieved.

The necrotic in#ected pu$p may act as a sca##o$dThe necrotic in#ected pu$p may act as a sca##o$d

#or the in "ro%th o# ne% tissue #rom the#or the in "ro%th o# ne% tissue #rom the

periapica$ area. This process is ca$$ed pu$pperiapica$ area. This process is ca$$ed pu$p


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2 In case of a tooth 3ith mature a+e4 and a2 In case of a tooth 3ith mature a+e4 and anecrotic +ul+necrotic +ul+pu$pectomy #o$$o%ed bypu$pectomy #o$$o%ed by

obturation o# the root cana$ is the recommendedobturation o# the root cana$ is the recommended

treatment.treatment.

Reattachment of the fra*ment-Reattachment of the fra*ment- 6eattachment6eattachmento# the #ra"ment is carried out in a simi$ar %ay aso# the #ra"ment is carried out in a simi$ar %ay as

#or an uncomp$icated #racture e&cept that an#or an uncomp$icated #racture e&cept that an

interna$ "roove is made in the dentin o# theinterna$ "roove is made in the dentin o# the

#ractured #ra ment #or the corona$ art o# the#ractured #ra"ment #or the corona$ part o# the


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)ana*ement of cro3n discoloration)ana*ement of cro3n discoloration00 In casesIn cases

%here cro%n disco$oration occurs due to seepa"e%here cro%n disco$oration occurs due to seepa"e

o# necrotic pu$p remnants into the dentina$o# necrotic pu$p remnants into the dentina$tubu$es0tubu$es0

*. Non vita$ b$eachin"0*. Non vita$ b$eachin"0 thermocata$ytic techniBuethermocata$ytic techniBue

$i"ht b$each $i"ht b$each

%a$+in" b$each. %a$+in" b$each.1. @eneers1. @eneers

-. Acry$ic cro%ns-. Acry$ic cro%ns


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EI. C/.. $ R/C'RE.EI. C/.. $ R/C'RE.

Denta$ avu$sion occurs %hen a tooth isDenta$ avu$sion occurs %hen a tooth iscomp$ete$y disp$aced or +noc+ed out o# thecomp$ete$y disp$aced or +noc+ed out o# the

denta$ soc+et.denta$ soc+et. IncidenceIncidence

,.) to *C) o#,.) to *C) o#

traumatic injuriestraumatic injuries Main etio$o"icMain etio$o"ic

#actors#actors

3i"hts3i"hts

Sports injuriesSports injuries

Automobi$eAutomobi$e

accidentsaccidents


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Avu$sed Permanent TeethAvu$sed Permanent Teeth

Ma&i$$ary centra$ incisorMa&i$$ary centra$ incisor

Most common$y avu$sed toothMost common$y avu$sed tooth

Mandibu$ar teethMandibu$ar teeth

Se$dom a##ectedSe$dom a##ected

Most #reBuent$y invo$ves aMost #reBuent$y invo$ves a

sin"$e toothsin"$e tooth

Most common a"e 0 G to **Most common a"e 0 G to ** Permanent incisors eruptin"Permanent incisors eruptin"

5oose$y structured PD55oose$y structured PD5


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Avu$sed Permanent TeethAvu$sed Permanent Teeth

Associated injuriesAssociated injuries

3racture o# a$veo$ar3racture o# a$veo$ar

soc+et %a$$soc+et %a$$

Injuries to the $ipsInjuries to the $ipsand "in"ivaand "in"iva


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Periodonta$ 5i"amentPeriodonta$ 5i"ament

6esponses6esponses Sur#ace 6esorptionSur#ace 6esorption 6ep$acement 6esorption (An+y$osis6ep$acement 6esorption (An+y$osis

In#$ammatory 6esorptionIn#$ammatory 6esorption


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6esponses6esponses Sur#ace resorptionSur#ace resorption

Super#icia$ resorptionSuper#icia$ resorption

cavitiescavities Main$y in cementumMain$y in cementum

2omp$ete repair o#2omp$ete repair o#

PD5PD5


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6esponses6esponses 6ep$acement6ep$acement

resorptionresorption(An+y$osis(An+y$osis Direct union o# boneDirect union o# bone

and rootand root

6esorption o# root 06esorption o# root 06ep$acement %ith6ep$acement %ith

bonebone Direct resu$t o# $oss o#Direct resu$t o# $oss o#

vita$ PD5vita$ PD5


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6esponses6esponses In#$ammatory resorptionIn#$ammatory resorption

6esorption o# cementum6esorption o# cementum

and dentinand dentin

In#$ammatory reaction in theIn#$ammatory reaction in the

periodonta$ $i"amentperiodonta$ $i"ament


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TJP/S H3


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Treatment 2onsiderationsTreatment 2onsiderations

/&traora$ time0 Shorter time 9etter/&traora$ time0 Shorter time 9etterpro"nosispro"nosis

O -, minO -, min *,) resorption*,) resorption

7, min 7, min

7,) resorption7,) resorption

/&tra ora$ environment/&tra ora$ environment

6oot sur#ace manipu$ation6oot sur#ace manipu$ation

Mana"ement o# the soc+etMana"ement o# the soc+et

Stabi$i8ationStabi$i8ation


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6ecommended Stora"e Media0 physio$o"ica$6ecommended Stora"e Media0 physio$o"ica$

stora"e media are recommended %hichstora"e media are recommended %hich

maintain the environment conducive to vita$itymaintain the environment conducive to vita$ityo# PD5 ce$$so# PD5 ce$$s

*. Soc+et (immediate*. Soc+et (immediate

rep$antationrep$antation1. 2e$$ cu$ture1. 2e$$ cu$ture

mediummedium

-. Mi$+-. Mi$+

. Physio$o"ic sa$ine. Physio$o"ic sa$ine

.. Sa$ivaSa$iva

C.C. Tap %aterTap %ater


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Mi$+ As A Stora"e MediumMi$+ As A Stora"e Medium

Physio$o"ic osmo$a$ityPhysio$o"ic osmo$a$ity Mar+ed$y #e%er bacteria than sa$ivaMar+ed$y #e%er bacteria than sa$iva

6eadi$y avai$ab$e6eadi$y avai$ab$e Stora"e #or 1 hrsStora"e #or 1 hrs

Periodonta$ hea$in" a$most as "ood asPeriodonta$ hea$in" a$most as "ood asimmediate rep$antationimmediate rep$antation

Stora"e #or C hrsStora"e #or C hrs Sa$ivaSa$iva e&tensive rep$acement resorptione&tensive rep$acement resorption

Mi$+Mi$+ hea$in" a$most as "ood as immediatehea$in" a$most as "ood as immediaterep$antrep$ant


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ashes to&ic brea+do%n products #rom the

root sur#aceroot sur#ace


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E)ERE:C; 'RE/')E:' /' 'R;/:D .I'E = I:>R;

*. 6ep$ant the tooth as soon as possib$e a#ter*. 6ep$ant the tooth as soon as possib$e a#ter

the avu$sion.the avu$sion.

1. I# it is not possib$e to reinsert the tooth! p$ace1. I# it is not possib$e to reinsert the tooth! p$aceit in a suitab$e transport medium.it in a suitab$e transport medium.


43/111

E)ERE:C; 'RE/')E:' /' '


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6ep$antation "uide$ines6ep$antation "uide$ines or a mature tooth 3ith a closed a+e4or a mature tooth 3ith a closed a+e4

*.*. If the tooth has already ,een re+lantedIf the tooth has already ,een re+lanted0 2$ean0 2$eana##ected area %ith %ater spray! sa$ine or ch$orhe&idine.a##ected area %ith %ater spray! sa$ine or ch$orhe&idine.

1.1.If the e4traoral dry time is ?%0 minutesIf the e4traoral dry time is ?%0 minutes and theand the

tooth has ,een ke+t in suita,le trans+ort mediumtooth has ,een ke+t in suita,le trans+ort medium 00

2$ean the contaminated root sur#ace and apica$ #oramen2$ean the contaminated root sur#ace and apica$ #oramen

%ith a stream o# sa$ine. 6emove the coa"u$um #rom the%ith a stream o# sa$ine. 6emove the coa"u$um #rom the

soc+et %ith a stream o# sa$ine. /&amine the a$veo$arsoc+et %ith a stream o# sa$ine. /&amine the a$veo$ar

soc+et. I# there is a #racture in the soc+et %a$$! repositionsoc+et. I# there is a #racture in the soc+et %a$$! reposition

it. 6ep$ant the tooth s$o%$y %ith s$i"ht di"ita$ pressure.it. 6ep$ant the tooth s$o%$y %ith s$i"ht di"ita$ pressure.


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6oot Sur#ace Manipu$ation6oot Sur#ace Manipu$ation /&traora$/&traora$ drydrytime * hrtime * hr

5oss o# PD5 ce$$ viabi$ity inevitab$e5oss o# PD5 ce$$ viabi$ity inevitab$e Treatment recommendationsTreatment recommendations

Q 6emove tissue ta"s6emove tissue ta"s

Q Soa+ in accepted denta$Soa+ in accepted denta$

#$uoride so$ution #or 1, min#$uoride so$ution #or 1, min

*.,01.) topica$ #$uoride*.,01.) topica$ #$uoride

so$utionso$ution

Sodium #$uorideSodium #$uoride (Andreasen(Andreasen

S"#o,s 0l,oride -1r#ser.% Fl,oride is ,sed 2ec#,se 0l,oro#"i"e

0or+ed is +ore resis"#" "o resor&"io


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ANAGEMENT OF A TOOTH WITH A NON VITAL PERIODONTAL LIGAMEN

curettae !"

PDLre#$a$t%"!&&!'e( )*e+tra!ra& r!!t ctreat#e$t,

re&a$tat.!$ a$(%&.$t.$


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)/'ERI/. .ED '= @REAE:' /IRE)/'ERI/. .ED '= @REAE:' /IRE= REI)@/:'ED '=='


48/111

or an immature tooth 3ith an o+en a+e4or an immature tooth 3ith an o+en a+e4/ If the tooth has already ,een re+lanted-/ If the tooth has already ,een re+lanted-

2$ean a##ected area %ith %ater spray! sa$ine or2$ean a##ected area %ith %ater spray! sa$ine or

ch$orhe&idine rinse.ch$orhe&idine rinse.

2 'he tooth has ,een ke+t in s+ecial2 'he tooth has ,een ke+t in s+ecial

stora*e media6 milk6 saline or saliva 'hestora*e media6 milk6 saline or saliva 'he

e4tra-oral dry time is ?%0 minutes-e4tra-oral dry time is ?%0 minutes-

I# contaminated! the root sur#ace and apica$I# contaminated! the root sur#ace and apica$


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MANAGEMENT OF A TOOTH WITH INCOMPLETE APEX FORMAT

INTRA CANAL CALCIUM HYDROXIDE DRESSING- APEXIFICAT


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or cases 3ith e4tra oral time of !0 to %0or cases 3ith e4tra oral time of !0 to %0

minutes-minutes-

Intracana$Intracana$p$acement o# 5edermi& paste hasp$acement o# 5edermi& paste has

been sho%n to produce promisin" resu$ts inbeen sho%n to produce promisin" resu$ts insuch cases. 5edermi& paste consists o#such cases. 5edermi& paste consists o#

triamcino$one (steroid and demec$ocyc$inetriamcino$one (steroid and demec$ocyc$ine

(tetracyc$ine.(tetracyc$ine.


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Mana"ement o# the Soc+etMana"ement o# the Soc+et

6emove contaminated coa"u$um in6emove contaminated coa"u$um in

soc+etsoc+et

Irri"ate %ith steri$e sa$ineIrri"ate %ith steri$e sa$ine


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/&amine soc+et/&amine soc+et If fracture is evidentIf fracture is evident

6eposition #ractured bone %ith a b$unt6eposition #ractured bone %ith a b$unt

instrumentinstrument


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6ep$ant usin" $i"ht di"ita$ pressure6ep$ant usin" $i"ht di"ita$ pressure


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Stabi$i8ationStabi$i8ation

Sp$intSp$int

De#initionDe#inition aa ri"idri"idoror #$e&ib$e#$e&ib$edevice used todevice used to

support! protect! or immobi$i8e teeth! preventin"support! protect! or immobi$i8e teeth! preventin"

#urther injury #or G to *, days.#urther injury #or G to *, days.

TypesTypes

Acid etch compositeAcid etch composite

2ross0suture2ross0suture

Titanium trauma sp$intTitanium trauma sp$int Acid etch %ire composite sp$intAcid etch %ire composite sp$int

6ibbond6ibbond


55/111

Acid /tch 2omposite Sp$intsAcid /tch 2omposite Sp$ints

Interpro&ima$ compositeInterpro&ima$ composite


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2omposite %ith arch %ire2omposite %ith arch %ire


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2omposite %ith mono#i$ament ny$on2omposite %ith mono#i$ament ny$on

2 S S $i2 S t S $i t


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2ross0Suture Sp$int2ross0Suture Sp$intIdic#"ios

No #d4#ce" "ee"$ "o s&li" "oU+##'e#2le "r#,+#"i5ed c$ildre


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Ti"#i,+ "r#,+#

s&li"

S&li"i' )i"$

Ri22od


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Pu$pa$ Pro"nosisPu$pa$ Pro"nosis

Sta"e o# root deve$opment0 as the maturitySta"e o# root deve$opment0 as the maturity

increases! the chances o# revascu$ari8ationincreases! the chances o# revascu$ari8ation

decreases.decreases.

Dry stora"e time0Dry stora"e time0 i# more! decreases chancesi# more! decreases chanceso# pu$p surviva$o# pu$p surviva$

Stora"e media0Stora"e media0 physio$o"ica$ media #avorphysio$o"ica$ media #avor

pu$p surviva$pu$p surviva$

Antibiotics0Antibiotics0topica$ antibiotics have a bene#icia$topica$ antibiotics have a bene#icia$

e##ecte##ect

/ndodontic 6ationa$e Mature/ndodontic 6ationa$e Mature


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6oot6oot

Pu$pectomyPu$pectomy G0* daysG0* days



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6oot6oot

2a$cium hydro&ide2a$cium hydro&ide

p$acementp$acement Antibacteria$Antibacteria$

Increases p< in dentinIncreases p< in dentin 3avors minera$i8ation over resorption3avors minera$i8ation over resorption

2a(H


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Treatment 3$o%chartTreatment 3$o%chart

//0 1r0 1r 2 0 1r2 0 1rE+tra!ra&E+tra!ra&DryDryT.#eT.#e

Ae+ Matur.t*Ae+ Matur.t*C&!%e(C&!%e( Oe$Oe$ Oe$ !r C&!%e(Oe$ !r C&!%e(Pu&ect!Pu&ect!

#*-04#*-04

(a*%(a*%

O)%er5O)%er5

ee

Ot.!$Ot.!$66

E+tra!ra&E+tra!ra&

RCTRCT

Pu&ect!Pu&ect!

#* -04#* -04

(a*%(a*%


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Additiona$ 2onsiderationsAdditiona$ 2onsiderations

Ana$"esics0 Paracetamo$ or NSAID basedAna$"esics0 Paracetamo$ or NSAID basedana$"esics are "enera$$y prescribed $i+eana$"esics are "enera$$y prescribed $i+e

paracetamo$ and codeine combination orparacetamo$ and codeine combination or

ibupro#en.ibupro#en.

2h$orhe&idine mouth%ash (,.*1) to2h$orhe&idine mouth%ash (,.*1) tomaintain ora$ hy"ienemaintain ora$ hy"iene

Tetanus0


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In case the avulsed tooth cannot ,e locatedIn case the avulsed tooth cannot ,e located00

There are t%o treatment options:There are t%o treatment options:

*. A provisiona$ removab$e partia$ denture.*. A provisiona$ removab$e partia$ denture.

1. Autotransp$antation01. Autotransp$antation0

Autotransp$antation is de#ined as the e&tractionAutotransp$antation is de#ined as the e&traction

o# a tooth #rom one $ocation and its rep$antationo# a tooth #rom one $ocation and its rep$antation

in a di##erent $ocation in the same individua$.in a di##erent $ocation in the same individua$.


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AUTOTRANSPLANTATION

OF SECONDPREMOLAR IN PLACE

OF MAXILAARY

CENTRAL INCISOR

FOLLOED !Y

CONTOURIN" AND

FULL CO#ERA"E

ALL CERAMIC

CRON PLACEMENT


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EI. C/.. % R/C'RE.EI. C/.. % R/C'RE.

6oot #ractures can be in t%o p$anes06oot #ractures can be in t%o p$anes0*.


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11 6oot #ractures are o#ten not apparent durin"6oot #ractures are o#ten not apparent durin"

a c$inica$ e&amination and can usua$$y bea c$inica$ e&amination and can usua$$y bedia"nosed usin" appropriate radio"raphs.dia"nosed usin" appropriate radio"raphs.

1.1. 2$inica$ #eatures %hen present are mobi$ity o#2$inica$ #eatures %hen present are mobi$ity o#

the corona$ #ra"ment. The $eve$ o# #racture canthe corona$ #ra"ment. The $eve$ o# #racture canbe discerned by arc o# mobi$ity o# the mobi$ebe discerned by arc o# mobi$ity o# the mobi$e

#ra"ment. The "reater the arc! the corona$ is the#ra"ment. The "reater the arc! the corona$ is the

$eve$ o# #racture.$eve$ o# #racture.


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'reatment of hori8ontal fractures-'reatment of hori8ontal fractures-

The de#initive treatment o# a hori8onta$ rootThe de#initive treatment o# a hori8onta$ root

#racture is the immediate reduction o# the#racture is the immediate reduction o# the

#ractured se"ments and comp$ete immobi$i8ation#ractured se"ments and comp$ete immobi$i8ationo# the corona$ se"ment. I# more than 10G1 hourso# the corona$ se"ment. I# more than 10G1 hours

have e$apsed! c$ose apposition o# the se"ments ishave e$apsed! c$ose apposition o# the se"ments is

"enera$$y impossib$e."enera$$y impossib$e.

MANAGEMENT OF ELLIS CLASS 7 FRACTURE BY S


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" Endodontic treatment-" Endodontic treatment-


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ACCESS OPENING FOLLOWED BY INTRA CANALCALCIUM HYDROXIDE DRESSING TILL THEFRACTURE LINE AND THEN FINALLY OBTURATION

WITH GUTTA PERCHA


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Aertical fractures-Aertical fractures-The #racture runs $en"th%iseThe #racture runs $en"th%ise

#rom the cro%n to%ards the ape&.#rom the cro%n to%ards the ape&.

Clinical reco*nitionClinical reco*nition00 *. Persistent du$$ pain o# $on"*. Persistent du$$ pain o# $on"

standin" ori"in.standin" ori"in.

1. Pain is e$icited by app$yin" pressure.1. Pain is e$icited by app$yin" pressure.

-. A chronica$$y non hea$in" poc+et that is not-. A chronica$$y non hea$in" poc+et that is not


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Treatment0Treatment0 In "enera$! pro"nosis #or sin"$eIn "enera$! pro"nosis #or sin"$erooted teeth is poor and e&traction is "enera$$yrooted teeth is poor and e&traction is "enera$$y

the su""ested treatment.


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EI. C/.. 7 R/C'RE.EI. C/.. 7 R/C'RE.

'his class of fractures includes'his class of fractures includes

1 Concussion1 Concussion00 Injury to tooth supportin" structuresInjury to tooth supportin" structures%ithout abnorma$ $oosenin" or disp$acement o# tooth.%ithout abnorma$ $oosenin" or disp$acement o# tooth.

! .u,lu4ation! .u,lu4ation00 Injury to tooth supportin" structuresInjury to tooth supportin" structures

%ith abnorma$ $oosenin" but %ithout disp$acement o#%ith abnorma$ $oosenin" but %ithout disp$acement o#

tooth.tooth.


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.2B/'I=: /:D DE:'/ C=:C..I=:.2B/'I=: /:D DE:'/ C=:C..I=:These injuries represent minor injuries to theThese injuries represent minor injuries to the

periodonta$ $i"ament and pu$p caused by anperiodonta$ $i"ament and pu$p caused by an

acute impact.acute impact.

Radio*ra+hicallyRadio*ra+hically! there are no patho$o"ica$! there are no patho$o"ica$

chan"es in the supportin" tissues.chan"es in the supportin" tissues.

Treatment consists o#:Treatment consists o#:

0 Hcc$usa$ re$ie#0 Hcc$usa$ re$ie# (e.". by se$ective "rindin" o#(e.". by se$ective "rindin" o#

CONCUSSION AND SUBLUXATIONCLINICAL AND RADIOGRAPHIC PICTURE


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CLINICAL AND RADIOGRAPHIC PICTURE

MANAGEMENT- REMOVAL OF OCCLUSAL INTERFERENCEFOR CONCUSSION AND SPLINTING FOR SUBLUXATION


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EB'R.IAE B/'I=:EB'R.IAE B/'I=:

An e&trusion occurs %hen a tooth is on$yAn e&trusion occurs %hen a tooth is on$ypartia$$y removed #rom the soc+et.partia$$y removed #rom the soc+et.

Clinical reco*nition-Clinical reco*nition-*. The tooth appears*. The tooth appears

e$on"ated and is e&cessive$y mobi$e.e$on"ated and is e&cessive$y mobi$e.

1. Sensitivity tests %i$$ $i+e$y "ive ne"ative1. Sensitivity tests %i$$ $i+e$y "ive ne"ative

resu$ts.resu$ts.


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-.-. Hrthodontic intrusionHrthodontic intrusion may a$so be carried out bymay a$so be carried out by

#i&ed app$iance therapy.#i&ed app$iance therapy.

.. /ndodontic treatment/ndodontic treatment is certain in cases o#is certain in cases o#

si"ni#icant e&trusion (more than 1 mm o# maturesi"ni#icant e&trusion (more than 1 mm o# mature

teeth. In such cases! pu$pectomy shou$d beteeth. In such cases! pu$pectomy shou$d beper#ormed and root cana$ space obturated %ith "uttaper#ormed and root cana$ space obturated %ith "utta

percha.percha.

.. 2ro%n disco$oration2ro%n disco$oration in such cases may be treatedin such cases may be treated

%ith non vita$ b$eachin" methods! veneers or #u$$%ith non vita$ b$eachin" methods! veneers or #u$$

ANAGEMENT OF EXTRUSION BY MANUAL REPOSITIONINGAND SUTURING TO SECURE THE TOOTH


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AND SUTURING TO SECURE THE TOOTH


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I:'R.I=:I:'R.I=:An intrusion injury is the most severe type o#An intrusion injury is the most severe type o#

$u&ation injury. The intruded tooth is impacted$u&ation injury. The intruded tooth is impacted

into the a$veo$ar bone! and the a$veo$ar soc+etinto the a$veo$ar bone! and the a$veo$ar soc+et

is #ractured.is #ractured.Clinical reco*nition-Clinical reco*nition-

*. In many cases! the tooth may not be visib$e.*. In many cases! the tooth may not be visib$e.

1. The tooth is disp$aced a&ia$$y into the a$veo$ar1. The tooth is disp$aced a&ia$$y into the a$veo$ar


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Clinical mana*ementClinical mana*ement0 Mana"ement strate"ies:0 Mana"ement strate"ies:*. sur"ica$ reduction (immediate repositionin"!*. sur"ica$ reduction (immediate repositionin"!

1. repositionin" %ith traction (active repositionin"!1. repositionin" %ith traction (active repositionin"!

-. %aitin" #or the tooth to return to its pre0injury-. %aitin" #or the tooth to return to its pre0injury

position (passive repositionin".position (passive repositionin".

Inc$%or% $ntruded &e%% than 'mm ma( )e a&&o*ed to repo%$t$on

them%e&+e%,Pro-no%$% o. $nc$%or% $ntruded )et*een ' /0 mm $% unpred$cta)&e1

)ut the( ma( )e orthodont$ca&&( e2truded *$th$n '30 *ee%,

Inc$%or% that ha+e )een $ntruded )e(ond 0 mm %hou&d )e

$mmed$ate&( repo%$t$oned 5%ur-$ca&&(6 to the$r norma&

/ .o&&o*ed )( root cana& treatment,

INTRUSION


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SPONTANEOUS ERUPTION

ORTHODONTIC

EXTRUSION


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/'ER/ B/'I=:/'ER/ B/'I=:

In $atera$ $ua&ation! a hori8onta$ impact #orcesIn $atera$ $ua&ation! a hori8onta$ impact #orces

the cro%n pa$ata$$y and the ape& $abia$$y.the cro%n pa$ata$$y and the ape& $abia$$y.

Clinical reco*nition-Clinical reco*nition- 11 The tooth is disp$aced!The tooth is disp$aced!usua$$y in a pa$ata$$in"ua$ or $abia$ direction.usua$$y in a pa$ata$$in"ua$ or $abia$ direction.

1. It %i$$ be immobi$e and percussion usua$$y1. It %i$$ be immobi$e and percussion usua$$y

"ives a hi"h! meta$$ic (an+y$otic sound."ives a hi"h! meta$$ic (an+y$otic sound.


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Clinical mana*ementClinical mana*ement00*.*.An anti0in#$ammatory a"ent! an ana$"esic and anAn anti0in#$ammatory a"ent! an ana$"esic and an

antibiotic are prescribed.antibiotic are prescribed.

1. 6epositionin"1. 6epositionin" a#ter $oca$ anesthesia! and app$yin" aa#ter $oca$ anesthesia! and app$yin" a

semi0ri"id sp$int #or %ee+s. A post0treatmentsemi0ri"id sp$int #or %ee+s. A post0treatment

radio"raph shou$d be per#ormed to assure properradio"raph shou$d be per#ormed to assure proper

position o# the tooth in the soc+et.position o# the tooth in the soc+et.


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EI. C/.. & R/C'RE.EI. C/.. & R/C'RE.

It is the #racture o# the cro%n enmasse and itsIt is the #racture o# the cro%n enmasse and its

disp$acement.disp$acement.

Clinical e4amination-Clinical e4amination-*.


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Clinical mana*ement-Clinical mana*ement-1 Reattachment-1 Reattachment-

3ractured #ra"ment is removed and +ept in3ractured #ra"ment is removed and +ept in

sa$ine.sa$ine.

Hbturation o# the cana$ carried out #o$$o%ed byHbturation o# the cana$ carried out #o$$o%ed bypost space preparation.post space preparation.

3iber rein#orced post is cemented into the3iber rein#orced post is cemented into the

cana$.cana$.

The #ractured #ra ment is cemented to theThe #ractured #ra"ment is cemented to the


88/111

MANAGEMENT OF ELLIS CLASS 8 FRACTURE BY SUEXTRUSION AND POST AND CORE BUILD UP FOLLOFULL COVERAGE CROWN


89/111

MANAGEMENT BY ORTHODONTICEXTRUSION


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/55IS 25ASS 7 36A2T6/S/55IS 25ASS 7 36A2T6/S

/$$is c$ass 7 #ractures inc$ude a$$ the injuries to/$$is c$ass 7 #ractures inc$ude a$$ the injuries to

the primary teeth and the supportin" tissues.the primary teeth and the supportin" tissues.

Trauma to the primary dentition presentsTrauma to the primary dentition presentsspecia$ prob$ems and the mana"ement is o#tenspecia$ prob$ems and the mana"ement is o#ten

di##icu$t and di##erent as compared to thedi##icu$t and di##erent as compared to the

permanent dentition. As much as *) o# a$$ thepermanent dentition. As much as *) o# a$$ the

in uries are seen in the ora$ re ion in chi$dren!injuries are seen in the ora$ re"ion in chi$dren!


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I "$e &ri+#r6 de"i"io( s+#ll coro#l

0r#c",res +#6 2e o2ser!ed i &ri+#r6 "ee"$2," l,7#"ios #re +ore co++o T$is is

2ec#,se o0 "$e &li#2ili"6 o0 "$e 0#ci#l s*ele"o

#d o0 "$e &eriodo"#l li'#+e"( "$e l#r'e!ol,+e o0 "ee"$ i rel#"io "o "$e 2oe i

&ri+#r6 #d +i7ed de"i"io &eriod #d

0i#ll6( "$e s$or"er roo"s o0 &ri+#r6 "ee"$

Se7ue&ae .or permanent dent$t$on a.ter traumat$c


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Se7ue&ae .or permanent dent$t$on a.ter traumat$c

$n8ur$e% to pr$mar( dent$t$on%9, :(pop&a%t$c de.ect%% +#6 r#'e 0ro+ )$i"e oci"ies "o 2ro)

s&o"s or &i"s o "$e l#2i#l s,r0#ce

/ T,rer8s $6&o&l#is# is #o"$er e7#+&le +#r*ed 26 discolor#"io o0

"ee"$ or s"r,c",r#l #l"er#"io i "$e cro)

3 S"r,c",r#l #l"er#"ios #ssoci#"ed )i"$ e#+el $6&o&l#si#( cro)

dil#cer#"io #d )$i"e( 6ello) or 2ro) discolor#"io

9 Roo" d,&lic#"io( roo" dil#cer#"io #d r"i#l or co+&le"e #rres" o0roo" 0or+#"io

: Al"er#"ios "o "$e &rocess o0 er,&"io o0 "$e &er+#e" "oo"$( or

+#l0or+#"io o0 "$e &er+#e" "oo"$ 'er+

Se;,el#e "o i4,r6 "o &er+#e" "ee"$ d,e "o "r#,+# "o &ri+#r6 "ee"$


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Se;,el#e "o i4,r6 "o &er+#e" "ee"$ d,e "o "r#,+# "o &ri+#r6 "ee"$


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Clinical e4aminationClinical e4amination00A detai$ed history aboutA detai$ed history about

the accident causin" the trauma and the timethe accident causin" the trauma and the time

e$apsed since the accident are importante$apsed since the accident are importantcomponents to be eva$uated. Thorou"h e&tracomponents to be eva$uated. Thorou"h e&tra

ora$ and intra ora$ e&amination must be carriedora$ and intra ora$ e&amination must be carried

out to discern any associated injuries.out to discern any associated injuries.


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1.1.

Com+licated cro3n fractureCom+licated cro3n fracture

00

3racture invo$ves ename$3racture invo$ves ename$

and dentin and the pu$p is e&posed.and dentin and the pu$p is e&posed.

Radio*ra+hic e4amination-Radio*ra+hic e4amination-A periapica$ vie% is used toA periapica$ vie% is used to

discern the e&tent o# #racture and the sta"e o# rootdiscern the e&tent o# #racture and the sta"e o# root

deve$opment.deve$opment.

'reatment-'reatment-In very youn" chi$dren %ith immature! sti$$In very youn" chi$dren %ith immature! sti$$

deve$opin" roots! it is advanta"eous to preserve pu$p vita$itydeve$opin" roots! it is advanta"eous to preserve pu$p vita$ity

by pu$p cappin" or partia$ pu$potomy. 2a$cium hydro&ide isby pu$p cappin" or partia$ pu$potomy. 2a$cium hydro&ide is

MANAGEMENT OF A CROWN ROOT FRACTURE BYEITHER EXTRACTION OR

ROOT CANAL TREATMENT IF THE PROGNOSIS IS


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ROOT CANAL TREATMENT IF THE PROGNOSIS ISFAVORABLE


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-.-. Cro3n root fractureCro3n root fracture00 3racture invo$ves ename$! dentin and3racture invo$ves ename$! dentin and

root structureU the pu$p may or may not be e&posed. Additiona$root structureU the pu$p may or may not be e&posed. Additiona$

#indin"s may be $oose but sti$$ attached #ra"ments o# the tooth.#indin"s may be $oose but sti$$ attached #ra"ments o# the tooth.

There is minima$ to moderate tooth disp$acement.There is minima$ to moderate tooth disp$acement.

Radio*ra+hic e4amination-Radio*ra+hic e4amination- InIn$atera$$y positioned i.e. ob$iBue$atera$$y positioned i.e. ob$iBue#ractures! the e&tent o# the #racture $ine in re$ation to the#ractures! the e&tent o# the #racture $ine in re$ation to the

"in"iva$ mar"ins can be seen"in"iva$ mar"ins can be seen..

'reatment-'reatment-

/&traction is the on$y recommended treatment/&traction is the on$y recommended treatment


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# Root fracture-# Root fracture- The corona$ #ra"ment is "enera$$yThe corona$ #ra"ment is "enera$$ymobi$e and may be disp$aced.mobi$e and may be disp$aced.

Radio*ra+hic e4amination-Radio*ra+hic e4amination- enera$$y! the #racture isenera$$y! the #racture is

$ocated in the midd$e or the apica$ third.$ocated in the midd$e or the apica$ third.

'reatment-'reatment-Root fracturesRoot fracturesin primary teeth!in primary teeth!

particu$ar$y those occurrin" in the apica$ third o# theparticu$ar$y those occurrin" in the apica$ third o# the


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.. /lveolar fracture/lveolar fracture00 The #racture invo$ves the a$veo$arThe #racture invo$ves the a$veo$arbone supportin" the primary teeth and permanent toothbone supportin" the primary teeth and permanent tooth

"erms."erms.

The tooth containin" se"ment is mobi$e and usua$$yThe tooth containin" se"ment is mobi$e and usua$$y

disp$aced.disp$aced.

Hcc$usa$ inter#erence is usua$$y noted.Hcc$usa$ inter#erence is usua$$y noted.

Radio*ra+hic e4amination-Radio*ra+hic e4amination- TheThe#racture $ine c$ose to#racture $ine c$ose to

the apices o# the primary teeth and their permanentthe apices o# the primary teeth and their permanent

successors %i$$ be disc$osed. A $atera$ radio"raph maysuccessors %i$$ be disc$osed. A $atera$ radio"raph may


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B/'I=: I:>RIE. I: '


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! .u,lu4ation-! .u,lu4ation- The tooth has increased mobi$ity butThe tooth has increased mobi$ity but

has not been disp$aced.has not been disp$aced.

Radio*ra+hic e4amination-Radio*ra+hic e4amination- No radio"raphicNo radio"raphicabnorma$ities are visib$e. The periodonta$ space isabnorma$ities are visib$e. The periodonta$ space is

norma$ in %idth.norma$ in %idth.

'reatment-'reatment- Monitorin" o# a##$icted teeth shou$d beMonitorin" o# a##$icted teeth shou$d be


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E4trusive u4ationE4trusive u4ation00 The tooth appears e$on"atedThe tooth appears e$on"ated

and is e&cessive$y mobi$eand is e&cessive$y mobi$e..

Radio*ra+hic e4amination-Radio*ra+hic e4amination- Increased periodonta$Increased periodonta$$i"ament space apica$$y.$i"ament space apica$$y.

'reatment-'reatment- Treatment depends upon the de"ree o#Treatment depends upon the de"ree o#


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ateral lu4ation-ateral lu4ation- The tooth is disp$aced usua$$y in aThe tooth is disp$aced usua$$y in apa$ata$ $in"ua$ direction. It %i$$ o#ten be immobi$epa$ata$ $in"ua$ direction. It %i$$ o#ten be immobi$e..

Radio*ra+hic e4amination-Radio*ra+hic e4amination- Increased periodonta$Increased periodonta$

$i"ament space apica$$y is best seen on an occ$usa$$i"ament space apica$$y is best seen on an occ$usa$vie%.vie%.

'reatment-'reatment- I# there is no occ$usa$ inter#erence as isI# there is no occ$usa$ inter#erence as is


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Intrusive lu4ation-Intrusive lu4ation- The tooth is usua$$yThe tooth is usua$$ydisp$aced throu"h the $abia$ bone p$ate or candisp$aced throu"h the $abia$ bone p$ate or can

impin"e upon the succedaneous tooth bud.impin"e upon the succedaneous tooth bud.

Clinical e4amination-Clinical e4amination- 2$inica$$y! the tooth may2$inica$$y! the tooth may

disappear comp$ete$y into the surroundin"disappear comp$ete$y into the surroundin"

It is e&treme$y important to determine a#ter the injury %hetherIt is e&treme$y important to determine a#ter the injury %hether


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the primary tooth is in contact %ith the permanent tooth "ermthe primary tooth is in contact %ith the permanent tooth "erm

or has been pushed a%ay in the $abia$ direction.or has been pushed a%ay in the $abia$ direction.

Severa$ c$inica$ and radio"raphic si"ns support the dia"nosisSevera$ c$inica$ and radio"raphic si"ns support the dia"nosis

o# $abia$ a$i"nment o# the root:o# $abia$ a$i"nment o# the root:

*. Pa$ata$ inc$ination o# the cro%n.*. Pa$ata$ inc$ination o# the cro%n.

1. hen the ape& is

disp$aced to ard or thro "h the $abia$ bone p$atedisp$aced to%ard or throu"h the $abia$ bone p$ate


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disp$aced to%ard or throu"h the $abia$ bone p$ate!disp$aced to%ard or throu"h the $abia$ bone p$ate!

the ape& can be visua$i8ed and appears shorterthe ape& can be visua$i8ed and appears shorter

than the contra $atera$ tooth.than the contra $atera$ tooth.>hen the ape& is disp$aced to%ards the permanent>hen the ape& is disp$aced to%ards the permanent

tooth "erm! the ape& cannot be visua$i8ed and thetooth "erm! the ape& cannot be visua$i8ed and the

root appears e$on"ated.root appears e$on"ated.

'reatment-'reatment- I# the ape& is disp$aced to%ard orI# the ape& is disp$aced to%ard or

throu"h the $abia$ bone p$ate! the tooth is $e#t #orthrou"h the $abia$ bone p$ate! the tooth is $e#t #or

spontaneous repositionin". I# the ape& is disp$acedspontaneous repositionin". I# the ape& is disp$aced

into the deve$opin" tooth "erm! e&traction o# theinto the deve$opin" tooth "erm! e&traction o# the

tooth is indicated.tooth is indicated.

INTRUSION FOLLOWED BY SPONTANEOUSERUPTION


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ERUPTION

INTRUSION- PRIMARY TOOTH INTRUDING INTOTHE PERMANENT TOOTH FOLLICLE

SHOULD BE TREATED BY EXTRACTION OF THE

PRIMARY TOOTH

/vulsion-/vulsion- The tooth is disp$aced comp$ete$y out o# the soc+et.The tooth is disp$aced comp$ete$y out o# the soc+et.


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Radio*ra+hic e4amination-Radio*ra+hic e4amination-A radio"raphic e&amination isA radio"raphic e&amination is

essentia$ to ensure that the missin" tooth is not intruded.essentia$ to ensure that the missin" tooth is not intruded.

'reatment-'reatment- It is "enera$$y not recommended to rep$ant anIt is "enera$$y not recommended to rep$ant anavu$sed primary tooth because o# the e$evated potentia$ #oravu$sed primary tooth because o# the e$evated potentia$ #or

chronic in#ection and subseBuent dystrophic chan"es that cou$dchronic in#ection and subseBuent dystrophic chan"es that cou$d

occur %ithin the deve$opin" teeth.occur %ithin the deve$opin" teeth.

Reim+lantation of avulsed +rimary teethReim+lantation of avulsed +rimary teeth -- 2ase se$ection2ase se$ectioncriteria inc$ude teeth %ith an e&traora$ dry time o# $ess than -,criteria inc$ude teeth %ith an e&traora$ dry time o# $ess than -,

minutes and periodonta$ $i"ament ce$$ maintenance throu"h anminutes and periodonta$ $i"ament ce$$ maintenance throu"h an

appropriate tooth stora"e medium.appropriate tooth stora"e medium.

unctional s+ace maintainers after e4articulation ofunctional s+ace maintainers after e4articulation of

+rimary teeth-+rimary teeth- In case the primary tooth teeth are e&tracted! aIn case the primary tooth teeth are e&tracted! a

removab$e or a #i&ed #unctiona$ space maintainer shou$d beremovab$e or a #i&ed #unctiona$ space maintainer shou$d be

"iven to the patient ti$$ the time the permanent teeth erupt."iven to the patient ti$$ the time the permanent teeth erupt.

To conc$ude0To conc$ude0 The majority o# denta$ and ora$The majority o# denta$ and ora$


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To conc$udeTo conc$ude The majority o# denta$ and ora$The majority o# denta$ and ora$injuries are une&pected %hich ma+es theirinjuries are une&pected %hich ma+es their

prevention di##icu$tprevention di##icu$t


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T$#* 6o,

Tooth Trauma.ppt

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