The document provides information on traumatic injuries to teeth, including concussions, luxations, and fractures. It describes the clinical signs, radiographic findings, and treatment approaches for each type of injury. Concussions involve inflammation of the periodontal ligament without tooth displacement. Luxations occur when a tooth is displaced from its socket, sometimes with alveolar bone fractures. Fractures are classified as enamel fractures, enamel-dentin fractures, enamel-dentin-pulp fractures, or root fractures. Treatment depends on the specific injury but may include repositioning displaced teeth, pulpotomies, root canals, extractions, or orthodontic/surgical repositioning.

1. TRAUMATIC
INJURIES OF
TEETH
Prepared by:
Dr. Rea Corpuz

2. Traumatic Injuries of
Teeth
 Case History
 Chief complaint
 History of present illness
 Medical History

3. Traumatic Injuries of
Teeth
 Clinical Examination
 External Examination
 Soft Tissues
 Facial Skeleton
 Teeth and Supporting Structures

4. Traumatic Injuries of
Teeth
 Radiographic Examination
 Periapical
 Occlusal
 Panoramic

5. Traumatic Injuries of
Teeth
 (1) Concussion
 (2) Luxation
 (3) Fracture

6. Concussion
 tooth is not mobile
 not displaced
 periodontal ligament (PDL)
absorbs injury + inflammed
 leaves tooth tender to
biting pressure + percussion

7. Concussion
 Visual sign:
 not displaced
 Percussion test:
 tender to touch or tapping
 Mobility test:
 no increased mobility

8. Concussion
 Pulp Sensibility Test:
 positive result
 it is important in assessing
future risk of healing
complications
 lack of response to the test
indicates an increased risk
of later pulp necrosis

9. Concussion
 Radiographic findings:
 no radiographic
abnormalities
 Radiographs:
 occlusal
 periapical
 lateral view from mesial +
distal aspect of tooth in
question

10. Concussion
 Treatment Objectives:
 usually there is no
treatment
 Treatment:
 monitor pulpal condition
for at least 1 year

11. Concussion
 Patient Instructions:
 soft food for 1 week
 brush with soft bristle
 rinse with chlorhexidine
0.1% to prevent plaque
accumulation

12. Luxation
 tooth is displaced in
a labial, lingual or lateral
direction
 PDL is usually torn
 fractures of supporting
alveolus may occur

13. Luxation
 similar to extrusion injuries
 partial or total separation
of periodontal ligament

14. Luxation
 Visual sign:
 displaced, usually in a
palatal/lingual or labial
direction
 Percussion test:
 usually gives a metallic
(ankylotic) sound
 Mobility test:


15. Luxation
 Pulp Sensibility Test:
 likely give a lack of
response except for teeth
with minor displacement
 test is important in assessing
risk of healing complications
 positive result at the initial
examination indicates a reduced
risk of future pulp necrosis

16. Luxation
 Radiographic findings:
 widened periapical ligament
space best seen on occlusal
or eccentric exposures
 Radiographs:
 occlusal
 periapical
 lateral view from mesial +
distal aspect of tooth in

17. Luxation
 Treatment Objective:
 reposition + splint a displaced
tooth to facilitate pulp +
periodontal ligament healing

18. Luxation
 Treatment:
 rinse the exposed part of root
surface with saline before
repositioning
 apply local anesthesia
 reposition tooth with forceps
or with digital pressure to
disengage it from its bony
socket

19. Luxation
 Treatment:
 gently reposition it into
its original position
 stabilize the tooth for 4 weeks
using a flexible splint
 4 weeks is indicated due to
associated bone fracture

20. Luxation
 Patient Instructions:
 soft food for 1 week
 brush with soft bristle
 rinse with chlorhexidine
0.1% to prevent plaque
accumulation

21. Fracture
 Ellis and Davey classification
of crown fracture is useful in
recording extent of damage to
crown
 Class I – simple fracture
of crown involving little
or no dentin
 Class II – extensive fracture
of crown involving considerable
dentin but not dental pulp

22. Fracture
 Class III – extensive fracture
of crown with an exposure
of dental pulp
 Class IV – loss of entire crown

23. Fracture
 Enamel Fracture
 Enamel-Dentin Fracture
 Enamel-Dentin-Pulp Fracture
 Root Fracture

24. Enamel Fracture
 fracture confined to the
enamel with loss of tooth
structure

25. Enamel Fracture
 Visual sign:
 visible loss of enamel
 no visible sign of exposed
dentin
 Percussion test:
 not tender
 if tenderness is observed
evaluate tooth for a possible
luxation or root fracture injury

26. Enamel Fracture
 Mobility test:
 normal mobility
 Sensibility test:
 usually positive
 test may be negative initially
indicating transient pulpal
damage

27. Enamel Fracture
 Sensibility test:
 monitor pulpal response
until definitive pulpal
diagnosis can be made
 test is important in assessing
risk of future healing
complications
 lack of response at initial
examination indicates an increased
risk of later pulpal necrosis

28. Enamel Fracture
 Radiographic findings:
 enamel lost is visible
 Radiographs:
 occlusal
 periapical
 recommended to rule out
possible presence of root
fracture or a luxation injury

29. Enamel Fracture
 Treatment:
 if tooth fragment is available,
it can be bonded to the tooth
 grinding or restoration with
composite resin depending on
extent + location of fracture

30. Enamel-Dentin Fracture
 fracture confined to enamel
+ dentin with loss of tooth
structure, but not involving
pulp

31. Enamel-Dentin Fracture
 Visual sign:
 visible loss of enamel
+ dentin
 no visible sign of exposed
pulp tissue
 Percussion test:
 not tender
 if tenderness is observed
evaluate tooth for a possible
luxation or root fracture injury

32. Enamel-Dentin Fracture
 Mobility test:
 normal mobility
 Sensibility test:
 usually positive
 test may be negative initially
indicating transient pulpal
damage

33. Enamel-Dentin Fracture
 Sensibility test:
 monitor pulpal response
until definitive pulpal
diagnosis can be made
 test is important in assessing
risk of future healing
complications
 lack of response at initial
examination indicates an increased
risk of later pulpal necrosis

34. Enamel-Dentin Fracture
 Radiographic findings:
 enamel-dentin lost
is visible
 Radiographs:
 occlusal
 periapical
 recommended to rule out
displacement or possible
presence of root fracture

35. Enamel-Dentin Fracture
 Treatment:
 if tooth fragment is available,
it can be bonded to the tooth
 otherwise perform provisional
treatment by covering exposed
dentin with glass ionomer
or a permanent restoration
using a bonding agent +
composite resin

36. Enamel-Dentin-Pulp
Fracture
 (Complicated Crown Fracture)
 a fracture involving enamel +
dentin with loss of tooth
structure + exposure of pulp

37. Enamel-Dentin-Pulp
Fracture
 Visual sign:
 visible loss of enamel
+ dentin
 exposed pulp tissue
 Percussion test:
 not tender
 if tenderness is observed
evaluate tooth for a possible
luxation or root fracture injury

38. Enamel-Dentin-Pulp
Fracture
 Mobility test:
 normal mobility
 Sensibility test:
 usually positive

39. Enamel-Dentin-Pulp
Fracture
 Sensibility test:
 test is important in assessing
risk of future healing
complications
 lack of response at initial
examination indicates an increased
risk of later pulpal necrosis

40. Enamel-Dentin-Pulp
Fracture
 Radiographic findings:
 lost of tooth substance
is visible
 Radiographs:
 occlusal
 periapical
 recommended to rule out
displacement or possible
presence of luxation or root
fracture

41. Enamel-Dentin-Pulp
Fracture
 Treatment:
 if young patients with open
apices, it is very important to
preserve pulp vitality by
pulp capping or partial
pulpotomy in order to secure
further root development
 this treatment is also
treatment of choice in patients
with closed apices

42. Enamel-Dentin-Pulp
Fracture
 Treatment:
 Calcium hydroxide compunds
+ MTA are suitable materials
for such procedures
 in older patients with closed
apices + luxation injury with
displacement, root canal
treatment is usually
treatment of choice

43. Crown-Root Fracture
without pulp involvement
 fracture involving:
 enamel
 dentin
 cementum
 with loss of tooth structure
 but not exposing pulp

44. Crown-Root Fracture
without pulp involvement
 Visual sign:
 crown fracture extending
below gingival margin
 Percussion test:
 tender

45. Crown-Root Fracture
without pulp involvement
 Mobility test:
 coronal fragment mobile
 Sensibility test:
 usually positive for apical
fragment

46. Crown-Root Fracture
without pulp involvement
 Radiographic findings:
 apical extension of fracture
usually not visible
 Radiographs:
 occlusal
 periapical
 recommended to detect fracture
lines in root
 cone beam exposure can reveal
whole fracture extension

47. Crown-Root Fracture
without pulp involvement
 Treatment:
 Fragment removal only
• removal of superficial coronal
crown-root fragment
• subsequent restoration of
exposed dentin above gingival
level

48. Crown-Root Fracture
without pulp involvement
 Treatment:
 Fragment removal + gingivectomy
(sometimes ostectomy)
• removal of coronal segment
with subsequent endodontic
treatment + restoration with
a post-retained crown

49. Crown-Root Fracture
without pulp involvement
 Treatment:
 Orthodontic extrusion of
apical fragment
• removal of coronal segment
with subsequent endodontic
treatment + orthodontic
extrusion of remaining root
with sufficient length after
extrusion to support a post-
retained crown

50. Crown-Root Fracture
without pulp involvement
 Treatment:
 Surgical extrusion
• removal of mobile fractured
fragment
• subsequent surgical
repositioning of root in a more
coronal position

51. Crown-Root Fracture
without pulp involvement
 Treatment:
 Decoronation (root submergence)
• implant solution is planned,
root fragment may be left in
situ after in order to avoid
alveolar bone resorption
• thereby maintaining volume of
alveolar process for later
implant installation

52. Crown-Root Fracture
without pulp involvement
 Treatment:
 Extraction
• with immediate or delayed
implant-retained crown
restoration or a coventional
bridge
• fractures with severe apical
extension, the extreme being
a vertical fracture

53. Crown-Root Fracture
with pulp involvement
 fracture involving:
 enamel
 dentin
 cementum
 with loss of tooth structure
 exposure of pulp

54. Crown-Root Fracture
with pulp involvement
 Visual sign:
 crown fracture extending
below gingival margin
 Percussion test:
 tender

55. Crown-Root Fracture
with pulp involvement
 Mobility test:
 coronal fragment mobile
 Sensibility test:
 usually positive for apical
fragment

56. Crown-Root Fracture
without pulp involvement
 Radiographic findings:
 apical extension of fracture
usually not visible
 Radiographs:
 occlusal
 periapical
 cone beam exposure can reveal
whole fracture extension

57. Crown-Root Fracture
with pulp involvement
 Treatment:
 Fragment removal + gingivectomy
(sometimes ostectomy)
• removal of coronal segment
with subsequent endodontic
treatment + restoration with
a post-retained crown

58. Crown-Root Fracture
with pulp involvement
 Treatment:
 Orthodontic extrusion of
apical fragment
• removal of coronal segment
with subsequent endodontic
treatment + orthodontic
extrusion of remaining root
with sufficient length after
extrusion to support a post-
retained crown

59. Crown-Root Fracture
with pulp involvement
 Treatment:
 Surgical extrusion
• removal of mobile fractured
fragment
• subsequent surgical
repositioning of root in a more
coronal position

60. Crown-Root Fracture
with pulp involvement
 Treatment:
 Decoronation (root submergence)
• implant solution is planned,
root fragment may be left in
situ after in order to avoid
alveolar bone resorption
• thereby maintaining volume of
alveolar process for later
implant installation

61. Crown-Root Fracture
with pulp involvement
 Treatment:
 Extraction
• with immediate or delayed
implant-retained crown
restoration or a coventional
bridge
• fractures with severe apical
extension, the extreme being
a vertical fracture

62. Root Fracture
 fracture confined to the
root of tooth involving:
 cementum
 dentin
 pulp

63. Root Fracture
 Visual sign:
 coronal segment may be
mobile
 some cases displaced
 transient crown discoloration
(red or gray) may occur
 bleeding from gingival sulcus
may be noted

64. Root Fracture
 Percussion test:
 tooth may be tender
 Mobility test:
 coronal segment may be
mobile

65. Root Fracture
 Sensibility test:
 the test is important in assessing
risk of healing complications
 a positive sensibility test
at the initial examination
indicates a significantly
reduced risk of later pulpal
necrosis

66. Root Fracture
 Sensibility test:
 may give negative results
initially
 indicating transient or permanent
neural damage
 pulp sensibility test is usually
negative for root fractures
except for teeth with minor
displacements

67. Root Fracture
 Radiographic findings:
 root fracture line is
usually visible
 fracture involves root of
the tooth in a horizontal
or diagonal plane

68. Root Fracture
 Treatment:
 rinse exposed root surface
with saline before repositioning
 if displaced, reposition the
coronal segment of the tooth as
soon as possible
 check that correct position
has been reached radiographically

69. Root Fracture
 Treatment:
 stabilize the tooth with flexible
splint for 4 weeks
 if the root fracture is near
cervical area of the tooth
stabilization is beneficial for
a longer period of time (upto 4
months)

70. Root Fracture
 Treatment:
 monitor healing for at least
1 year to determine pulpal
status
 if pulp necrosis develops, then
root canal treatment of the
coronal tooth segment to
the fracture is indicated

71. References:
 Books
McDonald, Avery et al: Dentistry for the
Child and Adolescent
• (pages 458-459)
 Internet
http://www.dentaltraumaguide.org