TRAUMATIC INJURIES OF TEETH LUXATION
 This is a condition where the tooth is dislocated
TREATING A PATIENT WITH ORAL FACIAL TRAUMA:
 One should record the patient’s medical & dental
history.
 This will include neurological signs, vital signs, and
changes in speech pattern.
 Tests involved are percussion, mobility test & pulp
vitality test.
 High quality radiographs are of great importance
for diagnosis & prognosis.
3 MAIN OBJECTIVES WHEN TREATING A PX FOR A
DENTAL TRAUMA EMERGENCY:
1. Preserve the pulp vitality
2. Control pain & bleeding
3. Look for radiographic changes, changes in
tooth color, and changes in pain.
- Rate the pain from 1 to 10
IN HUMAN DENTISTRY, THERE ARE 6 CLASSIFICATION
OF INJURIES THAT RESULT WHEN FORCES APPLIED
TO THE TOOTH IS GREATER THAN THE PHYSICAL
LIMITS OF THE PDL, NEUROVASCULAR SUPPLY &
BONE:
Concussion
 It is an alteration of consciousness, disturbance in
vision & equilibrium caused by a direct blow to the
head, rapid acceleration and/or deceleration of the
head, or direct blow to the base of the skull from a
vertical impact to the chin. (BRAIN CONCUSSION)
 In dentistry, results to mild injury to the tooth &
PDL without displacement from its position in the
alveolus.
 Tooth mobility may be present with no abnormal
loosening.
 Most noticeable clinical finding is a markedly
increased sensitivity to percussion.
 No radiographic changes are observed.
 May cause bleeding in the PDL & pulpal edema.
 For concussive tooth injuries in human dentistry,
no immediate treatment is necessary, the px
should allow the tooth to rest until sensitivity has
subsided.
 Px is instructed a soft diet for 2 weeks with close
monitoring of pulp vitality at 1, 3, 6, & 12 months.
 This type of injury usually requires no therapy &
usually resolves without complications.
within the socket but maintains some attachment.
 It is caused by a trauma that affects tooth nerves,
blood, cementum & surrounding bone.
Subluxation
 Injury to the tooth supporting structures with
abnormal loosening.
 Subluxated teeth exhibit mild to moderate
horizontal mobility or vertical mobility or both.
 No radiographic changes.
 Hemorrhage is usually evident around the neck of
the tooth at the gingival margin.
 If minimal, leave alone, monitor tooth with vitality
tests, and adjust occlusion if necessary.
 If extensive, place a flexible splint (monofilament
nylon or light orthodontic wire) bonded to the
tooth with acid etch resin for one to two weeks.
Extrusive luxation
 This type of injury is characterized by partial
displacement of the tooth out of its socket.
 Extruded teeth appear elongated; there is always
hemorrhage from PDL.
 Complete disruption of the PDL fibers.
 There is wider PDL space on radiographs.
 This type of injury requires immediate treatment.
 Therapy is directed at reduction (repositioning the
tooth) & fixation (splints) for 2 to 3 weeks.
Lateral & extrusive luxation is an angular displacement
of the tooth while it remains within the socket. There is
usually an associated fracture of the supporting
alveolar bone, especially with labial & palatal luxation.
Lateral luxation
 This type of injury is characterized by eccentric
displacement of tooth from its socket.
 The tooth is usually displaced lingually, buccally,
mesially, or distally, that is out of its normal
position and away from its long axis, with fracture
of the wall of the alveolar socket.
 There is fracture & rupture of the PDL fibers.
  There is little mobility w/ the apex locked.
 There is increased PDL space observed on
radiographs.
 These teeth need immediate treatment; the longer
the delay, the more likely the tooth will consolidate
in its ectopic position.
 Therapy is directed at reduction (repositioning
tooth) & fixation (splints)
 In addition, many such teeth become necrotic &
require endodontic therapy.
Intrusive luxation
 Displacement of the tooth deep into the alveolar
bone in an axial (apical) direction, at times to the
point of being buried & not visible.
 Fracture of the alveolus.
 All vessels are smashed and treatment results are
unpredictable.
 An intrusion injury is the most severe type of
luxation injury. The intruded tooth is impacted into
the alveolar bone, & alveolar socket is fractured.
The forces that drive the tooth into the socket wall
crush the PDL, & rupture blood and nerve supply to
the teeth. The tooth may not be visible, and can be
mistaken for an avulsion.
 This type of injury is rare in the permanent
dentition but is a common injury to primary
dentition.
 Immediate care is required & usual sequela is
ankylosis.
 Teeth may normally re-erupt spontaneously.
 Surgical repositioning has been shown to
increase complications such as external root
resorption & loss of marginal bone.
 Repositioning can be carried out
orthodontically over a period of 3 to 4 weeks.
Exarticulation/avulsion
 The most extreme luxation injury.
 Complete displacement/loss of tooth out of its
socket.
 An avulsed tooth can be generally be preserved &
maximize treatment successful, provided 2 steps
are taken:
 The tooth is replanted as soon as possible.
Preferably within 15 min of trauma, or 30 min
at the latest.
 RCT is performed within 1 to 2 weeks
The goal of the tooth reimplantation is complete
redevelopment of the PDL.
Avulsed primariy teeth are not reimplanted due to
possible injury to the developing permanent tooth.
PX CONFRONTED WITH EMERGENCY SITUATION CAN
BE INSTRUCTED TO:
1. Find the tooth
2. Rinse the tooth
- Do not scrub the tooth. Do not touch the root. After
plugging the sink drain, hold the tooth by the crown
and rinse it under running tap water.
3. Insert the tooth into the socket
- Gently place it back into its normal position.
- To protect the vitality of the PDL cells on the root
surface, an appropriate transport medium must be
used. (Milk is an excellent transport medium)
4. Go directly to the dentist
- Hold the tooth in place with gentle finger pressure.
- Apply an acid etch retained splint
- Complications include root surface resorption (no
treatment), replacement resorption (extraction if
progressive, otherwise root canal therapy) and
inflammatory resorption (root canal therapy)
TOOTH REPLANTATION
Success rate:
Less than 30 min – 90% success
30 to 90 min – 43% success
More than 90 min – 7& success
Successful replantation of a developing tooth recal
radiograph taken 1 year after replantation. The
continued root development proves that the pulp was
saved.
Filling material surrounded by bone. This tooth was
allowed to dry for several hours before it was
presented. The dentist removed the remaining
periodontal membrane, and performed RCT from the
root apex before replanting.
FRACTURE
WHAT CAUSES TEETH TO CRACK?
1. From repetitive chewing on your teeth, day
after day.
2. A history of clenching or grinding (bruxism)
teeth.
3. Chewing on hard substances or foods such as
ice, popcorn kernels or candy.
4. Trauma to the mouth such as a blow the chin
or lower jaw.
 5. Large fillings that are deep or that involve the
contacts bet. teeth.
6. Bone loss associated with PDL disease can be
predispose a tooth to root fracture because of
decreased support.
WHAT ARE THE SIGNS AND SYMPTOMS OF A CRACKED
TOOTH?
1. History of erratic pain upon chewing
(shock/jolt), especially upon release of biting
pressure (disclusion)
2. Discomfort with extreme temperatures,
especially cold
3. If the crack involves the root there may be a
localized periodontal pocket/defect
4. If the crack extends to the nerve, there may
be signs of irreversible inflammation
(irreversible pulpitis) which will lead to pulpal
death & ultimately an abscessed tooth
5. Sensitivity to sweets with lack of detectable
decay clinically or on an xray.
DIAGNOSIS:
Crown fracture
 Comprise about 33% of injuries to primary
teeth, and about 75% of injuries to permanent
teeth. It is classified based on the location of
the fracture in relation to the enamel, dentin or
pulp tissue of the tooth.
Root fracture
 It occur in only 7% of dental injuries.
Horizontal root fractures occur in anterior
teeth, and are caused by direct trauma.
Vertical root fractures usually occur in molars,
and may be caused by clenching or trauma to
the mandible. Vertical root fractures are more
difficult to detect, and may not be found until
extensive tooth destruction has occurred.
CLASSIFICATION OF DENTAL FRACTURES
Dental fractures are divided into the following
categories, based on the Ellis classification system:
Ellis class I
 These fractures involve the crown and extend
through the enamel only. These teeth are
usually non tender and without visible color
change but have rough edges.
Ellis class II
 These fractures involve the enamel as well as
the dentin layer. These teeth are typically
tender to touch and to an exposure. A yellow
layer of dentin may be visible.
Ellis class III
 These fractures involve enamel, dentin and
pulp layers. These teeth are typically tender
and have visible area of pink, red, or even
blood at the center of the tooth.
Cracked tooth syndrome
- It is exactly what the name implies, a tooth
with crack. This is a very common problem
that affects teeth that have large fillings in
them. Decay and large fillings cause a
weakening in the remaining tooth structure
over time. A hairline fracture often
develops at the bottom corner of the filling.
The longer people keep their teeth, the
more likely they are to have necessary
dental procedures (fillings, RCT) that leave
the tooth more susceptible to cracking.
TYPES OF CRACKS
Craze lines
 These are tiny cracks that affect only the outer
enamel of the tooth. They are common in all
adult teeth and cause no pain. Craze lines
need no treatment. They do not extend into
the dentin. They are the result of wear and
tear on teeth.
Fractured cusp
 When a cusp becomes weakened, a fracture
may result. A fractured cusp rarely damages
the pulp. This tooth will need to be restored
with a full a crown.
Cracked tooth
 This type of crack extends from the chewing
surface of the tooth and vertically migrates
towards the root.
 Tooth is not completely split into 2 distinct
movable segments.
 Damage to the pulp is common.
 A root canal treatment is usually necessary
and a full crown is needed to hold the tooth
together.
 A cracked tooth that is not treated will worsen,
resulting in the loss of the tooth.
Split tooth
 It is usually the result of an untreated cracked
tooth in which the crack has progressed so that
there are 2 distinct segments that can be
separated from one another.
 A split tooth can never be saved intact.
  In rare instances RCT, possible some gum
surgery, and a crown may be used to retain a
portion of the tooth.

Vertical root fracture

 It begins at the root and extends towards the
chewing surface of the tooth. Treatment may
involve root surgery, if a portion of the tooth
can’t be saved, tooth is extracted.

TOOTH FRACTURE
Management:
A fracture will probably not improve and will eventually
need to be treated. Teeth do have a limited ability to
heal themselves. Unfortunately, fractured teeth do not
heal themselves like other bones in your body. The
only real solution to hold the tooth together and to
prevent the tooth from breaking is with a crown. A
crown will allow chewing forces to move the whole
tooth rather than splitting it apart. This full crown is
bonded over the entire tooth to seal all the small
cracks and prevent bacterial leakage thus allowing the
nerve to recover and stabilize.

Considerations:
About 10% of cracked teeth have nerves that can still
die and need root canal treatment. Early treatment can
help to minimize this from happening. If you decide to
refuse treatment for this condition remember that the
tooth is like a ticking time bomb that will suddenly
flare up and cause severe pain, swelling, pus, and
possible bone loss that will put stress on your immune
system and may affect your overall health.

HOW CAN YOU CHECK TO SEE IF A TOOTH HAS A

CRACK AND/OR FRACTURE?
 No single test or technique provides the correct
diagnosis 100 of the time.

Transillumination
 Most of the time we use a transilluminating
light and see if the light transmits from one
side of the tooth to the other.

Tooth slooth biting test on each cusp

 A biting test can be performed. We concentrate
the biting forces commonly using an
instrument. This can isolate specific areas of
the tooth that might be sensitive to bite, but
does not tell us the underlying cause of
discomfort.

Stained cracked tooth (blue stain can be fully

removed after diagnosis)
 Sometimes, some dye might be used to
temporarily stain the tooth and check to see if
a tooth is fractured. It is then washed off and
evaluated. This is most commonly done once
access to root canals if obtained.