| Type of trauma | Clinical Findings | Imaging / Radiographic | Treatment | Follow up |
|---|---|---|---|---|
| 1. Enamel Fracture (primary teeth) | -Percussion: Normal -Palpation: Normal -Mobility: Normal -Pulp test: usually Normal | No radiographs recommended. |
- Smooth sharp edge - Parent/patient education |
No clinical or radiographic follow |
| 2. Enamel Infraction (permanent teeth) |
-Percussion: Normal -Palpation: Normal -Mobility: Normal -Pulp test: usually Normal |
-Radiography: Normal -Recommended Radiography: parallel P.A |
In mild case: no treatment -In Sever case: sealing with bonding resin. |
-No follow up :infraction only -Follow: infraction + any type of luxation |
| 3. Uncomplicated Crown Fracture – enamel only (permanent teeth) |
Mobility: Normal -Pulp test: usually positive -If tenderness (palpation): possible associated lux.injury or root fx |
missing fragment +soft tissue injury: lip and/or cheek radiographs -recommended radio graph: .Parallel P.A -present of sign or symptoms: additional radiographs |
if fragment available: bonded back on to tooth --depending on the extent and location: smoothed edge or composite restoration |
- After 6–8 weeks - After 1 year |
| 4. Uncomplicated Crown Fracture – enamel and dentin (primary teeth) | The location of missing tooth fragment should be explored |
Base line radiograph -missing fragment +soft tissue injury: lip and/or cheek radiographs |
cover exposed dentin with glass/composite -lost tooth: restored with composite immediately or later appointment --parent/patient education |
Clinical examination: after 6-8 wk |
| 5. Uncomplicated Crown Fracture – enamel and dentin (permanent teeth) |
- Mobility: Normal - Pulp test: usually positive - Percussion/palpation: no sensitivity |
-missing fragment +soft tissue injury: lip and/or cheek radiographs -recommended radio graph: .Parallel P.A -present of sign or symptoms: additional radiographs |
-if fragment available: bonded back on to tooth (20 min soaking in water or milk for rehydration) -cover exposed dentin with glass/composite --if the exposed dentin is within 0.5 mm of pulp: calcium lining + glass or MTA |
- After 6–8 weeks - After 1 year |
| 6. Complicated Crown Fracture (primary teeth) | The location of missing tooth fragment should be explored |
-missing fragment +soft tissue injury: lip and/or cheek radiographs -recommended radiographs: .Parallel P.A or occ radiograph |
Vital pulp therapy (based on pulp condition).. | — |
| 7. Complicated Crown Fracture (permanent teeth) |
Mobility: Normal Sensitive to stimuli (air , cold…) -Percussion or palpation: no sensitivity -possible associated with luxation |
missing fragment +soft tissue injury: lip and/or cheek -recommended radiograph: .Parallel P.A -present of sign or symptoms: additional radiographs |
Apexogenesis in immature permanent teeth -conservative treatment (eg,pulpotomy) in mature teeth -RCT : if a post is required -if fragment available: bonded back on to tooth (20 min soaking in water or milk for rehydration) --fragment absence: cover exposed dentin with glass/composite.. |
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| 8. Uncomplicated Crown-root Fracture (primary teeth) | — |
recommended radiographs: .Parallel P.A or occ radiograph |
Usually: No treatment --In Emergency treatment: .injection .remove the loose Fragment . if the crown can be restored: 1.cover dentin with glass. . if the crown can’t be restored: extract loose fragment and leave/ext the entire teeth(based on teeth condition and taking care not to damage the permanent teeth) |
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| 9. Uncomplicated Crown-root Fracture (permanent teeth) |
-pulp test: usually positive -Percussion: tender -The fragment is usually present and mobile |
-Apical extension of fracture usually not visible. -missing fragment +soft tissue injury: lip and/or cheek -recommended radio graphs: .Parallel P.A .2 additional radiographs with different angle .occ radiograph. -CBCT can be considered(to determine the crown/root ratio and help treatment options). |
- Temporary stabilization of loose fragment - Remove coronal/mobile fragment if needed - Cover exposed dentin -- Future options: 1. Orthodontic extrusion 2. Surgical extrusion 3. RCT (necrotic pulp) 4. Root submergence 5. Intentional replantation 6. Extraction 7. Autotransplantation |
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| 10. Complicated Crown-root Fracture (primary teeth) |
pulp test: usually positive -Percussion: tender -The fragment is usually present and mobile |
recommended radiographs: .Parallel P.A or occ radiograph |
Usually: No treatment --In Emergency treatment: .injection .remove the loose Fragment . if the crown can be restored: 1. pulp therapy and restoration . if the crown can’t be restored: extract loose fragment and leave/ext the entire teeth(based on teeth condition and taking care not to damage the permanent teeth) |
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| 11. Complicated Crown-root Fracture ( permanent teeth ) |
pulp test: usually positive -Percussion: tender -The fragment is usually present and mobile |
Apical extension of fracture usually not visible. -missing fragment +soft tissue injury: lip and/or cheek -recommended radiographs: .Parallel P.A .2 additional radiographs with different angles .occ radiograph. -CBCT can be considered (to determine the crown/root ratio and help treatment options). |
Until finalized treatment: temporary stabilization of the loos fragment A:Immature teeth: preserve the vital pulp(apexogenesis) B:mature teeth: RCT --future treatment options: 1-Completion of RCT and restoration 2.Orthodontic extrusion of apical fragment 3.surgical extrusion 4.Root submergence 5.intentional replantation 6.Extraction 7.autotransplantation.. |
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| 12. Root Fracture ( primary teeth) |
Depends on the location of fx -coronal fragment may be mobile or maybe displaced -occ interference maybe present |
Parallel P.A or occ -the fracture is usually located mid-root or in the apical third |
un displaced coronal fragment = No treatment -coronaly displaced (even with some occ interference) without excessively mobile: leave the coronal fragment to spontaneously reposition -displaced coronal fragment +excessively mobile + occ interference= 1-ext of loose fragment +left the apical fragment for normal resorption. 2-gently reposition the loose coronal fragment(if this fragment isn’t stable in new position: flexible splint for 4 weeks |
Un displaced coronal fragment: 1w 6-8w 1yr -reposition of coronal fragment and splint it: 1w 4w (for splint removal) 8w 1yr -coronaly extraction: 1yr |
| 13. Root Fracture (permanent teeth ) |
coronal fragment may be mobile or maybe displaced - Percussion: maybe tender -bleeding from the gingival sulcus may be seen -pulp test: maybe negative |
the fx maybe located at any level of the root -recommended radiographs: .Parallel P.A .2 additional radiographs with different angles .occ radiograph. CBCT can be considered (to determine the location , extension, and direction of the fx). |
Immediately reposition: in displaced coronal fragment -check repositioning radiographically -flexible splint of the mobile coronal fragment: 1- up to 4 mo (for cervically fx) 2-4w(for apical or mid root fx) -cervical fxs have the potential to heal: should not remove immobile coronal fragment in emergency visit -pulp necrosis may occurs in the coronal fragment only =endodontic treatment of the coronal segment only will be indicated -In mature teeth where the cervical fracture line is located above the alveolar crest and the coronal fragment is very mobile= coronaly fragment removal +RCT+ restoration with a post-retained crown --orthodontic extrusion e fragment |
Clinically and radiographic evaluations: .after 4 wk . after 6-8 wk . after 4 mo .after 6 mo . after 1 yr .then yearly for at least 5 yr |