Guidelines for the Management of Traumatic Dental Injuries, I. Fractures and Luxations of Permanent Teeth

Resident: Cho

Author(s): Flores, M et al.

Journal: Dental Traumatology

Year. Volume (number). Page #’s: 2007. 23. 66-71.

Major topic: Trauma, fractures, luxations

Minor topic: Splinting

Type of Article: Guidelines

Main Purpose: The purpose was to present the guidelines for appropriate treatment plan after crown fractures and luxations.

Overview of method of research: Review of dental literature and group discussions among experienced researchers and clinicians.

Key points/Summary:

Uncomplicated crown fracture

Fracture involves enamel or dentin and enamel; pulp is not exposed.

Treatment: bond fragment of tooth if available, glass ionomer, composite restoration.

Complicated crown fracture and Crown-root fracture

Complicated fracture: fracture involves enamel and dentin and pulp is exposed.

Crown-root fracture: fracture involves enamel, dentin and root structure.

Treatment: Young patients: pulp cap or partial pulpotomy

Older patients: RCT, pulp cap or partial pulpotomy

For crown-root fracture, can stabilize loose segments of the tooth by bonding.

Root fracture

Treatment: Flexible splint for 4 weeks.

If root fracture is near cervical area of the tooth, flexible splint for 4 months.

Monitor healing for at least 1 year.

If pulp necrosis develops, RCT of the coronal tooth segment to the fracture line is indicated.

Alveolar bone fracture

Treatment: Reposition and splint for 4 weeks.

Concussion

Tooth is tender to touch or tapping; has not been displaced and does not have increased mobility.

No treatment is needed. Monitor pulpal condition for at least 1 year.

Subluxation

Tooth is tender to touch or tapping and has increased mobility; it has not been displaced.

Treatment: Flexible splint for up to 2 weeks for patient comfort.

Extrusive luxation

Tooth appears elongated and excessively mobile. Increased PDL apically.

Treatment: Reposition tooth and flexible splint for 2 weeks. If pulp becomes necrotic -> RCT.

Lateral luxation

Tooth is displaced, immobile, and percussion gives metallic sound. Widened PDL.

Treatment: Flexible splint for 4 weeks. If pulp becomes necrotic -> RCT.

Intrusive luxation

Tooth is displaced axially into the alveolar bone. It is immobile and gives metallic sound.

PDL may be absent from all or part of the root.

Teeth with incomplete root formation:

allow spontaneous repositioning, if no movement within 3 weeks then orthodontic repositioning

Teeth with complete root formation: repositioned either orthodontically or surgically ASAP.

Most likely will be necrotic and RCT necessary.

Splinting

2 weeks: subluxation, extrusion, avulsion

4 weeks: lateral luxation, root fracture, alveolar fracture

4 months: root fracture at cervical third

Assessment of Article:

Good overview of managing dental trauma for permanent teeth. Note: AAPD recommends splinting for extrusion for 3 weeks, and splinting for root fracture at cervical third for 2-3 months.