Guidelines for the Management of

Traumatic dental injuries

本網頁內容引用自 2007

The International Association

of Dental Traumatology

之官方資料，僅供參考

Clinical examination Radiographic examination

– 900 horizontal angle– Occlusal view– Mesial or Distal shift

Sensitivity test– EPT– Cold test

Patient instruction– OHI– CHX gargling

Treatment guidelines for fractures of teeth and alveolar bone

Uncomplicated crown fracture

Treatment To bond fragment to tooth if available. To cover exposed dentin with GI or

CRF Definitive treatment

– May be restored with accepted dental restorative materials

Complicated crown fracture

Open apex Preserve pulp vitality

– Pulp capping– Partial pulpotomy

– Ca(OH)2 or MTA

Complicated crown fracture

Closed apex with vital pulp Younger patient

– Pulp capping or partial pulpotomy Older patient

– RCT

Pulp necrosis RCT

Crown-root fracture

Closed apex with vital pulp Younger patient

– Pulp capping or partial pulpotomy Older patient

– RCT

Pulp necrosis RCT

Root fracture

Reposition – As soon as possible– Check position radiographically– Flexible splint, 4 weeks– Cervical fracture: up to 4 months

Follow-up– 1 yr at least– Pulp necrosis

• RCT for coronal fragment

Alveolar bone fracture

Pano Treatment

– Reposition

– Stabilization: 4 weeks

Follow-up procedures

Trauma 4 w 6-8 w 4 M 6 M 1 Y 5 Y

Crown Fr.

Crwon-root Fr.

Root Fr. RS RS

Alveolar Fr. RS

RS: removal of splints

Unfavorable outcomes

Symptomatic Negative response to pulp testing Radiographic

– Signs of apical periodontitis– No continuing root development in

immature teeth.– Radiolucency adjacent to fracture line.– External inflammatory resorption

Treatment guidelines for luxation injuries

Concussion

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

year

Subluxation

Flexible splint, 2 weeks

Extrusive luxation

Reposition: gently re-inserting Stabilization

– flexible splint, 2 weeks Monitoring the pulpal condition

– Sensibility tests– Radiography

Lateral luxation

Reposition – Disengage tooth with forceps– Gently reposition into original location

Stabilization– Flexible splint, 4 weeks

Monitor the pulpal condition

Intrusive luxation

Incomplete root formation– Allow spontaneous repositioning to take

place within 3 weeks– Rapid orthodontic repositioning

Complete root formation– To be repositioned either orthodontically or

surgically as soon as possible.

– RCT with Ca(OH)2 dressing within 3 weeks

Follow-up procedures

Trauma 2 w 4 w 6-8 w 6 M 1 Y 5 YConcussionSubluxation

Extrusive Lux..

RS

Lateral Lux. RS

Intrusive Lux

RS: removal of splints

Unfavorable outcomes Symptomatic

– Crown discoloration Negative response to pulp testing Radiographic

– No continuing root development in immature teeth

– Periradicular radiolucencies– Breakdown of marginal bone– External inflammatory resorption or

replacementresorption

Treatment guidelines for avulsed permanent teeth

Tooth with Closed / Open apex

1. The tooth has been replanted prior to the arrival of patient

2. The tooth has been kept in storage media (HBSS, milk, saline or saliva); or the extr-aoral dry time < 60 min

3. Extra-oral dry time > 60 min

Tooth has been replanted

Do not extract the tooth Clean the area with water spray, saline,

or CHX.

Tooth has been kept in media

Clean root surface with a stream of saline and place the tooth in saline

Cover root surface with ArestinTM – Minocycline HCl microspheres– For tooth with open apex

Remove the coagulum from socket with a stream of saline.

Reposition the fractured socket wall Replant the tooth slowly with slight

digital pressure.

Extra-oral dry time > 60 min

Delayed replantation Remove attached soft tissue with gauze. RCT prior to replantation, or 7–10 days later

– Through open apex

Remove the coagulum from the socket Reposition the fractured socket wall Immerse the tooth in 2% NaF, 20 min Replant the tooth slowly with slight digital

pressure.

Reposition

Suture gingival lacerations if present. Verify position of the tooth both clinically

and radiographically. Flexible splint, 2 weeks

– 4 weeks for delayed replantation

Systemic antibiotics

Tetracycline (Doxycycline) for 7 days– Risk of discoloration– Not recommended for age < 12 y/o

Phenoxymethyl Penicillin (Pen V)

If the tooth has contacted soil, and if tetanus coverage is uncertain, refer to physician for evaluation and need for a tetanus booster.

Patient instruction

For all patients with dental trauma Soft diet, 2 weeks. Brush teeth with a soft toothbrush after

each meal. 0.12% CHX mouth rinse, bid, 1 week

Root canal treatment

RCT 7–10 days after replantation and before splint removal. – RCT prior to delayed replantation

Place Ca(OH)2 dressing until RCF

– 1 month Open apex: only when pulp necrosis

Follow-up procedures

RS: removal of splint Yearly after 1-year follow-up

Replantation

1 w 2 w 3 w 4 w 3 M 6 M 1 Y

immediate RS

Delayed RS

Unfavorable outcome

Symptomatic– Excessive mobility– No mobility with metallic percussion sound– Crown in infra-occlusal position

Resorption– inflammatory, infection-related– Ankylosis-related replacement resorption

Splinting times 2 weeks

– Subluxation – Extrusive luxation – Avulsion

4 weeks– Lateral luxation– Root fracture (middle third) – Alveolar fracture– Avulsion (delayed replantation)

4 months– Root fracture (cervical third)