Sports-related traumatic dental injuries (TDIs) account for 18–30% of all oral diseases. It is vital that such injuries be treated as soon as possible in order to lessen and prevent complications in the injured patients.
Classification of dental trauma
G.E. Ellis, a pediatric dentist, was the first to propose a standard classification of dental injuries in 1950. The type of dental injuries has been based on a number of variables, including etiology, anatomy, pathology, and treatment concerns.
Ellis classification is a simplified classification, which groups many injuries and allows for subjective interpretation by including broad terms such as simple or extensive fractures.
- Class I - Simple crown fracture with little or no dentin affected
- Class II - Extensive crown fracture with considerable loss of dentin, but pulp not affected.
- Class III - Extensive crown fracture with considerable dentin and pulp exposure/loss.
- Class IV - A tooth devitalized by trauma with or without loss of tooth structure.
- Class V - Teeth lost as a result of trauma.
- Class VI - Root fracture with or without the loss of crown structure.
- Class VII - Displacement of the tooth with neither root nor crown fracture Class VIII - Complete crown fracture and its replacement.
- Class IX - Traumatic injuries of primary teeth.
Treatment Guidelines for Tooth & Alveolar Fractures
Although it is impossible to guarantee that a traumatized tooth will remain in place permanently, prompt treatment with suggested methods can increase the likelihood of success. Variations in a patient's dental health, physical condition, and personal preferences are crucial considerations in deciding the treatment plan. The general considerations for different cases have been described below:
- CROWN FRACTURE
Enamel and dentin fracture without pulp exposure: It is possible to bind a tooth fragment to the tooth if it is accessible. If not, apply a temporary restoration using glass ionomer to cover the exposed dentin or a permanent restoration using a bonding agent and composite resin. Restoration with a standard dental restorative material is the only effective treatment for the fractured crown.
Enamel and dentin fracture with pulp exposure: In order to ensure future root development in young patients with open apices, pulp vitality must be preserved through pulp capping or partial pulpotomy. Additionally, this is also the recommended treatment for individuals with closed apices. Materials suited for such treatments include MTA (white) and calcium hydroxide compounds. It is possible to bind a tooth fragment to the tooth if it is accessible. Restoration using indirect dental restorative materials (veneers/crowns) may be the future course of treatment for the cracked crown.
- CROWN-ROOT FRACTURE
Without pulp exposure: Remove the fragments with or without gingivectomy and then repair them.
With pulpal exposure and immature roots: To maintain pulp vitality when there is pulpal exposure and immature roots, perform a partial pulpotomy.
Pulp exposure with mature roots: Endodontic therapy should be used when there is pulp exposure in mature roots before a post-retained crown is used to restore the tooth. Before a permanent repair, orthodontic or surgical extrusion of the apical fragment may be necessary to reveal the margins. Extraction is unavoidable in crown root fractures with extensive apical extension, the most severe of which is a vertical fracture.
- ALVEOLAR FRACTURE
Any displaced section should be realigned, and the affected teeth should subsequently be protected for four weeks by a flexible splint.If there is a gingival laceration, suture it.
Regular follow-up of these cases is required in order to avoid further trauma-related complications in the future.
Treatment Guidelines for Traumatic injuries i.e Concussion, Subluxation, and Luxation of Teeth
1. CONCUSSION
The tooth is tender to touch and/or percussion but without displacement or abnormal mobility.
- Treatment guidelines:
Immediate treatment:No immediate treatment is needed for concussion of teeth.
Endodontic considerations: The patient should be kept on follow-up and pulpal response should be monitored until a definitive pulpal diagnosis is confirmed.
Follow-up: Clinical and radiographic examinations should be regularly done for up to 5 years.
2. SUBLUXATION
The tooth is tender to touch and percussion and mobile, but not displaced.
- Treatment guidelines:
Immediate treatment: As a part of immediate treatment, stabilization of the affected tooth should be done using a flexible splint for 2 weeks, if needed.
Endodontic considerations:The patient should be kept on follow-up and pulpal response should be monitored until a definitive pulpal diagnosis is confirmed.
Follow-up: The splint should be removed after two weeks and regular clinical and radiological monitoring should be done for up to 5 years.
3. EXTRUSIVE LUXATION
Displacement of the tooth outward or incisally.
- Treatment guidelines:
Immediate treatment: Use saline to rinse the affected area. Gently reposition the tooth putting it back into the socket.
Gingival lacerations should be sutured, especially in the cervical region. The tooth should be stabilized for 2 weeks using a flexible splint.
Endodontic considerations:
Incomplete root formation: Pay particular attention to the pulp's vitality. Pulp revascularization therapy or apexification should be considered if the pulp becomes necrotic.
Complete root formation: Root canal therapy is indicated if the pulp is necrotic.
Follow-up: Splint removal should be done at 2 weeks followed by regular clinical and radiological examinations for up to 5 years.
4. LATERAL LUXATION
Displacement of the tooth in any lateral direction except axially; is usually associated with a fracture of the facial cortical bone.
Immediate treatment: Use saline to rinse the affected area. To release the tooth from its bone lock and gently reposition it into its original position, move the tooth digitally or with forceps. Gingival lacerations should be sutured, especially in the cervical region.
The tooth should be stabilized using a flexible splint for 2-4 weeks.
Endodontic considerations:
Incomplete root formation: Pay particular attention to the pulp's vitality. Pulp revascularization therapy or apexification should be considered if the pulp becomes necrotic.
Complete root formation: Root canal therapy is indicated if the pulp is necrotic.
Follow-up:Splint removal should be done at 2 weeks which can be extended up to 4 weeks in case of severe displacement. This should be followed by regular clinical and radiological examinations for up to 5 years.
5. INTRUSIVE LUXATION
Displacement of the tooth inward and into the alveolar bone.
Immediate treatment:
Incomplete root formation: Allow for re-eruption without any intervention for intrusion which is up to 7mm. This should be done for 3 weeks post-trauma. If no movement is seen during this period, orthodontic extrusion should be initiated.
If the intrusion is >7mm, go for surgical or orthodontic extrusion of the concerned teeth within 3 weeks of trauma.
Free for members
Keep reading — it's free
The rest of this article is open to DentalReach members. Create a free account, or sign in, and every article on the site opens in full.