Dental Fractures and Injuries Quiz

Crown Infraction

• An incomplete fracture (crack) of the enamel without loss of tooth enamel substance
• The enamel remains attached to the underlying dentin

Complicated Crown Fracture

• A fracture involving enamel and dentin, exposing the pulp

Uncomplicated Crown Root Fracture

• A fracture involving enamel, dentin, and cementum, but not the pulp

Complicated Crown Root Fracture

• A fracture involving enamel, dentin, and cementum, exposing the pulp

Root Fracture

• A fracture involving cementum, dentin, and the pulp

Concussion

• A minor injury to the periodontium with no displacement or mobility of the tooth

Subluxation

• An injury to the periodontium without tooth displacement, but with slight mobility
• Damage to the blood supply of the pulp and periodontium is usually minor, but pulpal problems can occasionally result

Extrusive Luxation

• Tooth displacement in an extrusive direction, involving the periodontal support and pulpal blood supply

Lateral Luxation

• Tooth displacement from its long axis, with the apical end displaced labially and the coronal part palatally. The pulpal blood supply is usually completely severed

Intrusive Luxation

• Tooth displacement apically, leading to crushing of neurovascular bundles entering the pulp and severe damage to the cementum and periodontium

Avulsion

• Complete displacement of the tooth from the alveolus, with disruption of the pulpal blood supply

Follow up Evaluation

• Radiographic evaluation every 6 weeks, 6 months, 12 months, then yearly
• Vitality test
• Mobility assessment
• Percussion

Observation of Color Changes

• Gray crown discoloration indicates necrosis
• Yellow crown discoloration indicates calcification

Pulpal Necrosis

• Studies indicate that approximately 1-16% of traumatized anterior teeth will develop pulpal necrosis

Observation of Soft Tissue Changes

• Swelling, fistula, and sinus formation

Treatment of Crown Infraction (Enamel Infraction)

• Typically requires no treatment unless associated with luxation injury
• Etching and sealing with resin to prevent discoloration if necessary

Enamel Fracture

• Fracture confined to enamel with no exposed dentin
• Usually requires no treatment
• Bonding of tooth fragments, if available
• Grinding/restoration with composite resin if fracture is extensive

Enamel-Dentin Fracture

• Fracture involving enamel and dentin, exposing dentin
• Bonding of tooth fragments, if available
• Provisional treatment with a glass-ionomer or permanent restoration using a bonding agent and composite resin.
• Definitive treatment with accepted dental restorative materials

Uncomplicated Crown Fracture

• Fracture involving the enamel and dentin, but not the pulp.
• No specific treatment needed; closely monitored for complications.

Complicated Crown Fracture

• Fracture involving the enamel, dentin, exposing the pulp.
• Options for treatment: direct pulp capping, pulpotomy, root canal treatment + class IV restoration, root canal treatment + post & core.

Incisal Edge Reattachment

• Used for reattaching fractured tooth fragments
• Adhesive dentistry and composite technology allow for good reattachment.

Reattachment Techniques

• Various techniques and materials have been reported for reattachment of fractured teeth.
• Authors sometimes use a combination of simple reattachment, labial chamfers, and internal grooves combined with bonding.

Crown-Root Fracture (Uncomplicated)

• Fracture involving enamel, dentin, and cementum, but no pulp exposure.
• Emergency treatment is initial temporary stabilization.
• Definitive treatment varies based on tooth maturity, and may involve fragment removal, gingivectomy (sometimes ostectomy), endodontics, and restoration.

Crown-Root Fracture (Complicated)

• Fracture involving the enamel, dentin, and cementum, exposing the pulp.
• Differential treatments depend on clinical findings and tooth maturity (open or closed apex)
• Possible treatments include emergency stabilization, partial pulpotomy, root canal treatment + restoration.

Intrusion

• Tooth displacement into the alveolar bone
• Treatment may include spontaneous eruption, orthodontic repositioning, surgical repositioning

Avulsion

• Complete tooth displacement from the socket
• Treatment includes immediate replantation, preserving the tooth in a suitable medium and promptly seeking dental care.

Subluxation

• An injury to the supporting structures causing tooth mobility
• Typically doesn't require treatment, supportive measures (splinting) are appropriate.

Patient Instructions

• Avoid participation in contact sports
• Soft food for 2 weeks.
• Brussh teeth with soft toothbrush after each meal
• Use chlorhexidine (0.1%) mouth rinse twice a day for 1 week.

Follow-up

• Clinical and radiographic assessment
• Regular follow ups (as per case type)