Trauma: Section D

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Questions and Answers

Why are radiographs typically taken in all dental trauma cases?

Radiographs are taken as a baseline for diagnostic purposes in all dental trauma cases.

Regarding radiographic views, what is generally recommended when assessing injuries, particularly root fractures?

Multiple views are recommended to assess the extent of the injury, especially in cases of root fractures.

Why might an occlusal radiograph be preferred over a periapical radiograph in young patients?

Occlusal radiographs may be preferred in young patients because periapical radiographs can be difficult to take in this population.

In what type of injury is a Panoramic radiograph (OPG) recommended?

<p>A panoramic radiograph is recommended in any injury where there is suspicion of an underlying bony fracture.</p> Signup and view all the answers

When might Cone Beam Computed Tomography (CBCT) be used instead of standard 2D radiographic views?

<p>CBCT can be used to assess complex dentoalveolar trauma that may not be easily evaluated using standard 2D views.</p> Signup and view all the answers

What radiographic follow-up is typically recommended for an enamel fracture in primary teeth without clinical signs of pathosis?

<p>A baseline radiograph should be taken, but no further radiographic follow-up is recommended unless clinical findings suggest pathosis.</p> Signup and view all the answers

When is radiographic follow-up indicated for enamel-dentine fractures in primary teeth?

<p>Radiographic follow-up is only indicated where clinical findings are suggestive of pathosis.</p> Signup and view all the answers

What radiographic follow-up is recommended one year after pulpotomy or root canal treatment for a complicated crown fracture in primary teeth?

<p>A radiograph is needed one year following pulpotomy or root canal treatment. Other follow-up radiographs are only indicated if clinical findings suggest pathosis.</p> Signup and view all the answers

How often should radiographic follow-ups be conducted for alveolar fractures in primary teeth if clinical findings suggest pathosis?

<p>Radiographic follow-up should be conducted at 4 weeks and 1 year. Other radiographs are only indicated where clinical findings are suggestive of pathosis.</p> Signup and view all the answers

What radiographic findings are expected in cases of tooth subluxation involving primary teeth?

<p>No radiographic abnormalities are expected in cases of tooth subluxation involving primary teeth.</p> Signup and view all the answers

What radiographic finding is typically associated with tooth extrusion?

<p>Increased periodontal ligament (PDL) space is typically found.</p> Signup and view all the answers

What radiographic finding could indicate lateral luxation?

<p>Increased PDL space is present, and an occlusal view is best to see its position in relation to succesor.</p> Signup and view all the answers

What radiographic characteristics might be observed in a case of tooth intrusion involving a primary tooth?

<p>Apex is visible and shorter than contralateral tooth if displaced towards/through labial plate, and tooth appears elongated if apex displaced towards successor.</p> Signup and view all the answers

What is the primary purpose of taking radiographs in cases of avulsion?

<p>Radiographs are taken to ensure that the missing tooth is not intruded.</p> Signup and view all the answers

When following up on an enamel fracture in permanent teeth, how long after the initial injury should a radiograph be taken?

<p>6-8 weeks and again at 1 year.</p> Signup and view all the answers

What radiographic findings would indicate an enamel-dentine fracture?

<p>Visible loss of enamel and dentine.</p> Signup and view all the answers

In the case of an enamel-dentine-pulp fracture, when is a follow-up radiograph recommended?

<p>6-8 weeks and again at 1 year.</p> Signup and view all the answers

What might be visualized in the radiograph of an uncomplicated crown-root fracture, and what does it necessitate?

<p>The apical aspect of the fracture is not usually visible. Multiple views are needed to assess for fracture extension of the root</p> Signup and view all the answers

How often is a radiographic follow-up recommended for a root fracture in permanent teeth?

<p>Follow-ups are recommended 4 weeks, 6-8 weeks, 4 months, 6 months, and 1 year after the initial injury. After that, yearly follow-ups for at least 5 years are needed.</p> Signup and view all the answers

What radiographic finding is expected in cases of tooth concussion involving permanent teeth?

<p>No radiographic abnormalities are expected.</p> Signup and view all the answers

How long after a tooth subluxation injury involving permanent teeth should a follow-up radiograph be taken?

<p>2 weeks, 12 weeks, 6 months, and 1 year.</p> Signup and view all the answers

In which direction will the periodontal ligament (PDL) space increase with cases of extrusion?

<p>In cases of extrusion, the periodical ligament space increases apically.</p> Signup and view all the answers

How does the CEJ appear in an intrusion relative to other teeth?

<p>The CEJ appears more apically located than adjacent non-injured teeth.</p> Signup and view all the answers

What is the typical radiographic follow-up schedule for a lateral luxation injury affecting permanent teeth?

<p>Yearly for at least 5 years.</p> Signup and view all the answers

What radiographic finding is expected in cases of tooth subluxation involving permanent teeth?

<p>No radiographic abnormalities are expected.</p> Signup and view all the answers

How frequently should follow-up radiographs be taken in the case of permanent tooth avulsion?

<p>It recommended that the injury be followed up on yearly for at least 5 years.</p> Signup and view all the answers

According to the IADT, under what circumstances should you take radiographs of enamel-dentine fracture in primary teeth?

<p>Radiographic follow up is only indicated where clinical findings are suggestive of pathosis.</p> Signup and view all the answers

According to the International Association of Dental Traumatology, what follow up actions should be taken for intrusion injuries to periodontal tissue?

<p>Radiographic follow up is only indicated where clinical findings are suggestive of pathosis</p> Signup and view all the answers

How many radiographs are often taken to detect root fractures?

<p>Often 2 radiographs are taken at 2 different angles to detect root fractures.</p> Signup and view all the answers

When is a radiograph needed after a complicated crown fracture in primary teeth according to the IADT?

<p>According to the IADT a radiograph is needed 1 year following pulpotomy or root canal treatment.</p> Signup and view all the answers

What is something that an occlusal view will show?

<p>An occlusal view will show the position of displaced tooth in relation to permanent successor.</p> Signup and view all the answers

If radiographs are taken after avulsion injury to a primary tooth, what should they ensure?

<p>Radiographs taken ensure missing tooth is not intruded</p> Signup and view all the answers

When is pulpotomy indicated?

<p>Complicated crown fracture</p> Signup and view all the answers

Will you always see an alveolar fracture?

<p>No, they may be above the apex of the root.</p> Signup and view all the answers

Why is it critical to consider the long-term follow-up for severe dental injuries, such as avulsions or root fractures, especially in young permanent teeth?

<p>This is to monitor long-term complications like pulp necrosis, root resorption, or ankylosis, crucial for treatment planning.</p> Signup and view all the answers

In terms of radiographic follow-up, how would the management of a subluxation differ in a primary tooth compared to a permanent tooth?

<p>Permanent teeth require more frequent follow-ups (2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, 1 year) compared to primary teeth.</p> Signup and view all the answers

What specific details about the primary tooth and its relationship to permanent successors might a clinician assess using radiographs after an intrusion injury?

<p>Proximity to the permanent tooth bud and potential for displacement are key factors to assess.</p> Signup and view all the answers

How would the approach to radiographic assessment change if a clinician suspects a vertical root fracture in a tooth previously treated with a root canal?

<p>Multi-angled radiographs or CBCT might be preferable for better visualization.</p> Signup and view all the answers

What considerations should clinicians keep in mind regarding radiographic techniques to minimize radiation exposure, particularly in pediatric patients?

<p>Use the fastest image receptor, proper collimation, and lead aprons for radiation protection to children.</p> Signup and view all the answers

In what way might the interpretation of a radiograph differ between a recent dental trauma and a follow-up radiograph taken several months later?

<p>A recent trauma focuses on immediate injuries, while a later one assesses healing or complications.</p> Signup and view all the answers

Why are radiographs taken as a baseline in all dental trauma cases?

<p>For diagnostic purposes.</p> Signup and view all the answers

In cases of injury, when is a panoramic radiograph (OPG) recommended?

<p>When there is suspicion of an underlying bony fracture.</p> Signup and view all the answers

When might Cone Beam Computed Tomography (CBCT) be indicated in dental trauma cases?

<p>To assess complex dentoalveolar trauma which may not easily be evaluated using standard 2D views.</p> Signup and view all the answers

What is primary radiographic finding for a tooth diagnosed with subluxation?

<p>No radiographic abnormalities.</p> Signup and view all the answers

Following trauma, what radiographic finding would indicate tooth intrusion?

<p>CEJ appears more apically located than adjacent non-injured tooth.</p> Signup and view all the answers

What is the recommended radiographic follow-up for an enamel-dentine fracture on a permanent tooth?

<p>6-8 weeks and 1 year.</p> Signup and view all the answers

What are the radiographic findings of tooth avulsion?

<p>PDL space may be absent from all or part of the root. Radiographs taken to ensure missing tooth is not intruded.</p> Signup and view all the answers

What radiographic view best shows increased PDL space apically for a tooth diagnosed with lateral luxation?

<p>Occlusal view.</p> Signup and view all the answers

What radiographic follow up is recommended for a concussion injury?

<p>4 weeks and 1 year.</p> Signup and view all the answers

What radiographic follow-up is advised for a root fracture in permanent teeth?

<p>4 weeks, 6-8 weeks, 4 months, 6 months, 1 year and yearly for at least 5 years.</p> Signup and view all the answers

When taking a periapical radiograph to detect root fractures, how many views are typically taken, and why?

<p>Often 2 radiographs are taken at 2 different angles to detect root fractures.</p> Signup and view all the answers

For an uncomplicated crown-root fracture in a primary tooth, when is a radiograph indicated?

<p>1 year (other radiographs are only indicated where clinical findings suggest pathosis).</p> Signup and view all the answers

For an alveolar fracture in a primary tooth, when is a radiograph indicated?

<p>4 weeks and 1 year (other radiographs are only indicated where clinical findings are suggestive of pathosis).</p> Signup and view all the answers

For an enamel-dentine fracture in a primary tooth, when is a radiograph indicated?

<p>Radiographic follow up is only indicated where clinical findings are suggestive of pathosis.</p> Signup and view all the answers

For an complicated crown-root fracture in a permanent tooth, when is a radiograph indicated?

<p>Apical aspect of fracture not usually visible - multiple views needed to assess for fracture extension of root.</p> Signup and view all the answers

For an alveolar fracture in a permanent tooth, when is a radiograph indicated?

<p>Visible fracture lines at any level from the marginal bone to the level of or above the root apex.</p> Signup and view all the answers

For an complicated crown fracture in a primary tooth, when is a radiograph for follow-up needed?

<p>1 year following pulpotomy or root canal treatment a radiograph is needed.</p> Signup and view all the answers

For an tooth extrusion in a primary tooth, when is a radiograph for follow-up needed?

<p>Radiographic follow up is only indicated where clinical findings are suggestive of pathosis.</p> Signup and view all the answers

For an tooth avulsion in a primary tooth, when is a radiograph needed?

<p>Radiographs taken to ensure missing tooth is not intruded.</p> Signup and view all the answers

What is the definition of a radiograph?

<p>Image from x-rays of internal structures of the teeth and surrounding bone.</p> Signup and view all the answers

Why is a clear justification required when requesting radiographs for dental trauma?

<p>To ensure that the benefits of the radiograph outweigh the risks of radiation exposure.</p> Signup and view all the answers

In the context of dental radiographs, what does 'OPG' stand for?

<p>Orthopantomogram.</p> Signup and view all the answers

In tooth intrusion, what is the clinical significance of the cementoenamel junction (CEJ) appearing more apically positioned than the adjacent uninjured tooth on a radiograph?

<p>Indicates tooth has been displaced into the alveolar bone.</p> Signup and view all the answers

What should radiographs ensure with missing teeth caused from tooth avulsion?

<p>Radiographs taken to ensure the missing tooth is not intruded.</p> Signup and view all the answers

What is the location for a visible fracture line for a root fracture injury on a permanent tooth using radiographs?

<p>Visible fracture line in root.</p> Signup and view all the answers

What is the treatment for tooth enamel-dentin-pulp fracture?

<p>Root canal and crown.</p> Signup and view all the answers

What is a periapical radiograph?

<p>A radiograph that shows the entire tooth and surrounding bone tissue.</p> Signup and view all the answers

What radiograph view is best to see the PDL space for a lateral luxation?

<p>Occlusal view</p> Signup and view all the answers

What does the radiograph ensure the missing avulsed tooth isn't?

<p>Intruded.</p> Signup and view all the answers

What is the radiograph for for a root fracture in a permanent tooth?

<p>Visible fracture line in root.</p> Signup and view all the answers

What is one potential difficulty in taking standard radiographs in young patients?

<p>It can be difficult in young patients so occlusal radiograph is preferred.</p> Signup and view all the answers

Name a benefit of using Cone Beam Computed Tomography (CBCT) over traditional 2D radiographs in assessing complex dentoalveolar trauma.

<p>CBCT can be used to assess complex dentoalveolar trauma which may not easily evaluated using the standard 2D views.</p> Signup and view all the answers

Multiple injuries to teeth and/or supporting structures often require radiographs taken at multiple angles, commonly known as multiple views. Why?

<p>Multiple views are recommended to assess extent on jury, especially root fractures.</p> Signup and view all the answers

Besides periapical views, which other intraoral radiographic technique is often used to assess root fractures?

<p>Occlusal</p> Signup and view all the answers

If a patient presents with clinical signs suggestive of pathosis following treatment for a complicated crown-root fracture in a primary tooth, what radiographic follow-up is indicated?

<p>1 year (other radiographs are only indicated where clinical findings suggest pathosis).</p> Signup and view all the answers

What radiographic finding would be present for an alveolar fracture in a permanent tooth?

<p>Visible fracture lines at any level from the marginal bone to the level of or above the root apex.</p> Signup and view all the answers

After trauma, a patient complains of slight pain upon chewing, but the tooth appears normal, with no abnormal mobility. What is the possible diagnosis and radiographic findings?

<p>Concussion, No radiographic abnormalities.</p> Signup and view all the answers

A patient presents with a tooth that is sensitive to touch and has slight mobility, but no displacement. What are the possible clinical findings?

<p>Subluxation, No radiographic abnormalities.</p> Signup and view all the answers

Following trauma, a primary tooth appears elongated with the apex displaced towards the permanent successor. What is the radiographic finding.

<p>Tooth appears elongated if apex displaced towards successor.</p> Signup and view all the answers

Flashcards

Radiographs in dental trauma

Taken as a baseline for diagnostic purposes in all dental trauma cases.

Periapical radiograph

A type of radiograph where two images are often taken at different angles to detect root fractures.

Occlusal radiograph

A radiograph used to assess for fractures in young patients where periapical radiographs may be difficult.

Panoramic radiograph (OPG)

Recommended to determine the presence of an underlying bony fracture.

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CBCT

Used to assess complex dentoalveolar trauma that isn't easily evaluated using standard 2D views.

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Enamel fracture (primary teeth)

Baseline radiograph, no follow-up needed unless clinical signs suggest issues.

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Enamel-dentine fracture (primary teeth)

Follow-up only if clinical signs suggest issues; radiograph needed one year after pulp treatment.

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Complicated crown fracture

Follow-up only if clinical signs suggest issues; extent of fracture and root development stage assessed.

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Complicated crown-root fracture

Follow-up only if clinical signs suggest issues; extent of fracture and root development assessed.

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Root fracture (primary teeth)

Follow-up radiograph only when clinical findings suggest issues.

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Alveolar fracture (primary teeth)

Follow-up at 4 weeks and 1 year; other radiographs only if clinical signs suggest issues.

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Concussion/Subluxation

Follow-up only if clinical signs suggest issues.

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Lateral Luxation (primary teeth)

Follow-up only if clinical signs suggest issues; occlusal view shows tooth position relative to successor.

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Extrusion (primary teeth)

Follow-up only if clinical signs suggest issues.

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Avulsion (primary teeth)

Follow-up only if clinical signs suggest issues; radiographs to ensure tooth isn't intruded.

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Enamel fracture (permanent teeth)

Radiograph needed in 6-8 weeks and 1 year.

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Enamel-dentine fracture Permanent

Radiograph needed in 6-8 weeks and 1 year.

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Enamel-dentine-pulp fracture permanent

Radiograph needed in 6-8 weeks and 1 year.

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Uncomplicated crown-root fracture

Radiograph needed: 1 week, 6-8 weeks, 3/6 months, 1 year, then yearly for 5 years.

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Complicated crown-root fracture

Radiograph needed: 1 week, 6-8 weeks, 3/6 months, 1 year, then yearly for 5 years.

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Root fracture permanent

Radiograph needed: 4 weeks, 6-8 weeks, 4/6 months, 1 year, then yearly for 5 years.

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Alveolar fracture permanent

Radiograph needed: 4 weeks, 6-8 weeks, 4/6 months, 1 year, then yearly for 5 years.

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Concussion permanent

Radiograph needed: 4 weeks, 1 year

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Subluxation permanent

Radiograph needed: 2 weeks, 12 weeks, 6 months, 1 year

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Extrusion permanent

Radiograph needed: 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, 1 year, then yearly for 5 years.

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Lateral luxation permanent

Radiograph needed: 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, 1 years, and then yearly if issues.

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Intrusion permanent

Radiograph needed: 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, 1 year, then yearly if issues.

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Avulsion permanent

Radiograph needed: 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, 1 year, then yearly if issues.

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Radiograph selection

Clinicians must carefully assess each dental trauma case to determine the most appropriate radiographic examination needed.

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Multiple radiographic views

Taking multiple radiographic views is recommended to evaluate the extent of injuries thoroughly, especially for root fractures.

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Radiograph for Intrusion

Intrusion, where the CEJ appears positioned more apically than the adjacent, uninjured tooth.

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Radiograph of Avulsion

Absence of the periodontal ligament (PDL) space from all or part of the root suggests this, and radiographs should verify tooth absence.

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Study Notes

  • Radiographs serve as a baseline for diagnosing dental trauma.
  • Clinicians need to justify which radiograph is needed on a case-by-case basis.
  • A clear justification is required for each radiograph taken.
  • Multiple views help assess the extent of injury, primarily root fractures.

Radiographs

  • Periapical radiographs are commonly taken at two different angles to detect root fractures.
  • It can be difficult to use in young patients, so occlusal radiograph is preferred.
  • The upper standard occlusal radiographs are used to evaluate root fractures.
  • Occlusal radiographs are taken alongside periapical radiographs to pinpoint the exact location and degree of a fracture.
  • Panoramic (OPG) radiographs are advised for any injury where a bony fracture is suspected.
  • Cone Beam Computed Tomography (CBCT) can evaluate complex dentoalveolar trauma and is not easily assessed using standard 2D views.

Radiographic Follow-Up Guidelines by International Association of Dental Traumatology

  • These guidelines are for both primary and permanent teeth

Primary teeth injuries to hard tissues

  • Enamel fracture: No radiographic abnormalities and a baseline radiograph should be taken with no further follow-up unless clinical signs indicate otherwise.
  • Enamel-dentine fracture: a visible fracture into dentine, and radiographic follow-up is only indicated when clinical signs suggest pathosis
  • Complicated crown fracture: Visible fracture into pulp and a 1-year radiograph is needed after pulpotomy or root canal treatment.
  • Uncomplicated crown-root fracture: The extent of fracture in relation to the gingival margin can be seen, and a 1-year radiograph is required unless clinical signs suggest pathosis.
  • Complicated crown-root fracture: Extent of fracture and stage of root development can be assessed and a 1-year radiograph is required unless clinical signs suggest pathosis.
  • Root fracture: Location of fracture line and proximity to permanent successors and only a follow-up radiograph is needed when clinical signs suggest pathosis.
  • Alveolar fracture: Location of fracture line and proximity to primary teeth and permanent successors and Radiograph after 4 weeks and 1 year are needed unless clinical signs suggest pathosis.

Primary teeth injuries to periodontal tissues

  • Concussion: No radiographic abnormalities and radiographic follow-up is only indicated where clinical signs suggest pathosis
  • Subluxation: No radiographic abnormalities and radiographic follow-up is only indicated where clinical signs suggest pathosis
  • Extrusion: Increased periodontal ligament space and radiographic follow-up is only indicated where clinical signs suggest pathosis
  • Lateral luxation: Increased PDL space and radiographic follow-up is only indicated where clinical signs suggest pathosis. Occlusal view will show position of displaced tooth in relation to permanent successor.
  • Intrusion: Apex visible and shorter than contralateral tooth if displaced towards/through labial plate and radiographic follow-up is only indicated where clinical signs suggest pathosis. Tooth appears elongated if apex is displaced towards successor.
  • Avulsion: Radiographs are taken to ensure the missing tooth is not intruded and radiographic follow-up is only indicated where clinical signs suggest pathosis

Permanent Teeth injuries to hard tissues

  • Enamel fracture: Visible loss of enamel and radiographic follow-up occurs after 6-8 weeks and after 1 year
  • Enamel-dentine fracture: Visible loss of enamel and dentine, and radiographic follow-up occurs after 6-8 weeks and after 1 year
  • Enamel-dentine-pulp fracture: Visible loss of enamel and dentine with pulpal involvement, and radiographic follow-up occurs after 6-8 weeks and after 1 year
  • Uncomplicated crown-root fracture: Apical aspect of the fracture is not usually visible but multiple views are needed to assess for fracture extension of root and radiographic follow-up occurs after 1 week, 6-8 weeks,3, 6 months and after 1 year and yearly for at least 5 years.
  • Complicated crown-root fracture: Apical aspect of fracture not usually visible but multiple views are needed to assess for fracture extension of the root: Radiographic follow-up is same as above
  • Root fracture: Visible fracture line in root and Radiographic follow-up occurs after 4 weeks, 6-8 weeks, 4, 6 months and after 1 year and yearly for at least 5 years.
  • Alveolar fracture: Visible fracture lines at any level from the marginal bone to the level of or above the root apex and the radiographic follow-up is the same as above

Permanent Teeth injuries to periodontal tissues

  • Concussion: No radiographic abnormalities, and radiographic follow-up occurs after 4 weeks and after 1 year
  • Subluxation: No radiographic abnormalities, and radiographic follow-up occurs after 2, 12 weeks, 6 months and after 1 year
  • Extrusion: Increased PDL space apically and radiographic follow-up occurs after 2, 4, 8, 12 weeks, 6 months and after a year
  • Lateral luxation: Increased PDL space apically – best seen in an occlusal view and the radiographic follow-up occurs yearly for 5 years at least.
  • Intrusion: CEJ appears more apically located than the adjacent non-injured tooth and the radiographic follow-up is the same as above
  • Avulsion: PDL space may be absent from all or part of the root, radiographs are taken to ensure missing tooth is not intruded and the radiographic follow-up is the same as above

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