This document provides guidance on managing traumatic dental injuries in children's permanent dentition. It discusses treatments for different types of injuries including soft tissue injuries, concussions, subluxations, tooth fractures, and displaced teeth. For tooth fractures, it describes classifying fractures as class I or II and outlines emergency and definitive treatment procedures for each, such as using calcium hydroxide or reattaching tooth fragments. The document emphasizes protecting the pulp, restoring esthetics and function, and monitoring teeth for changes over time.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
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2. College of Dentistry
Pedodontic II
Management of Traumatic Injuries in
Children - 3 -
Dr. Hazem El Ajrami
Master Degree in Orthodontic & Pedodontic
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3. Treatment of Traumatic Dental Injuries
(Permanent Dentition)
I. Soft tissue injuries.
II. Concussion.
III. Subluxation.
IV. Tooth Fracture.
V. Displacement of permanent anterior teeth.
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4. I. Soft tissue injuries:
a) Determination of child immunization
status:
If the child had received a primary
immunization the antibody forming
mechanism may be activated with booster
injection of toxoid. Un-immunized child
can be protected through passive
immunization or serotherapy with tetanus
antitoxin (tetanus immunoglobulin).
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5. b) Debridement, suturing and/or hemorrhage
control of open soft tissue wounds, and when
indicated refer the child to family physician.
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6. II. Concussion:
A mild blow to the tooth resulting in
mild sensitivity requires little or no
treatment. Examination with regular vitality
testing at subsequent visits is required.
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7. III. Subluxation:
With mobility of the tooth but no
displacement, there is often hemorrhage
around the gingival margin of the tooth, and
the tooth may be sensitive to percussion.
The treatment is similar to that of the
concussed tooth. If mobility is extensive,
splint the tooth using the acid-etch splinting
technique. Periodic reviews every 3 to 4
weeks are essential to monitor for abscess
formation and loss of vitality.
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8. IV. Tooth Fracture:
Class I:
 A crack or craze of the enamel without loss
of tooth structure:
Horizontal or vertical crack or craze
lines in enamel do not require immediate
treatment. Injury to the blood supply and
supporting structures may have occurred;
therefore vitality testing should be
performed at regular intervals to monitor
any changes.
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9. Fracture of enamel only:
Horizontal, vertical, and oblique fractures of
the crown involving enamel only or enamel
and a very small amount of dentine can be
treated either by leaving them alone or
smoothing down any sharp edges to prevent
irritation of the lips or tongue.
The patient should be re-examined at 2
weeks and again at 1 month and periodic
vitality testing is important.
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10. Class II:
Immediate treatment of horizontal, vertical,
or oblique fracture of the crown is required
to:
1) Protect the pulp from chemical or thermal
insult and bacterial contamination.
2) Restore esthetics and function.
3) Maintain the integrity of the arch by
restoring normal contact with adjacent
teeth.
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11. • Emergency treatment:
Cover the exposed dentine by a layer of hard
setting calcium hydroxide. This is to
encourage reparative dentine formation and
reduce the possibility of further trauma to the
pulp. Protection for this dressing can be
achieved temporarily by use of an acrylic or
polycarbonate crowns, stainless steel crown,
orthodontic band, fragment restoration
(reattachment of tooth fragment) or more
permanently by acid-etch composite resin.
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12. • Fragment Restoration (Reattachment of
Tooth Fragment)
Occasionally the dentist may have the
opportunity to reattach the fragment of a
fractured tooth using resin and bonding
techniques. This procedure is atraumatic and
seems to be the ideal method of restoring the
fractured crown.
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13. • The tooth requires no mechanical preparation
because retention is provided by enamel
etching and bonding techniques. If little or no
dentine is exposed, the fragment and the
fractured tooth enamel are etched and
reattached with a resin or glass ionomer
bonding material. If only a small amount of
dentin is exposed (well away from the pulp), it
should be protected with calcium hydroxide
before being etched, but the dressing is
removed before the fragment is reattached.
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14. • If considerable dentine is exposed or a direct
pulp cap is indicated, a thin protective dressing
of calcium hydroxide should remain over the
exposed dentine and pulp of the tooth. In this
case the inside portion of the fragment must be
modified with a bur to accommodate the
thickness of the calcium hydroxide dressing
when the fragment is repositioned on the tooth.
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15. • The removal of a small amount of the
remaining dentine on the inner surface of the
fragment must be done carefully so that the
outer enamel margins are undisturbed (the
outer enamel is important to provide guidance
for the exact repositioning of the fragment on
the fractured tooth).
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16. Acid-etch Composite Resin Restoration
The excellent marginal seal and retention
derived from applying esthetic restorative
materials to etched enamel surfaces have
revolutionized the approach to restoring
fractured anterior teeth. These bonding
techniques are highly successful and versatile
in many situations involving anterior trauma.
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17. • It may not be advisable to restore an extensive
crown fracture with a finished esthetic resin
restoration on the day of the injury, since it is
usually best not to manipulate the tooth more
than is absolutely necessary to make a
diagnosis and provide emergency treatment.
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18. • After the exposed dentine is protected with
calcium hydroxide and the enamel adjacent to
the fracture is etched, the restorative resin
material is applied as a protective covering at
the fracture site. However, the restoration
should cover the fractured surfaces and
maintain any natural proximal contacts the
patient may have had before the injury. After
an adequate recovery period (at least 4 weeks),
an esthetic resin restoration may be completed,
often without removing all the temporary resin
material.
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19. • However, the surfaces of the temporary
restoration should be freshened with a bur
before the new material is applied. The
margins of the new restoration should extend
beyond the margins of the temporary
restoration and onto newly etched enamel.
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20. Thank You
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