Primary dentition Guidelines
INJURIES IN THE PRIMARY DENTITION
1. Treatment guidelines for fractures of teeth and alveolar bone
ENAMEL FRACTURE
Clinical findings
Fracture involves enamel.
ENAMEL DENTIN
FRACTURE Clinical findings
Fracture involves enamel
and dentin; the pulp is not
exposed.
CROWN FRACTURE
WITH EXPOSED PULP Clinical findings
Fracture involves enamel
and dentin and the pulp is
exposed.
C=Clinical examination; R=Radiographic examination
Radiographic findings
No radiographic
abnormalities
Radiographic findings
No radiographic
abnormalities
The relation between the
fracture and the pulp chamber
will be disclosed
Radiographic findings
The stage of root
development can be
determined from one
exposure.
Follow-up Procedures Favorable and Unfavorable outcomes
for fractures of teeth include some, but not necessarily all, of the
and alveolar bone following:
Favorable Outcome Unfavorable Outcome
Treatment
Smooth sharp edges.
Favorable Outcome Unfavorable Outcome
Treatment
If possible, seal completely the involved 3-4 weeks C
dentin with glass ionomer to prevent
microleakage.
In case of large lost tooth structure, the tooth
can be restored with composite.
Treatment Followup Favorable Outcome Unfavorable Outcome
If possible preserve pulp vitality by partial 1 week C Continuing root Signs of apical
pulpotomy. Calcium hydroxide is a suitable 6-8 weeks C+R development in periodontitis; no continuing
material for such procedures. A well- 1 year C+R immature teeth and a root development in
condensed layer of pure calcium hydroxide hard tissue barrier. immature teeth.
paste can be applied over the pulp, covered Extraction or root canal
with a lining such as reinforced glass treatment
ionomer. Restore the tooth with composite.
The treatment is depending on the childs
maturity and ability to cope. Extraction is
usually the alternative option.
Primary dentition Guidelines
CROWN-ROOT FRACTURE
ROOT FRACTURE
ALVEOLAR FRACTURE
S=Splint removal C=Clinical examination; R=Radiographic examination; (C*)=Clinical and radiographic monitoring until eruption of the permanent successor
Clinical findings
Fracture involves enamel,
dentin and root structure; the
pulp may or may not be
exposed.
Additional findings may
include loose, but still
attached, fragments of the
tooth.
There is minimal to
moderate tooth displacement
Clinical findings
The coronal fragment may be
mobile and may be displaced.
Clinical findings
The fracture involves the
alveolar bone and may extend
to adjacent bone.
Segment mobility and
dislocation are common
findings.
Occlusal interference is often
noted.
. displaced in labial direction
Radiographic findings
In laterally positioned
fractures, the extent in relation
to the gingival margin can be
seen.
One exposure is necessary to
disclose multiple fragments
Radiographic findings
The fracture is usually
located mid-root or in the
apical third.
Radiographic findings
The horizontal fracture line
to the apices of the primary
teeth and their permanent
successors will be disclosed.
A lateral radiograph may
also give information about the
relation between the two
dentitions and if the segment is
Follow-Up Procedures Favorable and Unfavorable outcomes
for fractures of teeth include some, but not necessarily all, of the
and alveolar bone following:
Treatment Favorable Outcome Unfavorable Outcome
Depending on the clinical findings, two In cases of fragment Asymptomatic; Symptomatic; signs of
treatment scenarios may be considered: removal only: continuing root apical periodontitis; no
1 week C development in continuing root
Fragment removal only. If the fracture 6-8 weeks C+R immature teeth development in immature
involves only a small part of the root and the 1 year C(*) teeth.
stable fragment is large enough to allow .
coronal restoration.
Extraction in all other instances
Treatment Follow-Up Favorable Outcome Unfavorable Outcome
If the coronal fragment is not displaced no No displacement: 1 Signs of repair None
treatment is required. week C, between fractured
6-8 weeks C, segments.
If the coronal fragment is displaced, extract 1 year C+R and C(*) each Continuous resorption
only that fragment. The apical fragment subsequent year until of the left apical
should be left to be resorbed exfoliation. fragment
Extraction 1 .
year C+R and C(*)each
subsequent year until
exfoliation.
Treatment Follow-Up Favorable Outcome Unfavorable Outcome
Reposition any displaced segment and 1 week C Normal occlusion Signs of apical
then splint. 3-4 weeks S+C+R No signs of apical periodontitis or external
General anesthesia is often indicated. 6-8 weeks C+R periodontitis. inflammatory root
Stabilize the segment for 4 weeks. 1 year C+R and C(*) each No signs of resorption of primary
Monitor teeth in fracture line subsequent year until disturbances in the teeth.
exfoliation. permanent successors Signs of disturbances in
the permanent successors
require follow-up until full
eruption.
Primary dentition Guidelines
2. Treatment guidelines for luxation injuries
CONCUSSION Clinical findings
The tooth is tender to touch.
It has normal mobility and no
sulcular bleeding.
. radiolucencies.
SUBLUXATION Clinical findings
The tooth has increased
mobility but has not been
displaced.
Bleeding from gingival
crevice may be noted.
EXTRUSIVE LUXATION Clinical Findings
Partial displacement of the
tooth out of its socket.
The tooth appears elongated
and can be excessively
mobile.
. immature developing tooth, careful
C=Clinical examination; R=Radiographic examination
Radiographic findings
No radiographic abnormalities.
Normal periodontal space.
Radiographic findings
Radiographic abnormalities
are usually not found.
Normal periodontal space.
An occlusal exposure is
recommended in order to
screen for possible signs of
displacement or the presence
of a root fracture. The
radiograph can furthermore be
used as a reference point in
case of future complications.
Radiographic findings
Increased periodontal ligament
space apically.
Follow-Up
Treatment
No treatment is needed. Observation. 1 week C
. 6-8 weeks C
Treatment Follow-Up
No treatment is needed. Observation. 1 week C
Brushing with a soft brush and use of 6-8 weeks C
chlorhexidine 0.12% alcohol-free topically to Crown discoloration might
the affected area with cotton swabs twice a occur. No treatment is
day for one week. needed unless a fistula
develops.
Dark discolored teeth should
be followed carefully to
detect sign of infection as
soon as possible
Treatment Follow-Up
Treatment decisions are based on the 1 week C
degree of displacement, mobility, root 6-8 weeks C+R
formation and the ability of the child to cope 6 months C+R
with the emergency situation. 1 year C+R
For minor extrusion (< 3mm) in an Discoloration might occur.
Dark discolored teeth should
repositioning or leaving the tooth for be followed carefully to
spontaneous alignment can be treatment detect sign of infection as
options. soon as possible.
Extraction is the treatment of choice for
severe extrusion in a fully formed primary
tooth.
Favorable and Unfavorable outcomes
include some, but not necessarily all, of the
following:
Favorable Outcome Unfavorable Outcome
Continuing root No continuing root
development in development in immature
immature teeth teeth, periradicular
Crown dark
discoloration. No
treatment is needed
unless a fistula develops.
Favorable Outcome Unfavorable Outcome
Continuing root No continuing root
development in development in immature
immature teeth teeth, periradicular
Transient red/gray radiolucencies.
discoloration. A dark persisting
A yellow discoloration discoloration indicating
indicates pulp pulp necrosis.
obliteration and has a
good prognosis
Favorable Outcome Unfavorable Outcome
Continuing root No continuing root
development in development in immature
immature teeth. teeth, periradicular
Transient red/gray radiolucencies.
discoloration. A dark persisting
A yellow discoloration discoloration indicating
indicates pulp pulp necrosis.
obliteration and has a
good prognosis.
Primary dentition Guidelines
LATERAL LUXATION
INTRUSIVE LUXATION
C=Clinical examination; R=Radiographic examination; (C*)=Clinical and radiographic monitoring until eruption of the permanent successor
Clinical findings
The tooth is displaced,
usually in a palatal/lingual or
labial direction.
It will be immobile.
Clinical findings
The tooth is usually
displaced through the labial
bone plate,
or can be impinging upon the
succedaneous tooth bud
Radiographic findings
Increased periodontal ligament
space apically is best seen on
the occlusal exposure. And an
occlusal exposure can
sometimes also show the
position of the displaced tooth
and its relation to the
permanent successor
Radiographic findings
When the apex is displaced
toward or through the labial
bone plate, the apical tip can
be visualized and appears
shorter than its contra lateral.
When the apex is displaced
towards the permanent tooth
germ, the apical tip cannot
be visualized and the tooth
appears elongated
Follow-Up Favorable and Unfavorable outcomes
include some, but not necessarily all, of the
following:
Treatment Favorable Outcome Unfavorable Outcome
If there is no occlusal interference, as is 1 week C Asymptomatic Symptoms and
often the case in anterior open bite, the 2-3 weeks C Clinical and radiographic sign
tooth is allowed to reposition spontaneously. 6-8 weeks C+R radiographic signs of consistent with
1 year C+R normal or healed periodontitis.
If minor occlusal interference, slight periodontium. Grey persistent
grinding is indicated. Transient discoloration
discoloration might
When there is more severe occlusal occur
interference, the tooth can be gently
repositioned by combined labial and palatal
pressure after the use of local anesthesia.
In severe displacement, when the crown is
dislocated in a labial direction, extraction is
the treatment of choice.
Treatment Follow-Up Favorable Outcome Unfavorable Outcome
If the apex is displaced toward or through the 1 week C Tooth in place or Tooth locked in place
labial bone plate, the tooth is left for 3-4 weeks C + R erupting. Radiographic signs of
spontaneous repositioning 6-8 weeks C No or transient apical periodontitis
6 months C+R discoloration. Persistent discoloration
Damage to the
1 year C+R and (C*) permanent successor.
If the apex is displaced into the developing
tooth germ, extract
Primary dentition Guidelines

AVULSION Clinical findings Radiographic findings Treatment Follow-Up Favorable Outcome Unfavorable Outcome

The tooth is completely out of A radiographic examination is It is not recommended to replant avulsed 1 week C Damage to the permanent
the socket essential to ensure that the primary teeth. 6 months C + R successor.

missing tooth is not intruded. 1 year C + R and (C*)

C=Clinical examination; R=Radiographic examination; (C*)=Clinical and radiographic monitoring until eruption of the permanent successor