1. Guidelines for the Management of Traumatic dental injuries 本網頁內容引用自 2007 The International Association of Dental Traumatology 之官方資料，僅供參考

2. Clinical examination Radiographic examination –90 0 horizontal angle –Occlusal view –Mesial or Distal shift Sensitivity test –EPT –Cold test Patient instruction –OHI –CHX gargling

3. Treatment guidelines for fractures of teeth and alveolar bone

4. Uncomplicated crown fracture Treatment To bond fragment to tooth if available. To cover exposed dentin with GI or CRF Definitive treatment –May be restored with accepted dental restorative materials

5. Complicated crown fracture Open apex Preserve pulp vitality –Pulp capping –Partial pulpotomy –Ca(OH) 2 or MTA

6. Complicated crown fracture Closed apex with vital pulp Younger patient –Pulp capping or partial pulpotomy Older patient –RCT Pulp necrosis RCT

7. Crown-root fracture Closed apex with vital pulp Younger patient –Pulp capping or partial pulpotomy Older patient –RCT Pulp necrosis RCT

8. Root fracture Reposition –As soon as possible –Check position radiographically –Flexible splint, 4 weeks –Cervical fracture: up to 4 months Follow-up –1 yr at least –Pulp necrosis RCT for coronal fragment

9. Alveolar bone fracture Pano Treatment –Reposition –Stabilization: 4 weeks

10. Follow-up procedures Trauma4 w 6-8 w 4 M6 M1 Y5 Y Crown Fr. Crwon-root Fr. Root Fr.RS Alveolar Fr.RS RS: removal of splints

11. Unfavorable outcomes Symptomatic Negative response to pulp testing Radiographic –Signs of apical periodontitis –No continuing root development in immature teeth. –Radiolucency adjacent to fracture line. –External inflammatory resorption

12. Treatment guidelines for luxation injuries

13. Concussion No treatment is needed. Monitor pulpal condition for at least 1 year Subluxation Flexible splint, 2 weeks

14. Extrusive luxation Reposition: gently re-inserting Stabilization –flexible splint, 2 weeks Monitoring the pulpal condition –Sensibility tests –Radiography

15. Lateral luxation Reposition –Disengage tooth with forceps –Gently reposition into original location Stabilization –Flexible splint, 4 weeks Monitor the pulpal condition

16. Intrusive luxation Incomplete root formation –Allow spontaneous repositioning to take place within 3 weeks –Rapid orthodontic repositioning Complete root formation –To be repositioned either orthodontically or surgically as soon as possible. –RCT with Ca(OH) 2 dressing within 3 weeks

17. Follow-up procedures Trauma2 w4 w6-8 w6 M1 Y5 Y Concussion Subluxation Extrusive Lux..RS Lateral Lux.RS Intrusive Lux RS: removal of splints

18. Unfavorable outcomes Symptomatic –Crown discoloration Negative response to pulp testing Radiographic –No continuing root development in immature teeth –Periradicular radiolucencies –Breakdown of marginal bone –External inflammatory resorption or replacementresorption

19. Treatment guidelines for avulsed permanent teeth

20. Tooth with Closed / Open apex 1. The tooth has been replanted prior to the arrival of patient 2. The tooth has been kept in storage media (HBSS, milk, saline or saliva); or the extr-aoral dry time < 60 min 3. Extra-oral dry time > 60 min

21. Tooth has been replanted Do not extract the tooth Clean the area with water spray, saline, or CHX.

22. Tooth has been kept in media Clean root surface with a stream of saline and place the tooth in saline Cover root surface with Arestin TM –Minocycline HCl microspheres –For tooth with open apex Remove the coagulum from socket with a stream of saline. Reposition the fractured socket wall Replant the tooth slowly with slight digital pressure.

23. Extra-oral dry time > 60 min Delayed replantation Remove attached soft tissue with gauze. RCT prior to replantation, or 7–10 days later –Through open apex Remove the coagulum from the socket Reposition the fractured socket wall Immerse the tooth in 2% NaF, 20 min Replant the tooth slowly with slight digital pressure.

24. Reposition Suture gingival lacerations if present. Verify position of the tooth both clinically and radiographically. Flexible splint, 2 weeks –4 weeks for delayed replantation

25. Systemic antibiotics Tetracycline (Doxycycline) for 7 days –Risk of discoloration –Not recommended for age < 12 y/o Phenoxymethyl Penicillin (Pen V)

26. If the tooth has contacted soil, and if tetanus coverage is uncertain, refer to physician for evaluation and need for a tetanus booster.

27. Patient instruction For all patients with dental trauma Soft diet, 2 weeks. Brush teeth with a soft toothbrush after each meal. 0.12% CHX mouth rinse, bid, 1 week

28. Root canal treatment RCT 7–10 days after replantation and before splint removal. –RCT prior to delayed replantation Place Ca(OH) 2 dressing until RCF –1 month Open apex: only when pulp necrosis

29. Follow-up procedures RS: removal of splint Yearly after 1-year follow-up Replantation1 w2 w3 w4 w3 M6 M1 Y immediateRS DelayedRS

30. Unfavorable outcome Symptomatic –Excessive mobility –No mobility with metallic percussion sound –Crown in infra-occlusal position Resorption –inflammatory, infection-related –Ankylosis-related replacement resorption

31. Splinting times 2 weeks –Subluxation –Extrusive luxation –Avulsion 4 weeks –Lateral luxation –Root fracture (middle third) –Alveolar fracture –Avulsion (delayed replantation) 4 months –Root fracture (cervical third)