1. Hamed Homayouni DDS, MS

2. Overview  Classification  Definitions  Incidence  Biological consequences  Treatment

3. Classification  Concussion  Subluxation  Lateral luxation  Extrusive luxation  Intrusive luxation

4. Definitions  Concussion: no displacement and normal mobility sensitivity to percussion

5. Definitions  Subluxation: no displacement sensitivity to percussion and increased mobility

6. Definitions  Lateral luxation displacement labially, lingually, or distally.

7. Definitions  Extrusive luxation: Displacement in a coronal direction

8. Definitions  Intrusive luxation displacement in an apical direction

9. Incidence  Luxation injuries as a group are the most common of all dental injuries.  30% to 44%

10. Biological consequences  Attachment apparatus  Neurovascular supply

11. Neurovascular supply damage  Pulp canal obliteration open apex- extrusive and lateral luxation- rigidly splinted  Pulp necrosis intrusive luxation- mature apex  Pulp space infection consequence of pulp necrosis

13. Attachment apparatus  Favorable Healing: Cementum coverage Localized- 14 days- no treatment-  Unfavorable Healing: Ankylosis Diffuse- severe trauma- more than 20%- treatment: minimizing the initial inflammatory response  Unfavorable Healing: External inflammatory root resorption

16. Treatment  Concussion and Subluxation: 1- There is no need for immediate treatment. 2- Responses to vitality test should be investigated and noted.

17. Treatment  Lateral, Extrusive and Intrusive Luxations: 1- Neurovascular supply damage 2- Attachment apparatus damage

18. Attachment apparatus damage  Repositioning  Splinting

19. Repositioning  Repositioning as soon as possible.(extrusive and lateral luxation)  Orthodontic extrusion or immediate surgical repositioning. (Intrusion)

20. Splinting  Extrusion: 2 weeks  Lateral luxation: 4 weeks  Intrusion: more than 4 weeks

21. Neurovascular supply damage  Necrosis will occur after a fairly serious injury.  Usually by 3 weeks, the necrotic pulp will become infected.  The attention to pulp space infection should be ideally be 7 to 10 days after the injury.

22. Endodontic Treatment  Prevention of pulp space infection by reestablishing the vitality of the pulp.  Prevention of pulp space infection by root canal treatment at 7 to 10 days.  Elimination of pulp space infection.

26. Overview  Classification  Definitions  Incidence  Biological consequences  Treatment