AtlasTraumaDento-alveolar Trauma

Trauma

Dento-alveolar Trauma

aka Traumatic Dental Injury · TDI

Injuries involving teeth, periodontium and alveolar bone; management is time-critical and follows IADT 2020 guidelines.

Guideline
IADT 2020
Avulsion splint
Flexible 2 wk
Root fracture splint
Flexible 4 wk

§ figuresFigures (0)

Verified clinical image not yet available

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Dento-alveolar Trauma figures pending faculty review.

§ overviewOverview

Injury to the teeth, supporting tissues, and alveolar bone caused by acute mechanical trauma.

§ epidemiologyEpidemiology

Peak ages 2–4 (falls) and 8–12 (sports); maxillary central incisors most affected.

§ clinicalClinical Features

  • 01Fractured, displaced, or missing teeth
  • 02Mobility, occlusal interference
  • 03Gingival laceration, alveolar step
  • 04Vitality changes on follow-up

§ investigationsInvestigations

  • 01Multiple periapical radiographs (parallel, occlusal, 45°)
  • 02CBCT for root/alveolar fractures
  • 03Vitality testing (baseline and follow-up)
  • 04Photographs; document per IADT chart

§ classificationClassification

  • 01Andreasen/WHO: enamel fracture, enamel–dentin fracture, complicated crown fracture, crown–root fracture, root fracture, concussion, subluxation, extrusive/lateral luxation, intrusive luxation, avulsion, alveolar fracture

§ treatmentTreatment

  • 01Enamel fracture: smooth or composite restoration
  • 02Enamel-dentin: composite; monitor vitality
  • 03Complicated crown fracture: pulp cap / partial pulpotomy (Cvek) if <24 h; RCT if mature
  • 04Root fracture: reposition, flexible splint 4 wk (cervical: 4 mo)
  • 05Extrusion: reposition, flexible splint 2 wk
  • 06Lateral luxation: reposition, flexible splint 4 wk
  • 07Intrusion: monitor if immature/<3mm; orthodontic/surgical repositioning if mature/severe
  • 08Avulsion: replant ASAP; storage in HBSS/milk/saliva; flexible splint 2 wk; systemic doxycycline; tetanus check; RCT within 7–10 days for mature apex
  • 09Alveolar fracture: reposition, rigid splint 4 wk

§ complicationsComplications

  • 01Pulp necrosis
  • 02Pulp canal obliteration
  • 03Root resorption (surface, inflammatory, replacement/ankylosis)
  • 04Loss of tooth

§ prognosisPrognosis

Depends on extra-alveolar time, storage medium, root maturity and periodontal ligament vitality — best outcome if avulsed tooth replanted within 5 min.

§ examKey Examination Points

  • 01Extra-alveolar time and storage medium (avulsion)
  • 02Test vitality and record baseline

§ revisionQuick Revision Summary

  • 01IADT 2020 · replant ASAP · HBSS best medium · 2 wk flexible splint for avulsion

§ vivaBDS Viva Questions

  • 01Describe management of avulsed permanent incisor.
  • 02What is Cvek pulpotomy?
  • 03Types of root resorption?

§ mcqsMCQs — Assessment (3)

Question 1

Best storage medium for avulsed tooth:

Question 2

Splint duration for avulsion:

Question 3

Optimal extra-alveolar time:

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

  • L1 · Classification — 1
  • L6 · Textbook — 5

1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

Open PubMed

Current Classification

Reference #1L1 · ClassificationWHO / Classification Verified
WHO Classification of Tumours Online — Head and Neck

IARC / WHO. IARC · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

DOI: Identifier not availablePMID: Identifier not available
View source

Histopathology References

Reference #6L6 · TextbookHistopathology References Unverified
Surgical Pathology of the Head and Neck3rd Edition

Barnes L. CRC Press · 2008

Detailed histopathological reference for head and neck diagnostic criteria.

DOI: Identifier not availablePMID: Identifier not available

Textbook References

Reference #2L6 · TextbookTextbooksRecent Verified
Oral and Maxillofacial Pathology5th Edition

Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024

Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.

DOI: Identifier not availablePMID: Identifier not available
View source
Reference #3L6 · TextbookTextbooks Unverified
Shafer's Textbook of Oral Pathology9th Edition

Rajendran R, Sivapathasundharam B. Elsevier · 2020

Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.

DOI: Identifier not availablePMID: Identifier not available
Reference #4L6 · TextbookTextbooks Unverified
Contemporary Oral and Maxillofacial Surgery7th Edition

Hupp JR, Ellis E, Tucker MR. Elsevier · 2019

Core surgical textbook covering exodontia, infection, trauma and preprosthetic surgery.

DOI: Identifier not availablePMID: Identifier not available
Reference #5L6 · TextbookTextbooks Unverified
AO Principles of Internal Fixation of the Craniomaxillofacial Skeleton

Ehrenfeld M, Manson PN, Prein J. Thieme / AO Foundation · 2012

Reference standard for craniomaxillofacial trauma osteosynthesis principles and techniques.

DOI: Identifier not availablePMID: Identifier not available

Additional sources cited on this page

  1. Fouad AF et al. Dent Traumatol 2020 — IADT Guidelines

Browse the full evidence library →

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.