Theme notesTrauma & surgery
Theme notesTrauma & surgery
Trauma & surgery: protect the tooth’s future
First establish medical stability and the injury. Then split primary from permanent teeth: the successor, root maturity, and time outside the socket change the plan.
Remember
Child first. Tooth type. Injury. Apex. Follow-up.
Key points
Record injury timing, mechanism, associated injuries, soft tissues, imaging, and baseline findings. In permanent teeth, one negative sensibility test after trauma does not prove necrosis.
Permanent fractures/luxations (PDF opens in a new tab)For permanent fractures/luxations, use the injury-specific repositioning, flexible-splint, and follow-up table. Combined injuries follow the more frequent luxation schedule.
Permanent fractures/luxations (PDF opens in a new tab)In primary trauma, prioritize comfort and the developing successor. Discoloration alone is not an indication for endodontic treatment.
Primary trauma (PDF opens in a new tab)Before surgery, map roots and successors, assess medical and behavior needs, choose a suitable setting, and explain alternatives and aftercare.
Oral surgery (PDF opens in a new tab)Child abuse and neglect (2026 policy): document each injury’s type, character, and location, intra- and extraorally. Refer bite injuries to a hospital promptly. Proof is not needed for a mandated report; report promptly under state law. Sexual-abuse evidence collection can have a window of up to 72–120 hours, which is not a reporting cutoff. Dental neglect is willful caregiver failure to obtain or complete necessary care; caries alone does not establish it.
Child abuse & neglect (PDF opens in a new tab)Answer aloud
What is the first distinction to make when managing an avulsed tooth?
- Primary: never replant.
- Permanent: prompt replantation when appropriate, or a suitable moist storage medium and urgent care.
- Handle the crown, avoid root damage, and record dry time and storage.
How does an open versus closed apex change management of a replanted permanent tooth?
- Closed apex generally needs endodontic treatment within two weeks.
- Open apex may revascularize; intervene for definite necrosis/infection.
- Splint: Use a passive flexible splint for two weeks unless associated bone injury changes the plan.
- Recall: The open-apex clinical/radiographic schedule is 2 weeks, 1, 2, 3, and 6 months, 1 year, then annually for at least five years.
- Adjuncts: Include guideline-recommended antibiotics (benefit uncertain), tetanus assessment, and homecare.
Does the direction of intrusion alone justify extracting an intruded primary incisor?
Allow spontaneous repositioning irrespective of direction, arrange rapid referral to a child-oriented team, and monitor. The direction of displacement alone is not a routine extraction indication.
Primary trauma (PDF opens in a new tab)Should you keep searching for a primary root tip that fractures during extraction?
Remove an easily accessible fragment. A small, deep fragment near the successor may be safer to leave than pursue traumatically; document, explain, and monitor infection and eruption.
Oral surgery (PDF opens in a new tab)Compare intrusion pathways
Scroll across to view all columns
| Tooth and apex | Spontaneous re-eruption | If it does not re-erupt |
|---|---|---|
| Primary tooth, any direction | Allow spontaneous repositioning, usually within 6 months (up to 1 year) | Refer within a couple of days; review at 1 week, 6–8 weeks, 6 months, and 1 year; severe intrusion also at age 6 |
| Permanent, open apex, any depth | Allow re-eruption | Orthodontic repositioning after 4 weeks; treat promptly if necrosis or inflammatory resorption develops |
| Permanent, closed apex, under 3 mm | Allow re-eruption | After 8 weeks: surgical repositioning with a 4-week splint, or orthodontic repositioning before ankylosis |
| Permanent, closed apex, 3–7 mm | Do not wait; reposition actively | Surgical repositioning preferred, or orthodontic repositioning |
| Permanent, closed apex, over 7 mm | Do not wait; reposition surgically | Surgical repositioning |
A mature intruded tooth almost always becomes necrotic: start root canal treatment at about 2 weeks or as soon as tooth position permits, with calcium hydroxide or corticosteroid/antibiotic intracanal medication.
Permanent fractures/luxations (PDF opens in a new tab)Primary trauma (PDF opens in a new tab)Quick decisions
Does discoloration alone justify endodontic treatment of a primary tooth?
not an indication for endo
Does one negative sensibility test after dental trauma prove pulp necrosis?
does not prove necrosis
Which follow-up schedule should you use for combined traumatic dental injuries?
follow the more frequent (luxation) schedule
What documentation, referral, and reporting steps are needed when you suspect child abuse?
document type, character, location; bites → hospital; report
Decision pathways
Sources
- IADT Guidelines: Fractures and Luxations of Permanent Teeth, 2020 (IADT guideline; reprinted in the current AAPD manual)
- IADT Guidelines: Avulsion of Permanent Teeth, 2020 (IADT guideline; reprinted in the current AAPD manual)
- IADT Guidelines: Injuries in the Primary Dentition, 2020 (IADT guideline; reprinted in the current AAPD manual)
- Management Considerations for Pediatric Oral Surgery, 2025 (AAPD latest revision; manual edition is 2026-2027)
- Policy on Recognition and Management of Child Abuse and Neglect in a Dental Setting, New 2026
Official but unformatted 2026 PDF; page numbers may shift when typeset.