classification of traumatic injury of oral tissue.pptx

classification of traumatic injury of oral tissues and teeth.

1. Classification of traumatic injury

2. Content Dental trauma Etiology Mechanism of dental trauma classification of anterior teeth trauma by sweets Ellis and Davey classification Bennett’s classification Modified Ellie’s classification Gracia godoy’s classification David classification WHO classification Classification by hargreaves Andreasen classification

3. Dental trauma Dental trauma refers to trauma (injury ) to teeth or periodontium gums periodontal ligaments alveolar bone and nearby soft tissues such as lips tongue etc. Injury can be defined as an interruption in the continuity of tissue Result of this process can either be tissue repair where the continuity is restored but the healed tissue differs in anatomy and function or tissue regeneration Dental tissues are unique in comparison to most other tissues in the body due to their ability to completely regenerate. Injury and its sequelae in some important structure of teeth are :-

4. Dental follicle :- traumatic injury can be transmitted easily from the primary to permanent dentition. It has been shown in experiments that when parts of dental follicle are removed an Ankylosis is formed between tooth surface and the crypt Cervical loop :-cervical loop is highly resistant to trauma. Only profound contusion due to intrusion of primary incisors result in total arrest odontogenesis Inner enamel epithelium:-in case of total loss of ameloblast in secretory phase no regenerative phase potential exist. In case of partial damage enamel Matrix formation and maturation may be affected. If there total loss of ameloblasts during the maturation stage hypomineralized enamel will Develop. Reduced enamel epithelium:- minor injury to the reduced enamel epithelium is repaired with a thin squamous epithelium where as, Large area of destruction results in ankylosis and tooth Retention. Enamel and enamel matrix :- trauma to primary tooth may cause contusion of permanent matrix. Ameloblastoma will also be destroyed there by arresting enamel maturation and resulting in permanent hypomineralized enamel defect. HERS :-chronic trauma to HERS, such as orthodontic intrusion of immature teeth often leads to fragmentation. An acute trauma to the epithelial root sheet transmitted indirectly for example:-by intrusion of a primary tooth can damage HERS and leads to partial or complete arrest of root development.

5. Gingival and periosteal complex:- the gingiva attachment is often torn during luxation and displacement injuries. In injuries to the underline bone firstly the cortical bone plate loses an important part of its vascular supply and secondly the cellular cover of bone provided by the innermost layer of periosteum is partially or totally removed. Periodontal ligament : cementum complex:- following a severe dental injury the periodontal ligament must respond to a variety of injury these includes-temporary compressive, tensile or sharing stress which results in hemorrhage , edema rupture or Contusion of the periodontal ligament. Dentin pulp complex :- a deviation in the composition of the organic structure of dentin may lead to fracture. ( Dentinogenesis imperfecta ). Furthermore, the exposure of dentinal tubules during trauma leads to bacterial invasion with a resultant permanent or transitory inflammation reaction in the Pulp. Two basic response determine pulpal wound healing response- general features of the pulpal wound healing response is replacement of damaged tissue with newly formed Pulpal tissue along the pulpodentinal border.

6. Etiology Falls in infancy Child abuse -battered child syndrome Sports injuries Horse riding Automobile injury Mental retardation and epilepsy Drug related injuries Development defects of enamel and dentin like Dentinogenesis imperfecta .

7. Mechanism of dental trauma injuries Direct trauma- occurs when tooth itself is stuck example against table or chair. Indirect trauma-when lower dental arch is forcefully closed against upper dental arch example blow to chin. Extent of trauma can be assessed by four factors given by hallet in 1954 Energy of impact:- energy is equals to mass multiply by velocity. Hence if the impacting object either has more mass or has high velocity the impact will be more Resilience of impacting object:- This can be either hard or soft. More injury is bounded to occur in the case of former and less in case of later. Shape of impacting object:- the nature of wound depends upon whether the object is sharp or blunt . Direction of impacting force:-type of fracture will directly depend on direction

8. Classification of anterior teeth trauma by sweets (1955) It is mainly based on the anatomy and morphology of the tooth structure. The disadvantage of this classification is that no stress has been laid on injuries to supporting structures soft tissues and bones. It indicated more towards permanent teeth then primary teeth.

9. Classification of anterior teeth by sweets 1955 Class 1 A simple of crown exposing no dentation. Class 2. A parallel of crown involving little dentin. Class 3. Extensive fracture of crown involving more dentin but no pulp exposure. Class 4. Extensive fracture of crown exposing pulp. Class 5 complete fracture of crown exposing pulp. Class 6 Fracture of root with or without loss of crown structure. Class 7. Tooth loss as a result of trauma.

10. Ellis and Davey classification 1960 Class 1 simple fracture of crown involving only enamel with little or no dentin. Class 2 extensive fracture of crown involving considerable dentin but not exposing dental pulp. Class 3 extensive fracture of crown involving considerable dentin and exposing dental pulp. Class 4 the traumatized tooth that becomes non vital with or without loss of crown structure. Class 5 total tooth loss-avulsion. Class 6 Fracture of root with or without loss of crown. Class 7 displacement of tooth with neither crown nor root fracture. Class 8 fracture of crown en masse and its displacement. Class 9 tramatic injuries of primary teeth. . According to Cohen –cracked tooth . According to mathewson - cyclic Dislocation of tooth

11. Bennett’s classification Bennett’s classification is according to injuries to peridontium and Alveolus considering the anatomy and morphology of the teeth which can be applied partially for primary and permanent teeth. Class 1. Traumatized tooth 1a. Tooth is firm in Alveolus. . 1b. Tooth is subluxation in Alveolus Class 2. Coronal fracture. 2a. Fracture of enamel. 2b. Fracture of enamel and dentin. Class 3. Coronal fracture with pulp exposure. Class 4. Root fracture. 4a. Without coronal fracture 4b. With coronal fracture class 5. Avulsion of tooth.

12. Modified Ellis classification (by McDonald , Avery and Lynch 1983) Class 1 simple fracture of crown involving little or no dentin Class 2 extensive fracture of crown involving considerable dentin but not the dental pulp Class 3 extensive fracture of the crown involving considerable dentin and exposing the pulp Class 4 loss of entire crown

13. Garcia- godoy’s classification 1984 It is a numerically descriptive classification that holds good for the primary and permanent teeth It is based on andreasen’s modification of World health organisation classification Class 0 enamel crack Class 1 enamel fracture Class 2 enamel dentin fracture without pulp exposure Class 3 enamel dentin fracture with pulp exposure Class 4 enamel dentin cementum fracture without pulp exposure Class 5 enamel dentin cementum fracture with pulp exposure Class 6 root fracture Class 7 concussion Class 8 luxation Class 9 lateral displacement Class 10 intrusion Class 11 exclusion Class 12 avulsion

14. David classification 1988 It is simple and clear classification Description of the incisal injuries to supporting tissue and soft tissue has not been given Class 1 enamel chip of Class 2 enamel + dentin involvement Class 3 pulpal involvement Class 4 displacement

15. WHO classification 1993 873.60 enamel fracture 873.61 enamel and dentin fracture without pulp exposure 873.62 enamel and dentin fracture with pulp exposure 873.63 root fracture 873.64 crown root fracture 873.66 concussion luxation 873.67 intrusion and extrusion 873.68 avulsion 873.69 soft tissue injuries

16. Injury to the soft tissue

17. Classification by hargreaves 1999 It is a classification on basis of the type of injury to individual tooth and injuries to the supporting tissues and alveolar bone Trauma by type of injury to individual teeth Description Fracture of enamel only Fracture of involving dentin Fracture involving dental pulp Displacement or excessive mobility no fracture Displacement or excessive mobility and fracture of enamel Displacement or excessive mobility and fracture of dentin Displacement or excessive mobility fracture to dental pulp Displacement but no other sign of injury Tooth lost because of trauma luxation

18. Andreasen’s classification 1981 Injuries to hard dental tissues and pulp Injuries to periodontal tissues Injuries to supporting bone Injuries to gingiva and oral mucosa

19. Injuries to hard dental tissues and pulp Enamels infraction- incomplete fracture crack of enamel without loss of tooth substance Enamel fracture uncomplicated crown fracture - a fracture with loss of tooth substance confined to enamel only Enamel dentin fracture uncomplicated crown fracture- a fracture with loss of tooth substance confined to enamel dentin but not involving pulp Complicated crown fracture- fracture involving enamel and Dentin and also exposing Pulp Uncomplicated crown root fracture- Fracture involving enamel Dentin and Cementum but not exposing pulp Complicated crown root fracture -fracture involving exposing dentin and cementum and also exposing pulp Root fracture a fracture iinvolvin dentin cementum and pulp . They also be classified according to displacement of coronal fragment

20. Injuries to periodontal tissue Concussion and injury to supporting structure without abnormal loosening or displacement of tooth but with marked reaction to percussion subluxation and injury to the tooth supporting structures with abnormal loosening but without displacement of tooth Extrusive luxation (peripheral dislocation and partial avulsion ) partial displacement out of its sockets. Lateral luxation displacement of tooth in any other direction other than axial. Accompanied by fracture of alveolar socket intrusive luxation (Central dislocation): displacement of tooth into alveolar socket accompanied by fracture of alveolar socket Avulsion ( exarticulation ) Complete displacement out of its socket.

21. Injuries to the supporting bone Comminution of mandibular and maxillary alveolar socket : Crushing and compression of the alveolar socket found mostly with intrusive and lateral luxation. Fracture of maxillary Or mandibular socket wall :A Fracture confined to facial or lingual socket wall. Fracture of maxillary or mandibular alveolar process: A fracture involving the base of mandible or maxilla and often the alveolar process . May or may not involved alveolar socket

22. Injury to gingiva or oral mucosa Laceration of gingiva or oral mucosa : shallow or Deep wound in the mucosa resulting from a tear usually produced by sharp object Contusion of gingiva or oral mucosa : A bruise usually produced by impact with blunt object and not accompanied by a break in mucosa , but usually causing submucosal hemorrhage . Abrasion of gingiva or oral mucosa : superficial wound produced by rubbing or scraping of mucosa leaving a raw bleeding surface.

23. Zerman cavalleri g classification 1995 Dental trauma was divided into the following categories based on anatomic morphological aspects and injuries to supporting tissues It is indicated more towards the permanent Dentition then primary dentition. Fracture of enamel including enamel Chipping Fracture of enamel dentin without pulpal involvement Fracture of enamel Dentin with pulpal involvement Fracture of root Crown root fracture without palpal involvement Crown root fracture with palpal involvement. Concussion subluxation Intrusive laxation Extrusive luxation Lateral luxation avulsion

24. SUb gingival fracture classification by heithersay and morile They classified sub gingival fractures based on the level of tooth fracture in relation to various horizontal plains of periodontium Class 1 fracture line does not extend below the level of attached gingiva Class 2 fracture line below the level of attached gingiva but not below the level of alveolar crest Class 3 fracture line extends below the level of alveolar crest Class 4 fracture line is within the coronal third of root but below the level of alveolar crest

25. Hargreaves and Craig classification 1970 Class 1 no fracture or fracture of enamel only with or without displacement of tooth Class 2 fracture of crown involving both enamel and dentin without exposing of pulp with or without displacement of tooth Class 3 fracture of crown exposing the bulb with or without displacement of tooth Class 4 fracture of root with or without coronal fracture with or without displacement of tooth Class 5 total displacement of tooth

26. Al MajEd classification 2001 Classified the maxillary incisors for dental trauma This classification is applicable to both primary and permanent dentition It is based on anatomic consideration with the therapeutic and prognostic consideration Code 0 no trauma Code 1 discoloration Code 2 fracture involving enamel Code 3 fracture involving enamel and dentin Code 4 fracture involving enamel Dentin and pulp Code 5 missing due to trauma Code 6 acid etch composite restoration Code 7 permanent replacement including crown denture bridge pontic Code 8 temporary restoration Code 9 assessment could not be made when the tooth was either missing or badly broken by dental case

27. Classification of spinas 2002 It is an easy to use classification of dental crown lesion that helped to gather data easily to choose the right materials to improve communication among practitioners including by electronic means It consist of 4 classes ABCD and three subclasses b1 C1 D1 class A: All the simple enamel lesions which involve a mesial Or distal crown angle or only the incisal edges Class B :all the enamel dentin lesions which involves a mesial or distal angle and the incisal edge. When a Pulp exposition exists defined as a subclass b1 Class C : all the enamel dentin lesions which involves the incisal edge at least a third of the crown surface in case of pulp exposure defined as sub class c1 Class D :all the enamel dentin lesion which involves a mesial or distal crown angle and the incisal or palatal surface with root cement involvement crown route fracture in case of pulpal exposure exists as sub class D1.

28. Rocha mjc classification 2001 This classification is based on the type of injury of the dentition and due to consideration to the coronal fractures radicular fractures and the injuries to the supporting tissue have been laid. Type of crown fracture Enamel fracture radicular fracture Crown fracture with pulp exposure Crown fracture without pulp exposure Coronoradicular fracture with pulp exposure 2. Type of luxation Subluxation Intrusive luxation Avulsion Concussion Lateral luxation Extrusive luxation

29. According to the international classification of disease 1992 Injury to the hard dental tissue and pulpal enamel infraction- N502.50 Enamel fracture( uncompleted crown fracture) N502.50 Enamel dentin fracture (uncomplicated ,crown fracture) N502.51 Complicated crown fracture N502.52 Complicated crown root fracture N502.54 Root fracture N502.53 Injuries to periodontal tissue (concussion) N503.20 Subluxation N503.20 Extrusive relaxation (peripheral dislocation ,partial avulsion )N503.20 Lateral luxation N503.20 Intrusive luxation (Central dislocation) N503.20

30. According to the international classification of disease 1992 Avulsion ( exarticulation ) N502.22 Comminution of mandibular or maxillary N502.40 & N502.60 Fracture of mandibular or maxillary alveolar socket wall N502.40 &N502.60 Fracture of mandible or maxilla N502.61 & N502.42 Laceration of Gingiva or oral mucosa S01.50 Contusion of gingiva or oral mucosa S00.50 Abrasion of Gingiva or oral mucosa S00.50

31. Classification of dental trauma of primary teeth by fried and EricKson 1995 classification of hard tissue fractures class 1 simple fracture of enamel only Class 2 fracture involving enamel and dentin Class 3 fracture extends farther into tooth with a small pulpal exposure Class 4 fracture involves significant amount of pulpal exposure Class 5 complete loss of tooth Class 6 fracture of root trauma Affecting the periodontium Concussion sensitivity of tooth to trauma without abnormal losing or mobility Subluxation Loosening of Tooth without mobility Luxation displacement of traumatized teeth

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