This article addresses restorative options following dental trauma, focusing on immediate soft tissue management and interim stabilization. It highlights the importance of phased management, emphasizing initial concerns like airway safety and management of infection. A case study illustrates management of extensive injuries from an e-cigarette explosion, including avulsed and fractured incisors. The article discusses reimplantation guidelines, splinting techniques, sealing exposed dentin, and interim prosthetics. Growth monitoring and root banking are presented as important steps in achieving long-term esthetic and functional outcomes.
Key points
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Phased Management: Effective dental trauma management involves a phased approach, prioritizing immediate concerns like airway safety and infection risk while planning for future restoration.
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Interim Measures: Provisional prostheses, splinting, and composite temporization are vital to stabilize teeth, protect tissues, and address esthetic concerns in the short term.
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Growth Considerations: In younger patients, growth monitoring and techniques like root banking are essential to preserve alveolar bone and optimize future implant esthetics after trauma.
Abbreviation
| IADT | International Association of Dental Traumatology |
Introduction
Dental trauma is a significant clinical concern, though the causes, consequences, and management strategies vary greatly by age. Because the anterior teeth typically erupt between the ages of 6 and 8, traumatic injuries in children frequently involve permanent rather than primary dentition. , Teenagers usually possess a complete permanent dentition; however, ongoing craniofacial growth introduces significant challenges to restorative treatment planning. For these youth, restorative approaches need to be focused on preserving alveolar bone and gingival tissue until skeletal maturity is reached. In early and middle-aged adults, traumatic injuries continue to result from occupational accidents, motor vehicle collisions, physical assaults, and sports-related activities, while elderly individuals are more likely to sustain trauma from falls. Balance disorders and other systemic comorbidities not only increase the risk of injury but also complicate treatment. Age- and systemic-related factors such as reduced healing capacity, increasing severity of periodontal disease, and functional limitations must be carefully considered in restorative planning for an elderly age cohort.
Regardless of age, restorative treatment planning after dental trauma frequently requires both interim and definitive components ( Table 1 ). Interim measures —such as provisional prostheses, splinting, or composite temporization—are often necessary to stabilize teeth, protect pulpal and periodontal tissues, and address esthetic concerns in the short term. Definitive treatments , including crowns, implants, or fixed prostheses, can be pursued once tissues have healed and the prognosis is more predictable, with the goal of achieving long-term esthetic and functional outcomes.
Table 1
Summary of restorative dental workflow post-trauma, by treatment sequence
| Stages | Description | Timing | Key Elements |
|---|---|---|---|
| 1 | Acute (immediate management) | 24 h |
Medical evaluation
Suture placement Splinting |
| 2 | Postacute preliminary | 2 wk–6 mo |
Temporary restorations
Interim prosthesis fabrication Root canal therapy Root banking |
| 3 | Long-term phase (ongoing monitoring and growth considerations) | 6 mo-skeletal maturation/medical stability | Additional root canal therapy, if indicated |
| 4 | Definitive treatment | After 6 mo/skeletal maturation |
Fixed prostheses including implants, crowns, fixed partial dentures/bridgework
Follow-up |
The types of dental trauma that require attention to the enamel and dentin include all the Ellis fracture types: enamel only; enamel and dentin; enamel, dentin and pulp; and root fracture, as well as subluxation, lateral luxation, and avulsion injuries.
In this article, we will provide an overview of restorative options for dental trauma, focusing on immediate soft tissue management and interim measures to stabilize the dentition. In a subsequent article, we discuss definitive recommendations, recent advances in the treatment of dental trauma to the enamel and dentin, the situation of delayed treatment, and important socioeconomic and psychosocial considerations.
Case #1 description
A 16-year-old female presented with her mother 24 hours after an e-cigarette exploded in her mouth ( Fig. 1 ). Both mother and daughter were visibly distraught and expressed significant anxiety regarding the daughter’s appearance. Clinical examination revealed severe trauma involving both hard and soft tissues. Extraorally, the patient demonstrated burns of the upper and lower lips, as well as the cheeks, with associated perioral edema ( Fig. 2 ). Intraorally, the injuries were extensive: the maxillary central incisors (#8 and #9) were completely avulsed and not recovered at the scene, the maxillary lateral incisors (#7 and #10) exhibited crown–root fractures extending to the gingival margin, and the mandibular incisors (#23–26) sustained Ellis Class II fractures involving dentin. Additional findings included lacerations of the labial mucosa and gingiva, burns of both the hard and soft palate, and an embedded metal spring from the e-cigarette in the tongue. Radiographic evaluation with periapical ( Fig. 3 ), panoramic ( Fig. 4 ), and cone-beam computed tomography (CBCT_ imaging ( Fig. 5 ) confirmed oblique crown–root fractures of #7 and #10 and associated alveolar fracture at the sites of avulsed #8 and #9.
Case #1: 16-year-old girl immediately after e-cigarette explosion.
Sixteen-year-old girl 5 days after e-cigarette explosion.
Periapical radiograph of 16-year-old girl with avulsed #8,9 and fractured #7,10.
Panoramic radiograph of 16-year-old girl with avulsed #8,9 and fractured #7,10 and associated injuries to mandibular teeth.
CBCT image of a 16-year-old girl with avulsed #8,9 and fractured #7,10.
Phased principles of management
The management of traumatic dental injuries is most effective when approached in phases. This framework is endorsed by the International Association of Dental Traumatology (IADT) and ensures that immediate concerns such as airway safety, hemostasis, and pain control are addressed first, while simultaneously preserving tissues and planning for future restorative success.
Stage 1: Acute Phase (Immediate Management)— First 24 Hours
Case #1
While this patient initially presented in the dental clinic, she was referred to the emergency department for a medical evaluation, where airway patency was confirmed and systemic injuries, such as concussion or fractures, could be excluded. Lacerations were irrigated and sutured ( Fig. 6 ), burn dressings were applied to the lips and oral mucosa, and an embedded foreign body was carefully removed from the patient’s tongue.
Sixteen-year-old girl after e-cigarette explosion with dissolvable sutures placed.
In the acute setting, the primary goals are stabilization of the patient’s general health, management of wounds, and control of pain. It should begin with a systematic initial workup to ensure comprehensive assessment and appropriate intervention. This includes a detailed patient history focusing on the mechanism of injury, timing, and any associated symptoms such as bleeding, numbness, or visual disturbances. Extraoral examination assesses for swelling, lacerations, and bruising while carefully palpating bony landmarks to identify fractures. Intraoral evaluation involves inspecting mucosal and gingival soft tissues and tongue for lacerations, inspecting teeth for movement and/or fracture (which could manifest as sense that teeth moving when biting down, are biting together differently, or difficulty closing mouth), and alveolar bone integrity (is the observed symptom related to a fracture of the tooth, of the underlying bone, or both?). Radiographic imaging, including panoramic and CBCT scans, facilitates the detection of fractures, displacements, or other skeletal injuries, as well as identifying metallic foreign bodies that are not visible. Maintaining airway patency, controlling hemorrhage, and addressing other life-threatening conditions are priorities before any dental-specific treatment.
If the injury is relatively minor, lacerations of the lips, cheeks, and gingiva can and should be addressed by the dental professional. Lacerations should be carefully irrigated with sterile saline or a wound irrigation solution to remove debris and reduce the risk of infection. Embedded foreign bodies such as glass, metal fragments, or tooth fragments must be removed to prevent delayed healing or chronic infection. These foreign bodies must only be removed with sterile forceps, and gently, to avoid additional trauma to soft tissues. Local anesthesia may be helpful, and block injections preferable, if the timing and setting allow.
Burn injuries to extraoral tissues, as in our case example with the electronic cigarette, require the application of nonadherent dressings to protect tissues from drying out and minimize tissue necrosis. Common types of nonadherent dressings for burn injuries include petroleum jelly–based gauze such as Vaseline gauze and silicone-based dressings. Burn injuries inside the mouth, however, typically do not require traditional dressings like those used on skin wounds. The oral cavity has a rich blood supply, which promotes rapid healing, and the moist environment helps facilitate tissue regeneration.
Sutures may be necessary to optimize healing and esthetic outcomes. Sutures are indicated when wound edges cannot be approximated or hemostasis is difficult to obtain and/or sustain. Before suturing, it is essential to ensure that all foreign bodies have been removed from the laceration. Sutures can be absorbable or nonabsorbable; absorbable sutures are more common intraorally and when esthetics are less of a concern. When in doubt of how to suture or to properly care for minor soft tissue injuries more generally, however, do not hesitate to refer to the primary care physician, urgent care center, or emergency room. Improper soft tissue management can lead to both serious infection as well as poor esthetic outcomes.
Adjunctive pharmacologic measures included nonsteroidal anti-inflammatory drug (NSAIDs) for both analgesia and anti-inflammatory effects, acetaminophen for analgesia, prescription of chlorhexidine rinses for local antimicrobial control, administration of systemic antibiotics to reduce the risk of systemic infection, and verification and/or updating of tetanus immunization status.
Stage 2: Postacute Preliminary Phase— 2 Weeks to 6 Months
Case #1
The days and weeks following the injury were marked by the need to restore both function and esthetics. This happened on a Sunday. This patient was seen on Monday and then again on Thursday. She was going to be in her sister’s wedding the following weekend. The loss of the maxillary central incisors posed a significant challenge, as they were not available for replantation. A removable partial denture ( flipper ) was fabricated to restore teeth #7 to 10 ( Fig. 7 ). Direct composite restorations were placed on the mandibular incisors to seal the dentin and restore appearance. Endodontic therapy was initiated on the maxillary lateral incisors (#7 and #10), which had sustained crown–root fractures, while the mandibular incisors were monitored closely with vitality testing and radiographic follow-up. When signs of pulp necrosis developed in tooth #25, root canal therapy was subsequently performed.
