Dental trauma affects individuals across all age groups, with a higher frequency observed in children and young adults. Approximately 25% percent of all schoolchildren experience dental trauma. Epidemiologic studies indicate that 33% of adults have sustained trauma to the permanent dentition. The maxillary incisors are most frequently affected, followed by the mandibular incisors. Management of traumatic dental injuries aims to provide immediate symptom relief while considering long-term outcomes, particularly in the mixed dentition and immature teeth within growing skeletal systems.

The peak incidence of dental injury occurs in children aged 7 to 11 years. Although traumatic dental injuries were historically more prevalent in males, this gender disparity has narrowed due to increased female participation in sports and physical activities. Injuries sustained during this critical developmental period can significantly affect tooth retention and alveolar bone growth, potentially leading to substantial alveolar deficiencies that complicate future esthetic replacement. These concerns extend beyond dental health, influencing facial esthetics and contributing to physical and psychological trauma in young patients.

Recognition and appropriate management of traumatic dental injuries constitute true dental emergencies. Prompt treatment delivery is directly correlated with improved outcomes, particularly with respect to pulpal and periodontal health. Traumatic dental injuries are classified based on the location of the injury along the tooth structure and changes in tooth position within the alveolar socket, and are categorized as fractures, luxation, or combinations thereof.

The International Association of Dental Traumatology (IADT) periodically publishes guidelines for management of dental traumatic injuries that reflect the current best evidence and clinical practice, derived from a comprehensive literature review and expert panel discussions. The most recent guidelines were presented in 2020. ^,,,

Traumatic dental injuries affecting the pulp are classified into 2 primary categories: fractures and luxation injuries. Fractures are assessed and managed based on their anatomic location, including involvement of the crown, crown-root complex, or root structure. Luxation injuries are further categorized according to the degree and direction of displacement, ranging from concussion and subluxation to extrusive, intrusive, lateral luxations, and avulsion. ^,

Regardless of the specific traumatic injury sustained, a comprehensive evaluation is essential before initiating treatment. The clinician must obtain a detailed dental history, perform a thorough clinical examination, and complete an appropriate radiographic assessment. While dental trauma warrants immediate attention, the initial evaluation must first rule out skeletal or central nervous system injuries, which constitute medical emergencies and require priority management before addressing dental injuries.

Treatment options for traumatic dental injuries depend on 3 fundamental factors:

• 1.

  Pulpal status: vitality and potential for healing

• 2.

  Stage of root development: degree of root maturity

• 3.

  Remaining tooth structure: extent of damage and restorability

These factors are addressed individually for each injury type in the following sections:

The overarching guidelines for managing traumatic dental injuries prioritize the following objectives:

• 1.

  Address patient symptoms: provide immediate pain relief and comfort

• 2.

  Preserve pulp vitality: maintain the tooth’s biological integrity when possible

• 3.

  Retain the tooth in its socket: ensure continued alveolar bone preservation

• 4.

  Support future alveolar growth: particularly critical in developing dentitions

Among these objectives, tooth retention is paramount, especially in growing patients. In young individuals, premature tooth loss inevitably leads to alveolar bone resorption, significantly compromising future restorative options. Therefore, maintaining the tooth until skeletal growth completion—even if extraction is ultimately required—constitutes a successful treatment outcome, as it preserves alveolar bone volume essential for definitive prosthetic rehabilitation. The clinician should evaluate all maxillary and mandibular anterior teeth using pulp sensibility, percussion, and palpation tests to establish baseline reading. These assessments will serve as reference points for comparison during all subsequent follow-up visits.

Traumatic injuries may affect responses to pulp sensibility tests, and the dental pulp may demonstrate a negative response for up to 6 months following injury. Endodontic treatment is indicated only when 2 signs of pulpal necrosis are present. In addition to negative pulp sensibility testing, including both cold and electric pulp testing, at least one additional sign or symptom must be identified. These may include patient-reported discomfort, crown discoloration, excessive tooth mobility, development of a periapical lesion, radiographic evidence of a resorptive defect, or findings on cone-beam computed tomography (CBCT) evaluation. When available, CBCT evaluation is a key component of traumatic injury assessment. According to the American Association of Endodontists and American Academy of Oral and Maxillofacial Radiology guidelines, CBCT imaging may be necessary to arrive at the most appropriate treatment plan ( Fig. 1 ).

Diagnostic value of CBCT in traumatic dental injury. ( A ) Periapical radiograph demonstrating a crown fracture and a root fracture in the apical third of the maxillary left central incisor (#9). The crown fragment was repositioned and bonded, and the tooth was stabilized with a wire splint. ( B – D ) CBCT images revealing an obliquely oriented root fracture extending from the crown fracture line apically to the apical third of the root, a configuration not fully appreciated on the periapical radiograph.