PRIMARY TEETH TRAUMA CONCUSSION - DIAGNOSTIC SIGNS DESCRIPTION AN INJURY TO THE TOOTH-SUPPORTING STRUCTURES WITHOUT INCREASED MOBILITY OR DISPLACEMENT OF THE TOOTH, BUT WITH PAIN TO PERCUSSION AND WITHOUT GINGIVAL BLEEDING THE DIAGNOSTIC SIGNS OF CONCUSSION ARE TRANSIENT IT IS THEREFORE NOT POSSIBLE TO DIAGNOSE CONCUSSION IF THE EXAMINATION IS DONE SEVERAL DAYS AFTER INJURY VISUAL SIGNS NOT DISPLACED PERCUSSION TEST TENDER TO TOUCH OR TAPPING MOBILITY TEST NO INCREASED MOBILITY PULP SENSIBILITY NOT RELIABLE IN PRIMARY TEETH INCONSISTENT RESULTS TEST RADIOGRAPHIC FINDINGS NO RADIOGRAPHIC ABNORMALITIES NORMAL PERIODONTAL SPACE RADIOGRAPHS AN OCCLUSAL EXPOSURE IS RECOMMENDED IN ORDER TO SCREEN RECOMMENDED FOR POSSIBLE SIGNS OF DISPLACEMENT OR THE PRESENCE OF A ROOT FRACTURE THE RADIOGRAPH CAN FURTHERMORE BE USED AS A REFERENCE POINT IN CASE OF FUTURE COMPLICATIONS TREATMENT  NO TREATMENT IS NEEDED ONLY OBSERVATION PATIENT INSTRUCTIONS   SOFT FOOD FOR WEEK GOOD HEALING FOLLOWING AN INJURY TO THE TEETH AND ORAL TISSUES DEPENDS, IN PART, ON GOOD ORAL HYGIENE BRUSH WITH A SOFT BRUSH AFTER EVERY MEAL AND APPLY CHLORHEXIDINE 0.1 % TOPICALLY TO THE AFFECTED AREA WITH COTTON SWABS TWICE A DAY FOR ONE WEEK THIS IS BENEFICIAL TO PREVENT ACCUMULATION OF PLAQUE AND DEBRIS ALONG WITH RECOMMENDING A SOFT DIET   PARENTS SHOULD BE FURTHER ADVISED ABOUT POSSIBLE COMPLICATIONS THAT MAY OCCUR, LIKE SWELLING, DARK DISCOLORATION OF THE CROWN, INCREASED MOBILITY OR FISTULA CHILDREN MAY NOT COMPLAIN ABOUT PAIN; HOWEVER, INFECTION MAY BE PRESENT AND PARENTS SHOULD WATCH FOR SIGNS OF SWELLING OF THE GUMS AND BRING THE CHILD IN FOR TREATMENT FOLLOW-UP  CLINICAL CONTROL AT WEEK, 6-8 WEEKS EXTRUSION Partial displacement of the tooth out of its socket An injury to the tooth characterized by partial or total separation of the periodontal ligament resulting in loosening and displacement of the tooth The alveolar socket bone remains intact In addition to axial displacement, the tooth usually will have some protrusive or retrusive orientation Definition Partial displacement of the tooth out of its socket An injury to the tooth characterized by partial or total separation of the periodontal ligament resulting in loosening and displacement of the tooth The alveolar socket bone remains intact in an extrusion injury as opposed to a lateral luxation injury In addition to axial displacement, the tooth will usually have an element of protrusion or retrusion In severe extrusion injuries the retrusion/protrusion element can be very pronounced In some cases it can be more pronounced than the extrusive element Visual signs Appears elongated Percussion test Tenderness to percussion Mobility test Excessively mobile Sensibility test Not reliable in primary teeth Inconsistent results Radiographic findings Increased periodontal ligament space apically Radiographs recommended An occlusal exposure is recommended in order to evaluate the size of the displacement and rule out the presence of a root fracture The radiograph can furthermore be used as a reference point in case of late complications TREATMENT The treatment choice should be based on the degree of displacement, mobility, root formation and the ability of the child to cope with the emergency situation For minor extrusion (< 3mm) in an immature developing tooth, either careful reposition the tooth or leave the tooth for spontaneous alignment Extraction is the treatment of choice for severe extrusion in a fully formed primary tooth PATIENT INSTRUCTIONS     Soft food for week Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene Brush with a soft brush after every meal and apply chlorhexidine 0.1 % topically to the affected area with cotton swabs twice a day for one week This is beneficial to prevent accumulation of plaque and debris along with recommending a soft diet Parents should be further advised about possible complications that may occur, like swelling, dark discoloration of the crown, increased mobility or fistula Children may not complain about pain; however, infection may be present and parents should watch for signs of swelling of the gums and bring the child in for treatment FOLLOW-UP  Clinical control after weeks Clinical and radiographic control at 6-8 weeks, months, and year SUBLUXATION - DIAGNOSTIC SIGNS Description An injury to the tooth supporting structures resulting in increased mobility and pain to percussion but without displacement of the tooth Bleeding from the gingival sulcus is evident if the child is seen shortly after the accident The diagnostic signs of subluxation are transient It is therefore not possible to diagnose subluxation if the examination is done several days after injury Visual signs Not displaced Percussion test Tender to touch or tapping Mobility test Increased mobility Pulp sensibility test Not reliable in primary teeth Inconsistent results Radiographic findings Normal periodontal space Radiographs recommended An occlusal exposure is recommended in order to screen for possible signs of displacement or the presence of a root fracture The radiograph can furthermore be used as a reference point in case of future complications TREATMENT OBJECTIVE  No treatment is needed TREATMENT  No treatment is needed Observation PATIENT INSTRUCTIONS   Soft food for week Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene Brush with a soft brush after every meal and apply chlorhexidine 0.1 % topically to the affected area with cotton swabs twice a day for one week This is beneficial to prevent accumulation of plaque and debris along with recommending a soft diet   Parents should be further advised about possible complications that may occur, like swelling, dark discoloration of the crown, increased mobility or fistula Children may not complain about pain; however, infection may be present and parents should watch for signs of swelling of the gums and bring the child in for treatment FOLLOW-UP  Clinical control at week, 6-8 weeks 4.LATERAL LUXATION - DIAGNOSTIC SIGNS Description Displacement of the tooth other than axially Displacement is accompanied by comminution or fracture of either the labial or the palatal/lingual alveolar bone Palatal/lingual luxation of the maxillary incisors may result in occlusal interference expressed by premature contact with the opponent teeth Lateral luxation injuries, similar to extrusion injuries, are characterized by partial or total separation of the periodontal ligament However, lateral luxations are complicated by fracture of either the labial or the palatal/lingual alveolar bone and a compression zone in the cervical and sometimes the apical area If both sides of the alveolar socket have been fractured, the injury should be classified as an alveolar fracture (alveolar fractures rarely affect only a single tooth) In most cases of lateral luxation the apex of the tooth has been forced into the bone by the displacement, and the tooth is frequently non-mobile Visual signs Displaced, usually in a palatal/lingual or labial direction Percussion test Usually gives a high metallic (ankylotic) sound Mobility test Usually non-mobile Sensibility test Not reliable in primary teeth Inconsistent results Radiographic findings Increased periodontal ligament space apically is best seen on the occlusal exposure Radiographs recommended An occlusal exposure can sometimes show the position of the displaced tooth and its relation to the permanent successor TREATMENT Spontaneous repositioning If there is no occlusal interference, as is often the case in anterior open bites, the tooth should be allowed to reposition spontaneously Repositioning When there is occlusal interference local anesthesia should be applied where after the tooth should be repositioned by gentle combined labial and palatal pressure Extraction For teeth with severe displacement in a labial direction, extraction is the treatment of choice Extraction is indicated in these cases because of the collision between the primary tooth and the permanent tooth germ Slight grinding In cases with minor occlusal interference, slight grinding is indicated PATIENT INSTRUCTIONS Soft food for 10-14 days Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene Brush with a soft brush after every meal and apply chlorhexidine 0.1 % topically to the affected area with cotton swabs twice a day for one week This is beneficial to prevent accumulation of plaque and debris along with recommending a soft diet Parents should be further advised about possible complications that may occur, like swelling, dark discoloration of the crown, increased mobility or fistula Children may not complain about pain; however, infection may be present and parents should watch for signs of swelling of the gums and bring the child in for treatment FOLLOW-UP Clinical control after and 2-3 weeks Clinical and radiographic control at 6-8 weeks and year 5.INTRUSION - DIAGNOSTIC SIGNS Description Displacement of the tooth into the alveolar bone This injury is accompanied by comminution or fracture of the alveolar socket The tooth can be impinging upon the permanent tooth germ Visual signs The tooth is displaced axially into the alveolar bone and frequently penetrating the labial bone plate where it can be palpated The tooth may disappear completely in the tissues resembling avulsion and root fracture with complete extrusion of the coronal fragment In this case diagnosis is based on an occlusal radiograph Penetration of the tooth into the nasal cavity can be diagnosed by bleeding from the nose or simple observation of the nostril Percussion test The test will usually give a high metallic (ankylotic) sound However in severe intrusion cases the test will not always be possible to perform Mobility test The tooth is non-mobile Sensibility test Not reliable in primary teeth Inconsistent results Radiographic findings When the apex is displaced toward or through the labial bone plate the apical tip can be visualized and appears shorter than the unaffected contralateral tooth When the apex is displaced toward the permanent tooth germ, the apical tip cannot be visualized and the tooth appears elongated Radiographs recommended An occlusal or periapical exposure will normally show the position of the displaced tooth and its relation to the permanent successor If the tooth is totally intruded an extra-oral lateral exposure may be indicated to make sure that the tooth has not penetrated the nasal cavity TREATMENT Tooth intrusion is associated with a potential risk of damage to the permanent tooth bud Spontaneous eruption If the apex is displaced toward or through the labial bone plate, the tooth should be left for spontaneous repositioning In order to evaluate re-eruption, the degree of intrusion should be assessed by measuring the distance between the incisal edge of the intruded tooth and that of adjacent unaffected teeth Extraction If the apex is displaced into the developing tooth germ the tooth should be extracted to minimize the damage done to the permanent successor PATIENT INSTRUCTIONS Soft food for 10-14 days Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene Brush with a soft brush after every meal and apply chlorhexidine 0.1 % topically to the affected area with cotton swabs twice a day for one week This is beneficial to prevent accumulation of plaque and debris along with recommending a soft diet , restrict the use of a pacifier Parents should be further advised about possible complications that may occur, like swelling, dark discoloration of the crown, increased mobility or fistula Children may not complain about pain; however, infection may be present and parents should watch for signs of swelling of the gums and bring the child in for treatment Inform the parent about possible complications in the development of the permanent successor, especially following intrusion injuries sustained in children under years of age FOLLOW-UP Clinical control after week Clinical and radiographic control at 3-4 weeks, 6-8 weeks, month, year and yearly clinical and radiographic control until eruption of the permanent successor 6.AVULSION - DIAGNOSTIC SIGNS Description The tooth is completely displaced out of its socket Clinically the socket is found empty or filled with a coagulum Visual signs The tooth is removed from its socket Percussion test Not relevant Mobility test Not relevant Sensibility test Not relevant Radiographic findings The alveolar socket will be empty If the avulsed tooth is not present a radiographic examination is essential to ensure that the missing tooth is not intruded Radiographs recommended An occlusal exposure is recommended in order to screen for the presence of root fragments and to make sure that the missing tooth is not intruded TREATMENT It's not recommended to replant avulsed primary teeth A the initial examination make sure that all avulsed teeth are accounted for If not it is highly recommended to make a radiographic examination in order to ensure that the missing tooth is not a case of complete intrusion or root fracture with loss of the coronal fragment If the avulsed tooth has not been found refer the child to the paediatrician to exclude aspiration Patient instructions Soft food for week Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene Inform the parent about possible complications in the development of the permanent successor, especially following avulsion injuries sustained in children under years of age FOLLOW-UP Clinical control after week and clinical and radiographic control after months and year Yearly clinical and radiographic controls until eruption of the permanent successor 7.INFRACTION - DIAGNOSTIC SIGNS Description An incomplete fracture (crack) of the enamel without loss of tooth structure Visual signs A visible fracture line on the surface of the tooth Percussion test Not tender If tenderness is observed evaluate the tooth for a possible luxation injury or a root fracture Mobility test Normal mobility Sensibility pulp test Not reliable in primary teeth Inconsistent results Radiographic findings No radiographic abnormalities Radiographs recommended None TREATMENT No treatment necessary FOLLOW-UP No follow-up is needed for infraction injuries unless they are associated with a luxation injury or other fracture types involving the same tooth 8.ENAMEL FRACTURE - DIAGNOSTIC SIGNS Description A fracture confined to the enamel with loss of tooth structure Visual signs Visible loss of enamel No visible sign of exposed dentin Percussion test Not tender If tenderness is observed evaluate the tooth for a possible luxation or root fracture injury Mobility test Normal mobility Sensibility pulp test Not reliable in primary teeth Inconsistent results Radiographic findings The enamel loss is visible Radiographs recommended None TREATMENT Smooth sharp edges In patients with lip or cheek lesions it is advisable to search for tooth fragments or foreign material FOLLOW-UP No followup required 9.ENAMEL-DENTIN FRACTURE - DIAGNOSTIC SIGNS Description A fracture confined to enamel and dentin with loss of tooth structure, but not involving the pulp Visual signs Visible loss of enamel and dentin No visible sign of exposed pulp tissue Percussion test Not tender If tenderness is observed evaluate the tooth for possible luxation or root fracture injury Mobility test Normal mobility Sensibility pulp test Not reliable in primary teeth Inconsistent results Radiographic findings The enamel-dentin loss is visible The distance between the fracture and the pulp chamber can be evaluated Radiographs recommended None TREATMENT If possible, seal completly the involved dentin with glass ionomer to prevent microleakage In case of large lost tooth structure, the tooth can be restored with composite FOLLOW-UP Clinical control at 3-4 weeks 10.ENAMEL-DENTIN-PULP FRACTURE - DIAGNOSTIC SIGNS Description A fracture involving enamel and dentin with loss of tooth structure and exposure of the pulp Visual signs Visible loss of enamel and dentin and exposed pulp tissue Percussion test Not tender If tenderness is observed evaluate the tooth for luxation or root fracture injury Mobility test Normal mobility Sensibility test Not reliable in primary teeth Inconsistent results Radiographic findings The loss of tooth substance is visible Radiographs recommended An occlusal exposure is recommended in order to screen for possible signs of displacement or the presence of a root fracture The radiograph can furthermore be used as a reference point in case of future complications TREATMENT If possible, preserve pulp vitality by partial pulpotomy Calcium hydroxide is a suitable material for such procedures A well-condensed layer of pure calcium hydroxide paste can be applied over the pulp, covered with a lining such as reinforced glass ionomer Restore the tooth with composite The treatment is depending on the child's maturity and ability to cope Extraction is usually the alternative option FOLLOW-UP Clinical after week Clinical and radiographic control after 6-8 weeks and year 11.CROWN-ROOT FRACTURE WITHOUT PULP INVOLVEMENT - DIAGNOSTIC SIGNS Description A fracture involving enamel, dentin and cementum with loss of tooth structure, but not involving the pulp Visual signs Crown fracture extending below gingival margin The crown is split into two or more fragments, one of which is mobile Percussion test Tenderness to percussion Mobility test At least one coronal fragment is mobile Because of mobility during mastication there might be transitory pain Sensibility pulp test Not reliable in primary teeth Inconsistent results Radiographic findings Apical extension of fracture usually not visible In laterally positioned fractures, the extent in relation to the gingival margin can be seen Radiographs recommended An occlusal exposure LOCALIZATION OF FRACTURE LINE  The fracture involves the crown and root of the tooth and is in a horizontal or diagonal plane A radiographic examination usually only reveals the coronal part of the fracture and not the apical portion TREATMENT Depending on the clinical findings, two treatment scenarios may be considered Most of these may be deferred to later treatment   Fragment removal only If the fracture involves only a small part of the root and the stable fragment is large enough to allow coronal restoration, remove the mobile fragment Extraction Extraction in all other instances PATIENT INSTRUCTIONS Soft food for 10-14 days Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene Brush with a soft brush after every meal and apply chlorhexidine 0.1 % topically to the affected area with cotton swabs twice a day for one week This is beneficial to prevent accumulation of plaque and debris along with recommending a soft diet Parents should be further advised about possible complications that may occur, like swelling, increased mobility or fistula Children may not complain about pain; however, infection may be present and parents should watch for signs of swelling of the gums and bring the child in for treatment FOLLOW-UP In case of fragment removal only: Clinical control after week Clinical and radiographic control after 3-4 weeks Clinical control after year In case of tooth extration: Clinical and radiographic control at year and every year until eruption of the permanent successor 12.CROWN-ROOT FRACTURE WITH PULP INVOLVEMENT - DIAGNOSTIC SIGNS Definition A fracture involving enamel, dentin, cementum and the pulp Visual signs Crown fracture extending below gingival margin The crown is split into two or more fragments, one of which is mobile Percussion test Tenderness to percussion Mobility test At least one coronal fragment is mobile Beause of mobility during mastication there might be transitory pain Sensibility test Not reliable in primary teeth Inconsistent results Radiographic findings Apical extension of fracture usually not visible In laterally positioned fractures, the extent in relation to the gingival margin can be seen Radiographs recommended An occlusal exposure LOCALIZATION OF FRACTURE LINE The fracture involves the crown and root of the tooth and is in a horizontal or diagonal plane A radiographic examination usually only reveals the coronal part of the fracture and not the apical portion TREATMENT Depending on the clinical findings, two treatment scenarios may be considered   Fragment removal only if the fracture involves only a small part of the root and the stable fragment is large enough to allow coronal restoration Extration in all other instances PATIENT INSTRUCTIONS Soft food for 10-14 days Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene Brush with a soft brush after every meal This is beneficial to prevent accumulation of plaque and debris along with recommending a soft diet Parents should be further advised about possible complications that may occur, like swelling or fistula Children may not complain about pain; however, infection may be present and parents should watch for signs of swelling of the gums and bring the child in for treatment FOLLOW-UP In case of fragment removal only: Clinical and radiographic control at year and every year until eruption of the permanent successor In case of tooth extration: Clinical and radiographic control at year and every year until eruption of the permanent successor 13.ROOT FRACTURE - DIAGNOSTIC SIGNS Description A fracture confined to the root of the tooth involving cementum, dentin, and the pulp Visual signs The coronal segment is usually mobile and may be displaced Transient crown discoloration (red or grey) may occur Percussion test The tooth may be tender Mobility test The coronal segment is usually mobile Sensibility pulp test Not reliable in primary teeth Inconsistent results Radiographic findings The fracture is usually located mid-root or in the apical third Radiographs recommended An occlusal or periapical exposure TREATMENT No treatment If the coronal fragment is not displaced no treatment is required Extraction If the coronal fragment is displaced, repositioning and splinting might be considered Otherwise extract only that fragment The apical fragment should be left to be resorbed PATIENT INSTRUCTIONS Soft food for 10-14 days Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene Brush with a soft brush after every meal and apply chlorhexidine 0.1 % topically to the affected area with cotton swabs twice a day for one week This is beneficial to prevent accumulation of plaque and debris along with recommending a soft diet, restrict the use of a pacifier Parents should be further advised about possible complications that may occur, like swelling, increased mobility or fistula Children may not complain about pain; however, infection may be present and parents should watch for signs of swelling of the gums and bring the child in for treatment FOLLOW-UP Clinical control after week Clinical and radiographic control after 6-8 weeks and year In case of tooth extration: Clinical and radiographic control at year and every year until eruption of the permanent successor 14.ALVEOLAR FRACTURE - DIAGNOSTIC SIGNS Description A fracture of the alveolar process which may or may not involve the alveolar bone socket Teeth associated with alveolar fractures are characterized by mobility of the alveolar process; several teeth typically will move as a unit when mobility is checked Occlusal interference is often present Visual signs Displacement of an alveolar segment An occlusal change due to misalignment of the fractured alveolar segment is often noted This may cause occlusal interference Percussion test Tenderness to percussion Mobility test Entire segment mobile and moves as a unit Sensibility pulp test Not reliable in primary teeth Inconsistent results Radiographic findings The vertical line of the fracture may run along the PDL or in the septum Thehorizontal line may be located apical at the apex or coronal to the apex An associated root fracture may be present The horizontal fracture line may run at any level in regard to the permanent tooth germs The radiograph will give valuable information in the assessment of the risk for damage to the permanent teeth A lateral radiograph may give further information about the spatial relation between the two dentitions Radiographs recommended An occlusal exposure TREATMENT Manual repositioning or repositioning using forceps of the displaced segment General anesthesia is often indicated.Stabilize the segment with flexible splinting for weeks Monitor teeth in the fracture line PATIENT INSTRUCTIONS Soft food for 10-14 days Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene Brush with a soft brush after every meal and apply chlorhexidine 0.1 % topically to the affected area with cotton swabs twice a day for one week This is beneficial to prevent accumulation of plaque and debris Along with recommending a soft diet, restrict the use of a pacifier Parents should be further advised about possible complications that may occur, like swelling, increased mobility or fistula Children may not complain about pain; however, infection may be present and parents should watch for signs of swelling of the gums and bring the child in for treatment Inform the parents about possible complications in the development of the permanent teeth FOLLOW-UP Splint removal and clinical and radiographic control after weeks Clinical control after week Clinical and radiographic control and splint removal after 3-4 weeks Clinical and radiographic control after 6-8 weeks and year then yearly untill exfoliationh [...]... exposed dentin Percussion test Not tender If tenderness is observed evaluate the tooth for a possible luxation or root fracture injury Mobility test Normal mobility Sensibility pulp test Not reliable in primary teeth Inconsistent results Radiographic findings The enamel loss is visible Radiographs recommended None TREATMENT Smooth sharp edges In patients with lip or cheek lesions it is advisable to search... pulp tissue Percussion test Not tender If tenderness is observed evaluate the tooth for possible luxation or root fracture injury Mobility test Normal mobility Sensibility pulp test Not reliable in primary teeth Inconsistent results Radiographic findings The enamel-dentin loss is visible The distance between the fracture and the pulp chamber can be evaluated Radiographs recommended None TREATMENT If... and exposed pulp tissue Percussion test Not tender If tenderness is observed evaluate the tooth for luxation or root fracture injury Mobility test Normal mobility Sensibility test Not reliable in primary teeth Inconsistent results Radiographic findings The loss of tooth substance is visible Radiographs recommended An occlusal exposure is recommended in order to screen for possible signs of displacement... Percussion test Tenderness to percussion Mobility test At least one coronal fragment is mobile Because of mobility during mastication there might be transitory pain Sensibility pulp test Not reliable in primary teeth Inconsistent results Radiographic findings Apical extension of fracture usually not visible In laterally positioned fractures, the extent in relation to the gingival margin can be seen Radiographs... Percussion test Tenderness to percussion Mobility test At least one coronal fragment is mobile Beause of mobility during mastication there might be transitory pain Sensibility test Not reliable in primary teeth Inconsistent results Radiographic findings Apical extension of fracture usually not visible In laterally positioned fractures, the extent in relation to the gingival margin can be seen Radiographs... be displaced Transient crown discoloration (red or grey) may occur Percussion test The tooth may be tender Mobility test The coronal segment is usually mobile Sensibility pulp test Not reliable in primary teeth Inconsistent results Radiographic findings The fracture is usually located mid-root or in the apical third Radiographs recommended An occlusal or periapical exposure TREATMENT No treatment If... successor 14.ALVEOLAR FRACTURE - DIAGNOSTIC SIGNS Description A fracture of the alveolar process which may or may not involve the alveolar bone socket Teeth associated with alveolar fractures are characterized by mobility of the alveolar process; several teeth typically will move as a unit when mobility is checked Occlusal interference is often present Visual signs Displacement of an alveolar segment... alveolar segment is often noted This may cause occlusal interference Percussion test Tenderness to percussion Mobility test Entire segment mobile and moves as a unit Sensibility pulp test Not reliable in primary teeth Inconsistent results Radiographic findings The vertical line of the fracture may run along the PDL or in the septum Thehorizontal line may be located apical at the apex or coronal to the apex... for damage to the permanent teeth A lateral radiograph may give further information about the spatial relation between the two dentitions Radiographs recommended An occlusal exposure TREATMENT Manual repositioning or repositioning using forceps of the displaced segment General anesthesia is often indicated.Stabilize the segment with flexible splinting for 4 weeks Monitor teeth in the fracture line PATIENT... of the root and the stable fragment is large enough to allow coronal restoration Extration in all other instances PATIENT INSTRUCTIONS Soft food for 10-14 days Good healing following an injury to the teeth and oral tissues depends, in part, on good oral hygiene Brush with a soft brush after every meal This is beneficial to prevent accumulation of plaque and debris along with recommending a soft diet