Classification Of Dentofacial Injuries Notes

Classification Of Dentofacial Injuries Notes

Dental traumatic injuries can manifest in many forms but cracked and chipped teeth are seen most commonly. Though these can occur at any age but are most commonly seen at 1–3 years of age during which children are learning to walk (because their judgment and coordination is not fully developed).

At 7–10 years of age, incidence increases due to increased sports activity. Type and number of teeth injured in an accident vary according to the type of accident, the impact of force, the resiliency of the object hitting the tooth, the shape of the hitting object, and the direction of the force. If the bone is resilient, the tooth will be displaced by trauma but if the bone is thick and brittle tooth will fracture.

Read And Learn More: Endodontics Notes

Etiology of traumatic injuries

• Automobile injury
• Battered child
• Child abuse
• Drug abuse
• Epilepsy
• Fall from height
• Sports-related injuries

Risk factor for injuries is higher in the case of Angle’s class 2 div 1 malocclusion and predisposing factors are high overjet, protrusion of maxillary incisors, and insufficient lip closure.

The extent of trauma depends on (Hallet, 1954)

• The energy of impact: Hitting an object with more mass or high velocity creates more impact (energy = mass × velocity)
• The direction of impacting force
• Shape (sharp or blunt) of impacting object
• Resilience (hardness or softness) of impacting object

BDS Notes	Dental Materials	Medicinal Chemistry
Clinical Medicine And Surgery	Pathology	General Medicine
Face Anatomy	Anatomy	Public Health Dentistry
Abdomen And Pelvis	Microbiology	Basic Dental Materials

Classifiation Of Dentofacial Injuries

The purpose of classifying dental injuries is to provide a description of a specific condition allowing the clinician to identify and treat that condition using specific treatment remedies.

WHO Classifiation

WHO gave the following classifiation in 1978 with code no. corresponding to the International Classification of Diseases.

• 873.60: Enamel fracture
• 873.61: Crown fracture involving enamel, and dentin without pulpal involvement
• 873.62: Crown fracture with pulpal involvement
• 873.63: Root fracture
• 873.64: Crown root fracture
• 873.66: Luxation
• 873.67: Intrusion or extrusion
• 873.68: Avulsion
• 873.69: Other injuries such as soft tissue lacerations
• 802.20, 802.40: Fracture or communication of alveolar process which may or may not involve the tooth
• 802.21, 802.41: Fracture of a boy of maxilla or mandible

Classifiation by Andreasen (1981)

Injuries to Hard Dental Tissues and Pulp

• Crown infarction N873.60: Incomplete fracture of enamel without loss of tooth substance
• Uncomplicated crown fracture N873.61: Fracture of enamel and dentin but not involving the pulp
• Complicated crown fracture N873.62: Fracture of enamel and dentin exposing the pulp
• Uncomplicated crown root fracture N873.63: Fracture of enamel, dentin, and cementum but not involving the pulp
• Uncomplicated crown root fracture N873.64: Fracture of enamel, dentin, and cementum and exposing the pulp
• Root fracture N873: Fracture involving dentin, cementum, and pulp.

Injuries of Supporting Bone

• Communication of alveolar socket (mandible N802.20, maxilla 802.40): Crushing and compression of alveolar socket. This is normally found with intrusive and lateral luxation
• Fracture of alveolar socket wall (mandible N802.20, maxilla 802.40): Fracture contained to facial or lingual socket wall
• Fracture of the alveolar process (mandible N802.20, maxilla 802.40): Fracture of the alveolar process which may or may not involve socket
• Fracture of mandible and maxilla (mandible N802.20, maxilla 802.40): A fracture involving base of maxilla or mandible and alveolar process. The fracture may or may not involve the alveolar socket

Injuries to Gingival or Oral Mucosa

• Laceration of the gingiva or oral mucosa N873.69: Wound in mucosa resulting from tear and is normally produced by a sharp object
• Contusion of the gingiva or oral mucosa N902.00: Bruise resulting from the impact of a blunt object and not associated with a break in continuity in mucosa causing submucosal hemorrhage
• Abrasion of the gingiva or oral mucosa N910:00: Wound resulting from rubbing or scraping of mucosa leaving a raw bleeding surface

Ingle’s Classifiation

• Soft Tissue Injury
  • Laceration
  • Abrasion
  • Contusion
• Luxation Injury
  • Concussion
  • Intrusive luxation
  • Lateral luxation
  • Extrusive luxation
  • Avulsion
• Tooth Fractures
  • Enamel fractures
  • Uncomplicated crown fracture
  • Complicated crown fracture
  • Crown root fracture
  • Root fracture
• Facial Skeletal Injury
  • Alveolar process
  • Body of mandible
  • TMJ

Ellis and Davey’s Classifications (1970)

• Class 1: Crown fracture involving enamel
• Class 2: Crown fracture without involving the pulp
• Class 3: Crown fracture involving the pulp
• Class 4: Traumatized tooth becomes nonvital (with or without loss of crown structure)
• Class 5: Tooth lost due to trauma
• Class 6: Fracture of root with or without fracture of the crown
• Class 7: Displacement of the tooth without crown or root fracture
• Class 8: Fracture of crown en masse
• Class 9: Fracture of deciduous teeth

Classifiation by Heithersay and Mobile

Heithersay and Morile recommended a classifiation of subgingival fracture based on the level of fracture in relation to horizontal planes of periodontium as follows:

• Class 1: Fracture line does not extend below the level of attached gingivae
• Class 2: Fracture line extends below-attached gingivae but not below the level of the alveolar crest
• Class 3: Fracture line extends below the level of the alveolar crest
• Class 4: The fracture line is within the coronal third of the root but below the level of the alveolar crest