Dental traumatology: essential diagnosis and treatment planning

When teeth and their supporting structures are subjected to impact trauma, the resultant injury manifests either as a separation or a crushing injury or a combination of both (1) (Fig. 1). Separation injuries are exemplified by displacement of teeth during which there is cleavage of tissues such as the periodontial ligament (PDL). This occurs during avulsions and extrusive luxations. Damage to cells in the involved tissues is minimal, so rapid healing is favored following appropriate treatment. Crushing injuries cause more damage due to the destruction of both tissue cells and intercellular components. This type of injury is exemplified by displacement of teeth against adjacent alveolar bone, the worst of which is intrusive luxation. During a crushing traumatic event, the cells and associated tissues are damaged andmust be removed (by macrophages and osteoclasts) in order to initiate repair. Thus the healing process cannot be expected to proceed as quickly as that observed for separation injuries. Understanding the difference between separation and crushing injuries is helpful in assessing the extent and the severity of a traumatic injury, planning for the management of the patient, and predicting the likely outcome (1).