Traymatic dental injuries leave the dental grofession with severe therapeutic
problems. The population risk for sustaining traumatic dental injuries has
been shown to be of a n impressive magnitude. Thus a study by Schutzmannsky
(1963) showed that 13% of examined
school children at the age of 18 years
had been exposed to dental injuries during adolescence.
Whereas numerous studies have dealt
with the treatment procedures of these
injuries, the etiology and pathogenesis
have attracted minor interest. Consequently, the purpose of the present study
was to examine the following items:
'(1) The relationship between origin of
330
ANDREASEN
a,
P
0
+
.-
I0!
03
0
0
m
F
2n Eo
m
=m
*0
cu
0
.-
CI
P
L
cu
.-CIfn
0
v,
hl
N
-P
2M3
sa
u4
331
Table 3
Location of traumatized primary teeth'
05+
04+
03+
02+
01+
$01
+02
+03
+04
t05
14
85
27 1
224
96
16
13
17
24
13
-03
-04
04-
05-
03-
02-
01-
-01
-02
-05
* According to the Hade~-upsystem of dental designation, + signifies the maxilla, - the mandible. If the symbol is placed to the right of the figure, the right side is indicated, and vice
versa. 0 before the figure indicates a primary tooth.
Table 4
Location of traumatized permanent teeth
~~
8+
7+ 6+
5+
4+
16
3+
31
~~
2+
I+
+1
+2
227
607
639
233
+3
37
~~
0
9-
7-
6-
5-
4
4-
17
3-
69106108
2-
1-
-1
62
-2
+6 +7 + 8
+4
+5
15
-4
-5
14
-3
-6
-7
-8
Table 5
Distribution of injured teeth according t o diagnosis and type of dentition
(The number of diagnoses exceeds the number of teeth due t o multiple diagnoses
for some teeth)
Primary
dentition
Crown fractures without pulp exposure ....
Crown fractures with pulp exposure .........
Crown-root fractures ..............................
Root fractures .......................................
Subluxations .............
.............
Intrusive luxations ....
Extrusive luxations ....
.............
Exarticulations .......................................
Fractures of the labial or lingual bone plate
and/or alveolar socket ........................
Fractures of alveolar process ........ ......
Fractures of mandible or maxilla .............
Other irjuries or exact injury not specified
Total number of injured teeth .......
19
13
14
31
97
(2 %)
(2 %)
(2 %)
(4%)
(12%)
265 (34 %)
101 (L3 %)
33
26
0
172
(4%)
(3 %)
(0%)
(29 %)
Permanent
dentition
433 (19 %)
172 (8 %)
108 ( 5 %)
156 (7 %)
336
61
630
350
(15 %)
(3 %)
(28 %)
(16 %)
109
205
35
334
( 5 %)
2,239
(9%)
(2 %)
(15 %)
All teeth
452
185
122
187
433
186
895
451
(15 %)
(6 %)
(4 %)
(6%)
(14 %)
(6%)
(30 %)
(15 %)
142 5 % )
231 (8%)
36 (1 %)
506 (20 %)
3,026
ANDREASEN
332
Table 6
Relation between origin of trauma and injury pattern (primary dentition)
Group 4 :
Group 3 :
Group 2:
Group 1:
Fa11 against
Total
Fall on a
Fall from a
Fall during
an object
staircase
baby carriage
Play
No. of No. ol No. of No. o No.of No.o! No. of No. 01 No. of No. of
patients teeth iatients teeth ,atients teeth batients teeth Jatients teeth
Crown OT
crown-root
fractures
Root fractures
Luxations
5
10%
0
0%
0
0%
0
0%
0
0%
1
5%
2
5%
4
4%
7
3%
0
0%
2
6%
3
5%
1
5%
2
4%
2
9%
4
10%
5
5%
9
4%
24
46
83 % 8 8 %
29
94 %
93 %
3
10%
0
0%
57
16
40
76 % 77 %
18
32
82 % 8 0 %
87
175
84% 85%
Exarticulations
5
17%
5
10%
2
6%
4
7%
3
14%
6
12%
4
18%
8
20%
14
14%
23
11 %
Bone fractures
0
0%
0
0%
1
3%
4
7%
3
14%
10
19%
0
0%
0
0%
4
4%
14
7%
Gingival
injuries
Injuries to the
upper lip
Injuries to the
lower lip
10
34%
23
44 %
9
29 %
18
30%
6
14
29 % 27 %
4
18%
10
25%
15
52%
29
56%
13
42%
25
43 %
10
22
48 % 42 %
10
19
45 % 4 8 %
43
47 q G
5
12
17 % 23 %
4
13%
6
10%
6
29%
19
37%
4
18 %
10
25%
13
47
18 % 23 %
Injuries to
the chin
Total number
of injuries
Average number
of teeth involved
3
10%
5
10%
1
3%
1
2%
1
5%
4
8%
0
0%
0
0%
29
52
1.8
31
61
2 .o
21
52
2.5
22
40
1.8
23
65
28 % 32 %
5
5%
103
95
47 O/O
10
5%
205
2.0
Exarticulations
Bone
fractures
Gingival
injuries
Injuries to the
upper lip
Injuries to the
lower lip
Injuries to the
chin
Total number
of injuries
Average
number of
teeth involved
Luxations
Crown or
crown-root
fractures
Root
fractures
287
123
2.3
60%
40
14 %
28
10 %
69
24 %
146
51 %
86
30 %
39
14 %
66
54 %
18
15 %
8
7%
31
25 %
58
47 %
35
28 %
13
11 %
160
16
6%
118
62
52 %
13
11 %
10
8%
28
24 %
80
68 %
27
23 %
26
22 %
5%
51
43 %
114
40 %
50
41 %
2.7
319
14 %
86
27 %
207
65 %
78
24 %
89
26 %
45
14
4%
190
59 %
36
11 %
131
41 %
No.of
teeth
No.of
patients
No.of
patients
No.of
teeth
Group 6:
Fall with a bicycle
or motorvehicle
Group 5:
Fall during play,
athletics,
or fainting
7%
Table 7
58
9
16 %
41
71 %
12
21 %
13
22 %
18
31 %
33
57 %
15
26 %
2
3%
12 %
2.5
No. of
patients
144
67 %
31
21 %
49
34 %
51
35 %
85
59 %
45
31 %
10
7%
97
16
11 %
12
8%
No. of
teeth
Group 7:
Injury during
a fight
41
2
5%
29
71 %
4
10 %
13
32 %
10
24 %
20
49 %
19
46 %
16
39 %
10
24 %
4.3
No.of
patients
175
52 %
88
50 %
68
39 %
91
8
5%
104
59 Yo
25
13 %
51
29 %
50
29 %
46
26 o/c
No.of
teeth
Group 8:
Automobile
accident
46
23
61 %
7
15 %
7
15 Yo
11
24 %
22
48 %
18
39 %
3
7%
15 %
19
41 %
2.5
117
15
13 %
65
56 %
14
12 %
20
17 70
31
26 %
63
54 %
50
50 %
3
3%
47
40 %
Group 9 :
Foreign body
striking the
oral
structures
No.of
No.of
patients teeth
386
16 %
60
25 %
213
55 %
114
30 %
98
33
9%
226
58 %
54
14 %
51
13 %
137
35 %
69
7%
61G
59 %
146
14 %
193
19 %
287
27 %
592
57 %
355
34 %
209
20 %
350
34 %
No. of
teeth
1.042
3.0
No. of
patients
Total
ANDREASEN
334
F i g . 1 . Direct tooth trauma without soft tissue injury. T h e impact has struck the protruding
maxillary central incisors.
Table 8
Chi-square values for comparison ofLinjury patternEbetween different trauma groups
4.48
20.16" ::
2.03
11.96
2.07
13.15
16.34"
5.59
18.18"
::'""
14.20
19.27':'
r espectively. T h e degrees
335
Table 9
Association between different injuries affecting a single tooth (primary dentition).
(The frequency of associated injuries is found in the vertical columns. Each column
represents a separate type of injury t o the hard dental tissues)
Associated injuries to
involved teeth
Crown fractures
Crown-root fractures
Root fractures
Subluxations
Intrusive luxations
Extrusive luxations
Exarticulations
Fractures of facial
bone plate
Fractures of alveolar
Crown Crown- Root Subluxa- Intrusive Extru- Exartifractures root fractures tions luxations sive culations
fractures
luxations
n=5
n = 6 n = 1 6 n = 5 8 n = 7 1 n=139 n = 5 4
0
process
0
0
0
0
1
1
0
0
1
0
3
0
0
0
0
0
0
0
12
0
27
0
0
4
0
0
0
16
29
19
3
71
42
19
27
6
11
6
16
40
14
6
58
67
28
9
13
3
139
54
336
ANDREASEN
Table 10
Associated injuries to
involved teeth
Crown fractures
Crown-root fractures
Root fractures
Subluxations
Intrusive luxations
Extrusive luxations
Exarticulations
Fractures of facial
bone plate
Fractures of alveolar
process
Injuries to the gingiva
Injuries to the upper lip
Injuries to the lower lip
Injuries to the chin
No. of teeth involved
0
8
32
12
35
1
2
1
2
30
0
11
5
5
59
194
104
60
357
32
1
30
12
1
0
0
35
2
40
0
0
11
0
6
0
0
0
0
0
0
13
24
29
0
6
27
13
27
63
11
28
40
36
14
89
5
40
104
63
38
205
0
26
14
17
8
40
69
153
244
148
77
415
7
62
126
70
31
196
40
337
Table 11
Relation between hard and soft tissue injuries (primary dentition)
No. of involved
Crown
fractures
Crown-root
fractures
Root
fractures
Subluxations
Intrusive
luxations
Extrusive
luxations
Exarticulations
Fractures of
facial
bone plate
Fractures of
alveolar
process
-
teeth
Maxil- Mandilary
bular
teeth
teeth
4
1
15
53
67
135
49
19
Injuries to the
upper lip
Maxil- Mandilary
bular
teeth
teeth
Injuries to the
lower lip
Maxil- Mandilary
bular
teeth
teeth
2
50%
0
0%
10
67%
40
74%
28
42%
66
49%
25
51%
7
37 %
0
0%
1
100%
1
100%
0
0%
1
25%
1
25%
2
40%
0
0%
3
75%
0
0%
6
40%
12
22%
17
25%
28
21%
13
27 %
4
21%
0
0%
0
0%
0
0%
2
50%
2
50%
0
0%
0
0%
0
0%
6
100%
0
0%
0
0%
8
100%
Mandibular
teeth
2
50%
0
0%
0
0%
0
0%
1
25%
0
0%
1
25%
1
20%
0
2
4070
1
7%
5
9%
3
5%
8
6%
2
4%
0
0%
0
0 70
0%
0
0%
Fig. 2. Indirect trauma to the chin, transferred to the dental arches, has provoked crown-root
fractures of both maxillary right premolars by forceful occlusion.
338
A N D R E ASEN
Table 12
Relation b e t w e e n hard and s o f t tissue injuries (permanent d e n t i t i o n )
No. of involved
teeth
Crown
fractures
Crown-root
fractures
Root
fractures
Subluxations
Intrusive
luxations
Extrusive
luxations
Exarticulations
Fractures of
facial
bone plate
Fractures of
alveolar
process
Maxillary
teeth
Mandibular
teeth
319
38
56
68
21
159
46
39
320
95
178
18
63
22
79
51
Injuries to the
upper lip
Injuries to the
lower lip
Mandibular
teeth
Maxillary
teeth
Mandibular
teeth
175
55%
26
4674
35
52%
96
60%
13
33%
208
65 7~
117
66%
35
567c
19
50%
1
14%
5
24 %
8
17%
1
100%
36
38%
9
50%
13
59%
85
27%
11
20%
27
40%
43
28%
16
41 7 c
104
33%
64
36%
21
33%
19
50%
2
29%
9
43%
20
44%
1
1WC/O
44
46%
6
33%
12
55%
69
87%
20
39%
10
13%
Maxillary
teeth
Discussion
33
657~
Mandibular
teeth
5
l3fh
6
X6",
10
17%
21
38%
4
6%
18
11%
8
21%
42
13%
21
12%
12
19%
20
44%
1
100%
35
3776
10
56%)
9
40%
20
25%
10
20%
48%,
E T I O L O G Y A N D P A T I I O G E N E S I S OF T R A U M A T I C D E N T A L IhJLKIES
339
Fig. 3. Ilirect trauma to the upper lip, T h e impact has been transmitted through the lip, resulting in extrusive luxation of maxillary right incisors a n d laceration of gingiva. T h e upper
surface of the lip shows minor lacerations in the area which was in contact with thc tooth
surfaces during transmission of the trauma (arrows).
Fig. 4 . :2 frontal impact to the lower lip (arrows) h a s been transmitted through the lip to
the mandibular incisor rcgion, resulting in a fracture of the alveolar process. T h e oral mucosa
lacerated in areas where the incisor surfaces contacted the lahial niucosa (arrows).
i5
340
ANDREASEN
341
References
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Andreasen, J. 0.: Traumatic injuries of the
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Bennett, D. T.: Traumatised anterior teeth.
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286.
Down, C. H.: The treatment of permanent
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Edward, S. & Nord, C.-E.: Dental injuries of
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SOC.
1953: 266277.
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342
ANDREASEN
Address :
J. 0. Andreasen
Dental Department
University Hospital (Rigshospifalet)
9, Blegdamsvei
DK-2100, Copenhagen, Denmark