# Traumatic Dental Injuries in Children > Traumatic dental injuries in children — BDS Pedodontics notes on Andreasen classification, avulsion management, splinting times and resorption sequelae. - Canonical URL: https://prepelephant.com/topics/bds/pedodontics/traumatic-injuries-pedo - Exam / course: BDS · Subject: Pedodontics - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Traumatic Dental Injuries in Children", PrepElephant, https://prepelephant.com/topics/bds/pedodontics/traumatic-injuries-pedo ## Direct answer Trauma management in children is decided first by dentition: an avulsed primary tooth is never replanted because replantation endangers the developing successor, whereas an avulsed permanent tooth with a closed apex should be replanted immediately — at the accident site if possible — after rinsing the root clean, then splinted flexibly for about two weeks with root canal treatment started within a fortnight. Crown fractures range from enamel-only (smooth and observe) through enamel-dentine (bonded composite) to pulp-exposing (Cvek partial pulpotomy in a young tooth, root canal treatment in a mature necrotic one), and luxation injuries run from concussion through extrusion, lateral luxation and intrusion to avulsion. The long-term threats are the resorptions — infection-related inflammatory resorption and ankylosis-related replacement resorption — so every traumatised tooth is reviewed radiographically for years. ## What you must remember - Classify by Andreasen/WHO (concussion, subluxation, extrusive, lateral and intrusive luxation, avulsion; crown and root fractures) rather than the older Ellis scheme, though exams still quote Ellis Class I–III. - Uncomplicated crown fracture (enamel ± dentine): etch, bond, build composite; a fragment kept in milk can be reattached. A complicated fracture in a vital, immature tooth gets a Cvek (partial) pulpotomy with calcium hydroxide or MTA; a mature necrotic tooth gets root canal treatment. - Avulsed permanent tooth: hold by the crown, rinse the root briefly with saline, replant immediately, or transport in Hank's balanced salt solution, milk or saline — never water, never scrubbed. - Extraoral dry time over 60 minutes means a dead periodontal ligament: delayed replantation is still attempted, but ankylosis and replacement resorption are expected. - After replantation: flexible splint for about two weeks, root canal treatment within 7–14 days for closed apices (calcium hydroxide dressing first), amoxicillin systemically (tetracyclines avoided in children), tetanus checked, soft diet. - Immature open-apex teeth replanted within an hour may revascularise, so endodontics begins only if that fails — the opposite of the closed-apex strategy. - Intruded primary teeth usually re-erupt over months, but extraction is indicated if the tooth is driven toward the permanent follicle; root-fractured permanent teeth splint nearer four weeks. - Sequelae to monitor: pulp canal obliteration (common in immature teeth, usually harmless), inflammatory external resorption, replacement resorption with ankylosis and infraposition in a growing child, and damage to successors of injured primary teeth; prevention is the custom-made mouthguard. ## An avulsed incisor at the school gate A 9-year-old arrives forty minutes after a fall, with her upper left central incisor in a flask of milk supplied by a teacher who remembered the drill. The socket is intact, no alveolar fracture, no loss of consciousness. The root is rinsed with saline — never scrubbed — and replanted with steady finger pressure. The apex is closed on the film, so the plan is root canal treatment within a fortnight, calcium hydroxide dressing first, obturation later. A flexible splint spans the adjacent teeth for two weeks — rigid fixation is a mistake, because physiologic movement protects the periodontal ligament from ankylosis. Amoxicillin, a tetanus check, soft diet, and radiographic review for resorption continues for years. Every counterfactual carries a mark. A tooth kept dry for two hours has a non-viable periodontal ligament and a prognosis dropping to a deliberately ankylosed tooth maintained until growth completes. A 4-year-old with an avulsed primary incisor gets no replantation at all — only a follicle radiograph and follow-up. An intruded immature incisor is best watched for spontaneous re-eruption. The discipline lies in reading age, apex, extraoral time and displacement type before touching the tooth. ## Where marks are lost Practical errors dominate: scrubbing the root "to clean it", transporting the tooth in cotton or water, or splinting avulsion cases for six weeks as though it were a jaw fracture — each wrong by current guidance and each a favourite single-best-answer. The primary-versus-permanent trap is absolute: replanting an avulsed primary incisor risks the successor. Applied questions pair luxation type with management (extrusion — reposition and splint two weeks; intrusion in the young — observe; lateral luxation — reposition under anaesthesia and splint). Forgetting follow-up loses the long half of the marks: inflammatory versus replacement resorption, their radiographic looks, and why an ankylosed incisor in a growing child submerges. ## Frequently asked questions ### Should an avulsed primary tooth be replanted? No — replantation risks injuring the developing permanent successor through displacement and infection; management is assessment, a follicle radiograph and follow-up. ### What storage media keep an avulsed permanent tooth viable? Hank's balanced salt solution is best; milk, saline and saliva are acceptable; water is the worst common choice because its hypotonicity destroys periodontal ligament cells. ### How long is an avulsed permanent tooth splinted after replantation? About two weeks with a flexible splint, with root canal treatment begun within 7–14 days for a closed apex; root-fracture cases stay splinted nearer four weeks. ### What is the difference between inflammatory and replacement resorption? Inflammatory resorption is infection-driven, with bowl-shaped radiolucencies on root and bone, treated by canal disinfection; replacement resorption follows ankylosis, with bone replacing root directly, a metallic percussion note and progressive infraposition. ### Why can an immature replanted tooth avoid root canal treatment? An open apex replanted promptly may revascularise, so treatment is deferred and begun only if necrosis supervenes — the reverse of the closed-apex protocol.