# Dental Trauma Management > Dental trauma management for NEET-MDS Endodontics: IADT 2020 splinting durations, avulsion storage media, replantation protocol and luxation care. - Canonical URL: https://prepelephant.com/topics/neet-mds/conservative-dentistry/dental-trauma-management-mds - Exam / course: NEET-MDS · Subject: Conservative Dentistry - 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: "Dental Trauma Management", PrepElephant, https://prepelephant.com/topics/neet-mds/conservative-dentistry/dental-trauma-management-mds ## Direct answer Replantation within minutes decides an avulsed tooth's fate: under the International Association of Dental Traumatology 2020 guidelines, a permanent tooth replanted immediately or kept physiologically moist (Hank's balanced salt solution, milk, saliva — never plain water, which kills periodontal ligament cells) and splinted flexibly for two weeks retains a chance of periodontal healing; a closed-apex tooth dry over sixty minutes is managed expecting ankylosis. The guideline fixes the splinting numbers exams quote: two weeks for avulsion and extrusion, four weeks for lateral luxation and root fracture, four months for cervical root fracture, with root canal treatment timed at seven to ten days after replantation for closed apices. Fractures and luxations follow their own ladder, chosen by pulp maturity. ## What you must remember - **IADT 2020 splint durations:** avulsion and extrusive luxation two weeks; lateral luxation and mid-root fracture four weeks; cervical root fracture four months; associated alveolar fracture about four weeks with a stiffer splint — the single highest-yield table in trauma. - **Avulsion storage media ranked:** Hank's balanced salt solution best, milk acceptable, saliva and saline interim, plain water worst — hypotonic water lyses periodontal cells within minutes. - **Replantation protocol:** hold the crown, rinse the root gently without scrubbing, replant immediately, verify radiographically, apply a flexible 0.3-0.4 mm wire splint, and start root canal treatment at 7-10 days for closed apices. - **Open-apex avulsion:** replantation still attempted, with revascularisation possible if extraoral dry time was short — follow-up for continued maturation or, later, apexification. - **Dry time threshold:** under 60 minutes moist, the periodontal ligament is viable; over 60 minutes dry, ankylosis-related resorption is expected. - **Crown fracture ladder:** infraction sealed; enamel fracture smoothed; enamel-dentine fracture bonded with pulp protection; complicated fracture in a young tooth treated by Cvek pulpotomy (1-2 mm amputation) and in a mature tooth by root canal treatment. - **Luxation spectrum:** concussion (tender, no mobility), subluxation (mobility without displacement), extrusive and lateral luxation (reposition then splint), intrusive luxation in the young (watch for spontaneous re-eruption) and in the mature (orthodontic or surgical repositioning). - **Antibiotics and tetanus:** systemic amoxicillin is recommended for avulsion per current guidance, with tetanus cover checked — the 2020 update dropped earlier topical soaks. ## Receiving an avulsed central incisor courtside A 15-year-old arrives 25 minutes after his central incisor was knocked out; a parent carried it in a pouch of cold milk. Sequence the IADT way: rinse the root surface with saline (never scrub), rinse and inspect the socket for fracture, and replant the tooth immediately, pressing it into place with slow steady pressure. Verify seating clinically and with a radiograph. Splint flexibly — a 0.4 mm wire or monofilament bonded to the avulsed tooth and its neighbours — for two weeks. Because the apex is closed, begin root canal treatment at day 7-10: extirpate, place calcium hydroxide, and complete obturation once the splint is off, watching radiographs for inflammatory resorption. Prescribe amoxicillin, check tetanus, suture lacerations, and give written instructions: soft diet, no biting on the tooth, chlorhexidine rinses, review at one week, one month, and three, six and twelve months for resorption and ankylosis. Had it arrived dry after two hours, replantation is still offered for ridge preservation and aesthetics, but with an honest ankylosis prognosis. ## Where students slip The splint durations come straight from IADT 2020 — two weeks avulsion, four weeks lateral luxation and root fracture, four months cervical root fracture — and outdated MCQ banks quoting 2012-era durations are the trap. Storage media ranking has one distractor that never dies: water is the worst common option, and selecting it as "readily available fluid" loses the mark. Fourth, the Cvek pulpotomy is the answer to "complicated crown fracture with an open apex", while the same fracture in a mature tooth reads "root canal treatment" — pulp maturity, not the clock alone, decides. Finally, tetanus cover is asked as a one-liner; the trauma exam insists that dental injuries sit inside a general emergency assessment. ## Frequently asked questions ### What is the best storage medium for an avulsed tooth? Hank's balanced salt solution is optimal, with cold milk the practical alternative; saliva or saline buy time, and plain water is contraindicated because it lyses periodontal ligament cells. ### How long is an avulsed permanent tooth splinted? Two weeks with a flexible splint under IADT 2020 guidance, extended toward four weeks only with an associated alveolar fracture. ### When is root canal treatment started after replantation of a closed-apex tooth? Between seven and ten days after replantation, ideally before splint removal, with calcium hydroxide dressing then obturation. ### Which luxation injuries need four weeks of splinting? Lateral luxation and mid-root fracture; cervical root fractures need about four months, and avulsion and extrusion two weeks. ### How is a complicated crown fracture managed in a young permanent incisor? Cvek (partial) pulpotomy amputating 1-2 mm of exposed pulp with a diamond under irrigation, sealed with a calcium-silicate material and restored — preserving the open apex for apexogenesis.