AAE POSITION STATEMENT

Source file: Recommended Guidelines of the American Association of Endodontists for the Treatment of Traumatic Dental Injuries.pdf (17 pages).

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Field	Detail
Journal	Journal of Endodontics (JOE) • Volume 52, Number 8, August 2026 • pages 1237–1253
Authors	Asgeir Sigurdsson, DDS, MS; Brooke Blicher, DMD; Andrew J. Miller, DMD; Varun Singh, BDS, MS; Fabricio B. Teixeira, DDS, MS, PhD; Anne E. Williamson, DDS, MS; Cecilia Bourguignon, DDS
DOI	https://doi.org/10.1016/j.joen.2026.04.002
ISSN	0099-2399
Copyright	Copyright © 2026 The Authors. Published by Elsevier Inc. on behalf of American Association of Endodontists.
License	This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Reprints	Address requests for reprints to Asgeir Sigurdsson, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010. E-mail address: Asgeir.sigurdsson@nyu.edu

Author affiliations — From the *Department Endodontics, New York University College of Dentistry, New York, New York; † Private Endodontic Practice, White River Junction, Vermont; ‡ General Dentistry, BU School of Dental Medicine, Boston, Massachusetts; § Private Endodontic Practice, Edina, Minnesota; ‖ Department of Endodontics, Texas A&M University, Dallas, Texas; ¶ Private Endodontic Practice, Lincoln, Nebraska; and # Private Endodontic Practice, Paris, France.

Introduction

The Recommended Guidelines of the American Association of Endodontists (AAE) for the Treatment of Traumatic Dental Injuries are intended to aid the practitioner in the management and treatment of dental injuries. Although it is impossible to guarantee permanent retention of a traumatized tooth, timely treatment of the tooth using recommended procedures can maximize the chances for success.

The guidelines are not fixed protocols. Variations in an individual patient’s health, age, teeth, physical condition, and personal preferences are important factors in an endodontist’s treatment decisions. Individual endodontists may deviate from the guidelines when, in their sound dental judgement, the condition of the patient so requires. Practitioners cannot guarantee treatment outcomes.

The AAE gratefully acknowledges the cooperation of the International Association of Dental Traumatology, which granted the AAE permission to use the 2020 IADT Guidelines for the Evaluation and Management of Traumatic Dental Injuries in the development of the AAE trauma guidelines.

Table 1 — Treatment Guidelines for Tooth Fractures and Alveolar Fractures in the Permanent Dentition

Columns: Crown fracture (Uncomplicated | Complicated) · Crown/root fracture · Root fracture · Alveolar fracture

	Crown fracture — Uncomplicated	Crown fracture — Complicated	Crown/root fracture	Root fracture	Alveolar fracture
Definition and diagnosis	Enamel or enamel-dentin fracture without pulp exposure	Enamel-dentin fracture with pulp exposure.	A fracture involving enamel, dentin and cementum with loss of tooth structure. Crown fracture extends below gingival margin. The pulp may or may not be exposed.	A fracture involving the root structure. It can be localized in the apical, middle or cervical third of the root.	The bone segment containing the involved tooth/teeth is fractured and likely mobile.
Clinical assessment and findings	Pulp is likely responsive to sensibility testing. Tooth mobility is normal. Percussion test: not tender. If tenderness is observed, evaluate the tooth for possible associated luxation or root fracture injury.	Pulp is likely responsive to sensibility testing. Exposed pulp sensitive to stimuli. Tooth mobility is normal. Percussion test: not tender. If tenderness is observed, evaluate the tooth for possible associated luxation or root fracture injury.	Pulp is likely responsive to sensibility testing. Tooth is tender to percussion. If still present, the coronal fragment is likely to be mobile.	The coronal fragment may be mobile and sometimes displaced. The apical segment is usually not displaced. Bleeding from the gingival sulcus may be seen. Tooth is tender to percussion. Pulp may initially be unresponsive to sensibility testing, indicating pulpal damage that may be transient.	Fracture lines may be located at any level, from the marginal bone to the root apex. There might be displacement of an alveolar segment. Mobility of the teeth may be segmental if the fracture involves more than one alveolar socket. Occlusal interference is often present due to misalignment of the fracture alveolar segment. Teeth in the fractured segment may initially be unresponsive to pulp sensibility testing.
Radiographic assessment and findings	(This cell is merged across the Crown fracture [uncomplicated/complicated], Crown/root fracture and Root fracture columns in the original.) Intraoral radiographs are recommended after an injury, for diagnostic purposes and as a baseline for follow-ups. Positioning devices should be used, aiming for imaging standardization essential to future comparisons. The set of suggested radiographs below allows a thorough examination of the injured or potentially injured area, usually the maxillary or mandibular incisor teeth. It provides visualization of each tooth through different angulations. • Three intraoral parallel periapical radiographs centered on the 2 central incisors, the right lateral incisor and the left lateral incisor. • One occlusal angulation radiograph (a periapical size film or sensor may be used, as its size is often sufficient to visualize the injured incisor area).	(same text as the Uncomplicated column — merged cell) Intraoral radiographs are recommended after an injury, for diagnostic purposes and as a baseline for follow-ups. Positioning devices should be used, aiming for imaging standardization essential to future comparisons. The set of suggested radiographs below allows a thorough examination of the injured or potentially injured area, usually the maxillary or mandibular incisor teeth. It provides visualization of each tooth through different angulations. • Three intraoral parallel periapical radiographs centered on the 2 central incisors, the right lateral incisor and the left lateral incisor. • One occlusal angulation radiograph (a periapical size film or sensor may be used, as its size is often sufficient to visualize the injured incisor area). Additional (merged across the Crown fracture [uncomplicated/complicated] columns): Radiograph of lip or cheek lacerations to search for embedded tooth fragments or foreign materials.	(same text as the Uncomplicated column — merged cell) Intraoral radiographs are recommended after an injury, for diagnostic purposes and as a baseline for follow-ups. Positioning devices should be used, aiming for imaging standardization essential to future comparisons. The set of suggested radiographs below allows a thorough examination of the injured or potentially injured area, usually the maxillary or mandibular incisor teeth. It provides visualization of each tooth through different angulations. • Three intraoral parallel periapical radiographs centered on the 2 central incisors, the right lateral incisor and the left lateral incisor. • One occlusal angulation radiograph (a periapical size film or sensor may be used, as its size is often sufficient to visualize the injured incisor area). Additional (merged across the Crown/root fracture and Root fracture columns): Limited field of view (FOV) CBCT imaging should be strongly considered as it exhibits greater sensitivity in detecting dental and dentoalveolar fractures. It is also ideal for determining and differentiating fracture location and extent. This information can assist the practitioner in obtaining the most accurate diagnosis to guide treatment decisions that could ultimately lead to the most favorable clinical outcomes.	(same text as the Uncomplicated column — merged cell) Intraoral radiographs are recommended after an injury, for diagnostic purposes and as a baseline for follow-ups. Positioning devices should be used, aiming for imaging standardization essential to future comparisons. The set of suggested radiographs below allows a thorough examination of the injured or potentially injured area, usually the maxillary or mandibular incisor teeth. It provides visualization of each tooth through different angulations. • Three intraoral parallel periapical radiographs centered on the 2 central incisors, the right lateral incisor and the left lateral incisor. • One occlusal angulation radiograph (a periapical size film or sensor may be used, as its size is often sufficient to visualize the injured incisor area). Additional (merged across the Crown/root fracture and Root fracture columns): Limited field of view (FOV) CBCT imaging should be strongly considered as it exhibits greater sensitivity in detecting dental and dentoalveolar fractures. It is also ideal for determining and differentiating fracture location and extent. This information can assist the practitioner in obtaining the most accurate diagnosis to guide treatment decisions that could ultimately lead to the most favorable clinical outcomes.	In addition to the 3 parallel periapical angulations and occlusal image, additional views such as a panoramic radiograph can be helpful in determining the course and position of the fracture lines. CBCT may also be useful for diagnosis of alveolar fractures, especially in cases involving the palatal or both cortical plates

Crown fracture — Uncomplicated

Crown fracture — Complicated

Crown/root fracture

Root fracture

Alveolar fracture

Definition and diagnosis

Enamel or enamel-dentin fracture without pulp exposure

Enamel-dentin fracture with pulp exposure.

A fracture involving enamel, dentin and cementum with loss of tooth structure.

Crown fracture extends below gingival margin.

The pulp may or may not be exposed.

A fracture involving the root structure. It can be localized in the apical, middle or cervical third of the root.

The bone segment containing the involved tooth/teeth is fractured and likely mobile.

Clinical assessment and findings

Pulp is likely responsive to sensibility testing.

Tooth mobility is normal.

Percussion test: not tender. If tenderness is observed, evaluate the tooth for possible associated luxation or root fracture injury.

Pulp is likely responsive to sensibility testing.

Exposed pulp sensitive to stimuli.

Tooth mobility is normal.

Percussion test: not tender. If tenderness is observed, evaluate the tooth for possible associated luxation or root fracture injury.

Pulp is likely responsive to sensibility testing.

Tooth is tender to percussion.

If still present, the coronal fragment is likely to be mobile.

The coronal fragment may be mobile and sometimes displaced.

The apical segment is usually not displaced.

Bleeding from the gingival sulcus may be seen.

Tooth is tender to percussion.

Pulp may initially be unresponsive to sensibility testing, indicating pulpal damage that may be transient.

Fracture lines may be located at any level, from the marginal bone to the root apex. There might be displacement of an alveolar segment.

Mobility of the teeth may be segmental if the fracture involves more than one alveolar socket.

Occlusal interference is often present due to misalignment of the fracture alveolar segment.

Teeth in the fractured segment may initially be unresponsive to pulp sensibility testing.

Radiographic assessment and findings

(This cell is merged across the Crown fracture [uncomplicated/complicated], Crown/root fracture and Root fracture columns in the original.)

Intraoral radiographs are recommended after an injury, for diagnostic purposes and as a baseline for follow-ups. Positioning devices should be used, aiming for imaging standardization essential to future comparisons.

The set of suggested radiographs below allows a thorough examination of the injured or potentially injured area, usually the maxillary or mandibular incisor teeth. It provides visualization of each tooth through different angulations.

• Three intraoral parallel periapical radiographs centered on the 2 central incisors, the right lateral incisor and the left lateral incisor.
• One occlusal angulation radiograph (a periapical size film or sensor may be used, as its size is often sufficient to visualize the injured incisor area).

(same text as the Uncomplicated column — merged cell)

Additional (merged across the Crown fracture [uncomplicated/complicated] columns):
Radiograph of lip or cheek lacerations to search for embedded tooth fragments or foreign materials.

(same text as the Uncomplicated column — merged cell)

Additional (merged across the Crown/root fracture and Root fracture columns):
Limited field of view (FOV) CBCT imaging should be strongly considered as it exhibits greater sensitivity in detecting dental and dentoalveolar fractures. It is also ideal for determining and differentiating fracture location and extent. This information can assist the practitioner in obtaining the most accurate diagnosis to guide treatment decisions that could ultimately lead to the most favorable clinical outcomes.

(same text as the Uncomplicated column — merged cell)

In addition to the 3 parallel periapical angulations and occlusal image, additional views such as a panoramic radiograph can be helpful in determining the course and position of the fracture lines.

CBCT may also be useful for diagnosis of alveolar fractures, especially in cases involving the palatal or both cortical plates

	Crown fracture — Uncomplicated	Crown fracture — Complicated	Crown/root fracture	Root fracture	Alveolar fracture
Treatment	If a tooth fragment is available, it can be bonded to the tooth. The fragment should first be rehydrated in water or saline for 15–20 min if it was stored dry. Otherwise perform a provisional treatment by covering the exposed dentin with glass ionomer or a long-term restoration using a bonding agent and composite resin. If the exposed dentin is within 0.5 mm of the pulp (dentin is pink but there is no pulpal bleeding), place a calcium hydroxide base and cover with a material such as glass ionomer. The definitive treatment for the fractured crown is restoration with accepted dental restorative materials.	In young patients with open apices, it is important to preserve pulp vitality by pulp capping or partial pulpotomy to secure further root development. These treatments are also the treatment of choice in patients with closed apices. Calcium hydroxide compounds and non-staining calcium silicate cements are suitable materials for such procedures. If tooth fragment is available, it can be bonded to the tooth after pulp capping procedure or partial pulpotomy. The fragment should first be rehydrated in water or saline for 15–20 min if it was stored dry. Future treatment for the fractured crown may be restoration with accepted dental restorative materials.	If a post is required for crown retention in a mature tooth with complete root formation, endodontic treatment is the preferred treatment. Until a treatment plan is finalized, a few days of temporary stabilization of the loose fragment to the adjacent tooth/teeth or to the non-mobile fragment can be attempted for esthetic reasons. • Without pulp exposure: fragment removal with or without gingivectomy and restoration. • With pulpal exposure and immature root: perform a partial pulpotomy to preserve pulp vitality. • With pulpal exposure and mature root: perform endodontic treatment then restore with a post retained crown. Orthodontic or surgical extrusion of apical fragment may be indicated to expose the margins prior to permanent restoration. Extraction with immediate or delayed implant-retained crown restoration or a conventional/bonded bridge are alternatives for adult patients. Root submergence, intentional replantation with or without rotation of the root or auto-transplantation might also be alternatives.	For root fractures where the coronal fragment has been avulsed out of the socket, please refer to treatment guidelines for avulsion (Tables 6–8). Otherwise, proceed as described below. Rinse exposed root surface with saline before repositioning. If displaced, reposition the coronal segment of the tooth as soon as possible. Check radiographically that correct position has been reached. Stabilize the tooth with a flexible splint for 4 wk. If the fracture line is near the tooth’s cervical area, stabilization is beneficial for a longer period (up to 4 mo). In mature teeth where the cervical fracture line is located above the alveolar crest and the coronal fragment is very mobile, removal of the coronal fragment, followed by endodontic treatment and restoration with a post-retained crown will likely be required. Additional procedures such as orthodontic extrusion of the apical segment, crown lengthening surgery, surgical extrusion or even extraction may be required as future treatment options (similar to those outlined for crown-root fractures). Monitor healing for at least 1 y to determine pulpal status. Continued (p. 1240): There is a good likelihood that the pulp will survive or spontaneously revascularize if the coronal half was well repositioned. Therefore, endodontic treatment should not be initiated until later if there are clear signs of pulpal necrosis and infection. Transient internal root resorption in the fracture line area has been reported as part of the healing process and does not indicate need for endodontic treatment. If pulp necrosis and infection develop, endodontic treatment of the coronal tooth segment to the fracture line is indicated. The apical segment rarely requires endodontic treatment.	Reposition any displaced segment and then splint the involved teeth with a flexible and passive splint for 4 wk. Suture gingival and soft tissue lacerations if present. Endodontic treatment is contraindicated at the emergency visit. Monitor the pulp condition of all teeth involved, both initially and at follow ups, to determine if or when endodontic treatment becomes necessary.

Crown fracture — Uncomplicated

Crown fracture — Complicated

Crown/root fracture

Root fracture

Alveolar fracture

Treatment

If a tooth fragment is available, it can be bonded to the tooth.

The fragment should first be rehydrated in water or saline for 15–20 min if it was stored dry.

Otherwise perform a provisional treatment by covering the exposed dentin with glass ionomer or a long-term restoration using a bonding agent and composite resin.

If the exposed dentin is within 0.5 mm of the pulp (dentin is pink but there is no pulpal bleeding), place a calcium hydroxide base and cover with a material such as glass ionomer.

The definitive treatment for the fractured crown is restoration with accepted dental restorative materials.

In young patients with open apices, it is important to preserve pulp vitality by pulp capping or partial pulpotomy to secure further root development.

These treatments are also the treatment of choice in patients with closed apices.

Calcium hydroxide compounds and non-staining calcium silicate cements are suitable materials for such procedures.

If tooth fragment is available, it can be bonded to the tooth after pulp capping procedure or partial pulpotomy. The fragment should first be rehydrated in water or saline for 15–20 min if it was stored dry.

Future treatment for the fractured crown may be restoration with accepted dental restorative materials.

If a post is required for crown retention in a mature tooth with complete root formation, endodontic treatment is the preferred treatment.

Until a treatment plan is finalized, a few days of temporary stabilization of the loose fragment to the adjacent tooth/teeth or to the non-mobile fragment can be attempted for esthetic reasons.

• Without pulp exposure: fragment removal with or without gingivectomy and restoration.
• With pulpal exposure and immature root: perform a partial pulpotomy to preserve pulp vitality.
• With pulpal exposure and mature root: perform endodontic treatment then restore with a post retained crown.

Orthodontic or surgical extrusion of apical fragment may be indicated to expose the margins prior to permanent restoration.

Extraction with immediate or delayed implant-retained crown restoration or a conventional/bonded bridge are alternatives for adult patients.

Root submergence, intentional replantation with or without rotation of the root or auto-transplantation might also be alternatives.

For root fractures where the coronal fragment has been avulsed out of the socket, please refer to treatment guidelines for avulsion (Tables 6–8). Otherwise, proceed as described below.

Rinse exposed root surface with saline before repositioning.

If displaced, reposition the coronal segment of the tooth as soon as possible. Check radiographically that correct position has been reached.

Stabilize the tooth with a flexible splint for 4 wk.

If the fracture line is near the tooth’s cervical area, stabilization is beneficial for a longer period (up to 4 mo).

In mature teeth where the cervical fracture line is located above the alveolar crest and the coronal fragment is very mobile, removal of the coronal fragment, followed by endodontic treatment and restoration with a post-retained crown will likely be required. Additional procedures such as orthodontic extrusion of the apical segment, crown lengthening surgery, surgical extrusion or even extraction may be required as future treatment options (similar to those outlined for crown-root fractures).

Monitor healing for at least 1 y to determine pulpal status.

Continued (p. 1240): There is a good likelihood that the pulp will survive or spontaneously revascularize if the coronal half was well repositioned. Therefore, endodontic treatment should not be initiated until later if there are clear signs of pulpal necrosis and infection.

Transient internal root resorption in the fracture line area has been reported as part of the healing process and does not indicate need for endodontic treatment.

If pulp necrosis and infection develop, endodontic treatment of the coronal tooth segment to the fracture line is indicated. The apical segment rarely requires endodontic treatment.

Reposition any displaced segment and then splint the involved teeth with a flexible and passive splint for 4 wk.

Suture gingival and soft tissue lacerations if present.

Endodontic treatment is contraindicated at the emergency visit.

Monitor the pulp condition of all teeth involved, both initially and at follow ups, to determine if or when endodontic treatment becomes necessary.

Patient instructions (all injury types — merged cell, p. 1240):

Soft diet, brush teeth with a soft toothbrush after each meal, use a 0.12% chlorhexidine mouth rinse twice a day for 1–2 wk.

Follow-up (all injury types — merged cell, p. 1240):

Follow-up as indicated in Table 2.

If the crown fracture injury is combined with a luxation injury, the follow-up regimen of Table 5 applies. If the crown fracture injury is combined with an avulsion injury, the follow-up regimen of Table 8 applies.

_{CBCT, cone-beam computed tomography.}

Table 2 — Follow-up Procedures for Fractured Permanent Teeth and Alveolar Fractures

Time	Crown fracture — Uncomplicated	Crown fracture — Complicated	Crown/root fracture — Uncomplicated	Crown/root fracture — Complicated	Root fracture	Alveolar fracture
1 wk	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.
4 wk	When the pulp is unresponsive to sensibility testing immediately after trauma, clinical, and radiographic examination should be considered at 4 wk.	When the pulp is unresponsive to sensibility testing immediately after trauma, clinical, and radiographic examination should be considered at 4 wk.			Clinical and radiographic examination. Splint removal for apical third and mid root fractures.	Clinical and radiographic examination. Splint removal.
6–8 wk	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.
4 mo			Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination. Splint removal when root fracture is located cervically.	Clinical and radiographic examination.
6 mo		Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.
1 y	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.
Yearly for at least 5 y		Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.

(Blank cells = merged cells in the original; the merged cell’s statement applies to all the columns it spans.)

Important general considerations on follow-ups

Regarding combined injuries:

When a crown fracture injury is combined with a luxation injury, the follow-up regimen of Table 5 applies.
When a crown fracture injury is combined with an avulsion injury, the follow-up regimen of Table 8 applies.

Regarding radiographic examination:

Intraoral parallel radiographs should be taken at follow-ups. Occlusal angulation radiographs may also be taken. Positioning devices should be used, aiming for imaging standardization essential to comparisons.

Regarding discolorations and sensibility testing:

Discolorations or nonresponsiveness to sensibility testing are insufficient signs to assert the diagnosis of pulp necrosis. However, a lack of response to sensibility testing of a mature tooth by 3 months after trauma is strongly indicative of pulp necrosis.

Practitioners should inform the patients (and/or their parents or guardians) about:

Potential post-traumatic complications
The necessity to comply with the follow-up regimen
Unfavorable outcomes requiring prompt endodontic treatment
The necessity to return to the clinic if they observe any unfavorable outcomes in the interval between follow-up visits.

Table 3 — Treatment Guidelines for Concussion, Subluxation, and Luxation of Permanent Teeth

Columns: Concussion | Subluxation | Extrusive luxation | Lateral luxation | Intrusive luxation

	Concussion	Subluxation	Extrusive luxation	Lateral luxation	Intrusive luxation
Definition and diagnosis	Patients commonly report tooth tenderness to touch/biting. Tooth is not displaced or abnormally mobile.	Patients commonly report tooth tenderness to touch/biting. Tooth is not displaced, but is tender to percussion and palpation and slightly mobile.	Displacement of the tooth outward or incisally.	Displacement of the tooth in any lateral direction except axially; usually associated with a fracture of the facial cortical bone.	Displacement of the tooth inward into the alveolar bone.
Clinical assessment and findings	Pulp is likely responsive to sensibility testing. Tooth is tender to percussion and palpation.	Pulp may initially be unresponsive to sensibility testing, indicating transient pulpal damage that may heal gradually. Tooth is tender to percussion.	The tooth appears elongated and is excessively mobile. Pulp is likely non-responsive to sensibility testing. Tooth is tender to percussion.	The tooth is displaced, usually in a palatal/lingual or labial direction. The tooth appears immobile or locked into bone. Fracture of the alveolar process may be palpable. Pulp is likely unresponsive to sensibility testing. Tooth is tender to percussion and palpation.	The tooth appears partially or totally infra-occluded, immobile, and locked. Fracture of the alveolar process may be palpable and palpation sensitive. Pulp is likely unresponsive to sensibility testing. Tooth is tender to percussion with high metallic (ankylotic) sound.
Radiographic assessment and findings	One parallel periapical radiograph. Additional radiographs are indicated if clinical signs or symptoms of other potential injuries are present. No radiographic abnormalities are expected.	(This cell is merged across the Subluxation, Extrusive luxation, Lateral luxation and Intrusive luxation columns in the original.) Intraoral radiographs are recommended after an injury, for diagnostic purposes and as a baseline for follow-ups. Positioning devices should be used, aiming for imaging standardization essential to future comparisons. The set of suggested radiographs below allows a thorough examination of the injured or potentially injured area, usually the maxillary or mandibular incisor teeth. It provides visualization of each tooth through different angulations. • Three intraoral parallel periapical radiographs centered on the 2 central incisors, the right lateral incisor and the left lateral incisor. • One occlusal angulation radiograph (a periapical size film or sensor may be used, as its size is often sufficient to visualize the injured incisor area). Additional for this column: No radiographic abnormalities are expected.	(same merged text as the Subluxation column) Intraoral radiographs are recommended after an injury, for diagnostic purposes and as a baseline for follow-ups. Positioning devices should be used, aiming for imaging standardization essential to future comparisons. The set of suggested radiographs below allows a thorough examination of the injured or potentially injured area, usually the maxillary or mandibular incisor teeth. It provides visualization of each tooth through different angulations. • Three intraoral parallel periapical radiographs centered on the 2 central incisors, the right lateral incisor and the left lateral incisor. • One occlusal angulation radiograph (a periapical size film or sensor may be used, as its size is often sufficient to visualize the injured incisor area). Additional for this column: Periodontal ligament (PDL) space appears enlarged. Limited FOV CBCT imaging should be strongly considered as it exhibits greater sensitivity in detecting dental and dentoalveolar fractures. It is also ideal for determining and differentiating fracture location and extent. This information can assist the practitioner in obtaining the most accurate diagnosis to guide treatment decisions, that could ultimately lead to the most favorable clinical outcomes. Please read **	(same merged text as the Subluxation column) Intraoral radiographs are recommended after an injury, for diagnostic purposes and as a baseline for follow-ups. Positioning devices should be used, aiming for imaging standardization essential to future comparisons. The set of suggested radiographs below allows a thorough examination of the injured or potentially injured area, usually the maxillary or mandibular incisor teeth. It provides visualization of each tooth through different angulations. • Three intraoral parallel periapical radiographs centered on the 2 central incisors, the right lateral incisor and the left lateral incisor. • One occlusal angulation radiograph (a periapical size film or sensor may be used, as its size is often sufficient to visualize the injured incisor area). Additional for this column: PDL space appears enlarged. Limited FOV CBCT imaging should be strongly considered as it exhibits greater sensitivity in detecting dental and dentoalveolar fractures. It is also ideal for determining and differentiating fracture location and extent. This information can assist the practitioner in obtaining the most accurate diagnosis to guide treatment decisions, that could ultimately lead to the most favorable clinical outcomes. Please read **	(same merged text as the Subluxation column) Intraoral radiographs are recommended after an injury, for diagnostic purposes and as a baseline for follow-ups. Positioning devices should be used, aiming for imaging standardization essential to future comparisons. The set of suggested radiographs below allows a thorough examination of the injured or potentially injured area, usually the maxillary or mandibular incisor teeth. It provides visualization of each tooth through different angulations. • Three intraoral parallel periapical radiographs centered on the 2 central incisors, the right lateral incisor and the left lateral incisor. • One occlusal angulation radiograph (a periapical size film or sensor may be used, as its size is often sufficient to visualize the injured incisor area). Additional for this column: The periodontal ligament space may be absent from all or part of the root. The cemento-enamel junction is located more apically than the adjacent, non-injured teeth. If the tooth is totally intruded, a lateral radiograph should be considered to evaluate its penetration into the nasal cavity. Limited FOV CBCT imaging should be strongly considered as it exhibits greater sensitivity in detecting dental and dentoalveolar fractures. It is also ideal for determining and differentiating fracture location and extent. This information can assist the practitioner in obtaining the most accurate diagnosis to guide treatment decisions, that could ultimately lead to the most favorable clinical outcomes. Please read **

Concussion

Subluxation

Extrusive luxation

Lateral luxation

Intrusive luxation

Definition and diagnosis

Patients commonly report tooth tenderness to touch/biting.

Tooth is not displaced or abnormally mobile.

Patients commonly report tooth tenderness to touch/biting.

Tooth is not displaced, but is tender to percussion and palpation and slightly mobile.

Displacement of the tooth outward or incisally.

Displacement of the tooth in any lateral direction except axially; usually associated with a fracture of the facial cortical bone.

Displacement of the tooth inward into the alveolar bone.

Clinical assessment and findings

Pulp is likely responsive to sensibility testing.

Tooth is tender to percussion and palpation.

Pulp may initially be unresponsive to sensibility testing, indicating transient pulpal damage that may heal gradually.

Tooth is tender to percussion.

The tooth appears elongated and is excessively mobile.

Pulp is likely non-responsive to sensibility testing.

Tooth is tender to percussion.

The tooth is displaced, usually in a palatal/lingual or labial direction.

The tooth appears immobile or locked into bone.

Fracture of the alveolar process may be palpable.

Pulp is likely unresponsive to sensibility testing.

Tooth is tender to percussion and palpation.

The tooth appears partially or totally infra-occluded, immobile, and locked.

Fracture of the alveolar process may be palpable and palpation sensitive.

Pulp is likely unresponsive to sensibility testing.

Tooth is tender to percussion with high metallic (ankylotic) sound.

Radiographic assessment and findings

One parallel periapical radiograph.

Additional radiographs are indicated if clinical signs or symptoms of other potential injuries are present.

No radiographic abnormalities are expected.

(This cell is merged across the Subluxation, Extrusive luxation, Lateral luxation and Intrusive luxation columns in the original.)

Additional for this column:
No radiographic abnormalities are expected.

(same merged text as the Subluxation column)

Additional for this column:
Periodontal ligament (PDL) space appears enlarged.

Limited FOV CBCT imaging should be strongly considered as it exhibits greater sensitivity in detecting dental and dentoalveolar fractures. It is also ideal for determining and differentiating fracture location and extent. This information can assist the practitioner in obtaining the most accurate diagnosis to guide treatment decisions, that could ultimately lead to the most favorable clinical outcomes. Please read **

(same merged text as the Subluxation column)

Additional for this column:
PDL space appears enlarged.

(same merged text as the Subluxation column)

Additional for this column:
The periodontal ligament space may be absent from all or part of the root.

The cemento-enamel junction is located more apically than the adjacent, non-injured teeth.

If the tooth is totally intruded, a lateral radiograph should be considered to evaluate its penetration into the nasal cavity.

**Footnote (merged cell spanning the Extrusive, Lateral and Intrusive luxation columns — p. 1243):

**A CBCT study is inherently higher effective radiation dose than intraoral imaging; however, CBCT imaging maintains a higher diagnostic utility for certain entities over traditional intraoral images. The safety of such three-dimensional imaging modalities must be considered, especially given that traumatic dental injuries disproportionately affect children and adolescents under the age of 18 who are more susceptible to radiation during their physiologic growth. Therefore, the practitioner should make strong efforts towards individualized CBCT protocols which balance diagnostic efficacy with dose reduction aimed at dose optimization consistent with ALADA (as low as diagnostically acceptable)

As per the AAE and AAOMR Joint Position Statement on the use of cone-beam computed tomography in endodontics, CBCT should only be performed after a thorough history taking, clinical examination, and the need for imaging cannot be met by lower dose two-dimensional radiographs. Patients, especially children, should be properly instructed and positioned to prevent any movements during image acquisition in order to avoid the need for a repeat exposure(s). Practitioners should be aware of operator-dependent settings specific to their particular CBCT imaging machine with the appropriate resolution settings and smallest FOV selected for the given patient-specific factors. Practitioners might also consider obtaining informed consent from the patient or their legal guardian prior to proceeding with CBCT imaging.

	Concussion	Subluxation	Extrusive luxation	Lateral luxation	Intrusive luxation
Immediate treatment	No treatment	Usually, no treatment is needed. Splint may be indicated for patient comfort, stabilizing the tooth for 2 wk using a flexible and passive splint.	Rinse the affected area with saline. Reposition the tooth by gently reinserting it into the socket. Stabilize the tooth for 2 wk using a flexible and passive splint. Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area. Repositioning of an extruded tooth should be done as soon as possible. After 12–24 h orthodontics or intentional replantation with prior curettage of the socket could be considered in select cases.	Rinse the affected area with saline. Reposition the tooth by gently pulling it incisally digitally or with extraction forceps to disengage it from its bony lock and delicately reposition it into its original location. Alternatively, palpate the buccal gingiva to feel the apex of the tooth. Use one finger to push the apex downwards then use another finger or thumb to first rotate and then push the tooth upwards back into its socket. Splint for 4 wk using a flexible and passive splint. Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area. Repositioning of a laterally luxated tooth should be done as soon as possible. After 12–24 h orthodontics or intentional replantation with prior curettage of the socket could be considered in select cases.	Rinse the affected area with saline. Teeth with incomplete root formation: – Up to 7 mm intrusion, allow for re-eruption without intervention. If no movement, initiate orthodontic repositioning within 4 weeks. – In cases of intrusion > 7 mm, reposition surgically or orthodontically within 4 weeks. Teeth with complete root formation: – Up to 3 mm intrusion, allow for re-eruption without intervention. If no movement after 8 wk, reposition surgically or orthodontically before ankylosis develops. – Between 3–7 mm intrusion, reposition surgically or orthodontically. – In cases of > 7 mm, reposition surgically. After orthodontic or surgical repositioning, splint for 2 wk using a flexible and passive splint. If displacement is extensive, splint for 4 wk. Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area.

Concussion

Subluxation

Extrusive luxation

Lateral luxation

Intrusive luxation

Immediate treatment

No treatment

Usually, no treatment is needed.

Splint may be indicated for patient comfort, stabilizing the tooth for 2 wk using a flexible and passive splint.

Rinse the affected area with saline.

Reposition the tooth by gently reinserting it into the socket.

Stabilize the tooth for 2 wk using a flexible and passive splint.

Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area.

Repositioning of an extruded tooth should be done as soon as possible. After 12–24 h orthodontics or intentional replantation with prior curettage of the socket could be considered in select cases.

Rinse the affected area with saline.

Reposition the tooth by gently pulling it incisally digitally or with extraction forceps to disengage it from its bony lock and delicately reposition it into its original location.

Alternatively, palpate the buccal gingiva to feel the apex of the tooth. Use one finger to push the apex downwards then use another finger or thumb to first rotate and then push the tooth upwards back into its socket.

Splint for 4 wk using a flexible and passive splint.

Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area.

Repositioning of a laterally luxated tooth should be done as soon as possible. After 12–24 h orthodontics or intentional replantation with prior curettage of the socket could be considered in select cases.

Rinse the affected area with saline.

Teeth with incomplete root formation:
– Up to 7 mm intrusion, allow for re-eruption without intervention. If no movement, initiate orthodontic repositioning within 4 weeks.
– In cases of intrusion > 7 mm, reposition surgically or orthodontically within 4 weeks.

Teeth with complete root formation:
– Up to 3 mm intrusion, allow for re-eruption without intervention. If no movement after 8 wk, reposition surgically or orthodontically before ankylosis develops.
– Between 3–7 mm intrusion, reposition surgically or orthodontically.
– In cases of > 7 mm, reposition surgically.

After orthodontic or surgical repositioning, splint for 2 wk using a flexible and passive splint. If displacement is extensive, splint for 4 wk. Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area.

	Concussion	Subluxation	Extrusive luxation	Lateral luxation	Intrusive luxation
Endodontic treatment and considerations	Monitor pulpal response until a definitive pulpal diagnosis can be made.	Monitor pulpal response until a definitive pulpal diagnosis can be made.	Teeth with complete root formation: – Pulp necrosis and infection are common complications. If diagnosed, endodontic treatment is indicated. Teeth with incomplete root formation: – Monitor closely for pulp vitality.	Teeth with complete root formation: – Pulp necrosis and infection are common complications. If diagnosed, endodontic treatment is indicated. Teeth with incomplete root formation: – Monitor closely for pulp vitality	Teeth with complete root formation: – The pulp will likely become necrotic and endodontic treatment should be initiated 2 wk after the injury (or as soon as rubber dam isolation is possible) – After canal cleaning and disinfection, a temporary dressing with calcium hydroxide is recommended for up to 4 wk. Teeth with incomplete root formation: – Monitor closely for pulp vitality.

Concussion

Subluxation

Extrusive luxation

Lateral luxation

Intrusive luxation

Endodontic treatment and considerations

Monitor pulpal response until a definitive pulpal diagnosis can be made.

Teeth with complete root formation:
– Pulp necrosis and infection are common complications. If diagnosed, endodontic treatment is indicated.

Teeth with incomplete root formation:
– Monitor closely for pulp vitality.

Teeth with complete root formation:
– Pulp necrosis and infection are common complications. If diagnosed, endodontic treatment is indicated.

Teeth with incomplete root formation:
– Monitor closely for pulp vitality

Teeth with complete root formation:
– The pulp will likely become necrotic and endodontic treatment should be initiated 2 wk after the injury (or as soon as rubber dam isolation is possible)
– After canal cleaning and disinfection, a temporary dressing with calcium hydroxide is recommended for up to 4 wk.

Teeth with incomplete root formation:
– Monitor closely for pulp vitality.

Footnote (merged cell spanning all five columns — p. 1244):

• Apexification or regenerative endodontic treatments are indicated when the pulp of teeth with incomplete root formation becomes necrotic.

• Endodontic treatment should be initiated immediately when there is evidence of infection-related (inflammatory) external root resorption. The canal should be medicated with calcium hydroxide for 3 weeks, followed by its replacement every 3 months until there is radiographic evidence of periradicular bone healing. Final obturation of the root canal system can then be performed. Gradual re-establishment of the lamina dura and periodontal ligament space with arrest of the resorption process usually ensue and should be monitored.

Patient instructions (all injury types — merged cell):

Soft diet, brush teeth with a soft toothbrush after each meal, use a 0.12% chlorhexidine mouth rinse twice a day for 1–2 wk.

Follow-up (all injury types — merged cell):

Follow-up as indicated in Table 5.

Table 4 — Differential Diagnosis of Concussion, Subluxation, and Luxation of Permanent Teeth

	Concussion	Subluxation	Luxation (extrusive, lateral)
Percussion	Yes	Yes	Yes
Mobility	No	Yes	Yes
Displacement	No	No	Yes

Table 5 — Follow-up Procedures for Luxated Permanent Teeth

Time	Concussion/subluxation	Extrusion	Lateral luxation	Intrusion
2 wk	Splint removal (if applied for subluxation). Clinical and radiographic examination.	Splint removal. Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.
4 wk	Clinical and radiographic examination.	Clinical and radiographic examination.	Splint removal. Clinical and radiographic examination.	Splint removal if tooth was repositioned surgically or orthodontically. Clinical and radiographic examination.
6–8 wk	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.
3 mo	If other signs of pulp necrosis are absent, but the pulp is unresponsive to sensibility testing at 6–8 wk after the trauma, clinical and radiographic examination at 3 mo should be considered.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.
6 mo	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.
1 y	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.
Yearly for at least 5 y	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.	Clinical and radiographic examination.

(Blank cells = merged cells in the original; the merged cell’s statement applies to all the columns it spans.)

Important general considerations on follow-ups

Regarding radiographic examination

In the absence of clinical signs and symptoms, intraoral parallel radiographs should be taken. Occlusal angulation radiographs may also be taken. Positioning devices should be used, aiming for imaging standardization essential to comparisons.

Regarding discolorations and sensibility testing:

Discolorations or nonresponsiveness to sensibility testing are insufficient signs to assert the diagnosis of pulp necrosis. However, a lack of response to sensibility testing of a mature tooth by 3 mo after trauma is strongly indicative of pulp necrosis.

Regarding infection-related (inflammatory) external root resorption:

Endodontic treatment should be initiated immediately when there is evidence of infection-related (inflammatory) external root resorption. The canal should be medicated with calcium hydroxide for 3 wk, followed by its replacement every 3 mo until there is radiographic evidence of periradicular bone healing, usually accompanied by gradual reestablishment of the lamina dura and periodontal ligament space with arrest of the resorption process. The final obturation of the root canal system can then be performed.

Regarding CBCT utilization:

Limited FOV CBCT may be the appropriate modality for follow-up if it was indicated for the initial evaluation. However, CBCT should not be performed routinely at every follow-up visit but may be considered when clinical findings or complications suggest that additional three-dimensional information is needed.
The same precautions as stated previously regarding safety of CBCT imaging should be followed, including:
- CBCT should only be performed after a thorough history taking, clinical examination and the need for imaging cannot be met by lower dose two-dimensional radiography
- If CBCT three-dimensional examination is decided upon, the patient-specific proper resolution and smallest possible FOV should be selected considering the ALADA principles (as low as diagnostically achievable)
- Patients, especially children, should be properly instructed and positioned to prevent any movements during image acquisition in order to avoid the need for a repeat exposure(s).

Practitioners should inform the patients (and/or their parents or guardians) about:

Potential post-traumatic complications
The necessity to comply with the follow-up regimen
Unfavorable outcomes requiring prompt endodontic treatment
The necessity to return to the clinic if they observe any unfavorable outcomes in the interval between follow-up visits.

_{CBCT, cone-beam computed tomography.}

Table 6 — Treatment Guidelines for Avulsed Mature Permanent Teeth with Closed Apex

In the original table the immediate treatment cell differs by clinical situation, whereas the rows Radiographic assessment and findings, Endodontic treatment and considerations, Antibiotics, Patient instructions and Follow-up are single cells merged across all three clinical situations.

Immediate treatment

Clinical situation A — Tooth has already been replanted

Leave tooth in place.
Clean affected area with water, saline or 0.12% chlorhexidine.
Verify normal position of the replanted tooth clinically and radiographically.
If the tooth or teeth were replanted in the wrong socket or rotated, consider repositioning into the proper location up to 48 h after the traumatic accident.
Apply a flexible and passive splint for 1–2 wk. In cases of associated alveolar or jawbone fracture, a more rigid splint is indicated and should be left for about 4 wk.
Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area.

Clinical situation B — Extra-oral dry time 60 minutes or less – or – extra-oral dry time 60 minutes or less and tooth kept in physiologic storage medium (milk, hanks balanced salt solution [HBSS], saline) or saliva for several hours

Place or leave the tooth in a storage medium while taking a history, examining the patient clinically and radiographically, and preparing the patient for the replantation.
Administer local anesthesia, preferably without a vasoconstrictor.
Irrigate the alveolar socket with saline.
Examine the alveolar socket. If there is a fracture of the socket wall, reposition the fractured fragment into its original position with a suitable instrument.
Removal of the coagulum with a saline stream may allow better repositioning of the tooth.
Hold the tooth by the crown and gently clean the root surface and apical foramen with saline.
Replant the tooth slowly using slight digital pressure.
Verify normal position of the replanted tooth clinically and radiographically.
Apply a flexible and passive splint for 1–2 wk. In cases of associated alveolar fracture, a more rigid splint is indicated and should be left for about 4 wk.
Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area.

Clinical situation C — Extra-oral dry time longer than 60 minutes

Remove loose debris and visible contamination by agitating the tooth in physiologic storage medium, or with gauze soaked in saline.
Tooth should be placed in storage medium while taking a history, examining the patient clinically and radiographically, and preparing the patient for the replantation.
Administer local anesthesia, preferably without a vasoconstrictor. Irrigate the alveolar socket with saline.
Examine the alveolar socket. If there is a fracture of the socket wall, reposition the fractured fragment into its original position with a suitable instrument.
Removal of the coagulum with a saline stream may allow better repositioning of the tooth.
Hold the tooth by the crown and gently clean the root surface and apical foramen with saline.
Replant the tooth slowly using slight digital pressure.
Verify normal position of the replanted tooth clinically and radiographically.
Apply a flexible and passive splint for 1–2 wk. In cases of associated alveolar fracture, a more rigid splint is indicated and should be left for about 4 wk.
Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area.

Radiographic assessment and findings (merged cell — applies to all three clinical situations)

Three intraoral parallel periapical radiographs centered on the 2 central incisors, the right lateral incisor and the left lateral incisor.
One occlusal angulation radiograph (a periapical size film or sensor may be used, as its size is often sufficient to visualize the injured incisor area).

An intraoral parallel periapical and an occlusal radiograph can be taken to confirm the proper repositioning.

CBCT is usually not needed to confirm the proper repositioning of the avulsed tooth. CBCT may however be considered if there are clinical signs indicating a possible alveolar bone fracture and if the additional information it could provide will likely change the anticipated treatment plan. Limited FOV CBCT imaging may then be cautiously used as an additional exam. It is important to consider that current dental CBCTs can expose patients, to a higher effective radiation dose than an intra-oral radiograph. Please read **

**Regarding CBCT utilization: Although a CBCT study is inherently higher effective radiation dose than intraoral imaging, CBCT imaging maintains a higher diagnostic utility over traditional intraoral images. The practitioner should consider the benefits and risks of such three dimensional imaging modalities, given that traumatic dental injuries disproportionately affect children and adolescents under the age of 18 who are more susceptible to radiation during their physiologic growth. Therefore, the practitioner should make strong efforts towards individualized CBCT protocols which balance diagnostic efficacy with dose reduction aimed at dose optimization consistent with ALADA (as low as diagnostically acceptable)

Endodontic treatment and considerations (merged cell — applies to all three clinical situations)

Endodontic treatment should be initiated 7–14 d after replantation and before splint removal.

Calcium hydroxide is recommended as an intracanal medication for up to 4 wk followed by root canal filling.

Antibiotics (merged cell — applies to all three clinical situations)

Clinicians can consider antibiotic use based on individual risk factors such as patient’s immune status, level of contamination during the tooth’s extra-alveolar time and the presence of severe gingival and soft tissue lacerations.

If the clinician deems systemic antibiotics necessary, penicillin class of antibiotics should be considered for 7 d at the appropriate dose according to patient’s age and weight.

If the avulsed tooth has been in contact with soil, and if tetanus coverage is uncertain, refer to a physician for a tetanus booster.

Patient instructions (merged cell — applies to all three clinical situations)

Avoid participation in contact sports for at least 2 wk.

Soft diet, brush teeth with a soft toothbrush after each meal, use a 0.12% chlorhexidine mouth rinse twice a day for 1–2 wk.

Follow-up (merged cell — applies to all three clinical situations)

Splint removal and clinical and radiographic examination after 1–2 wk.

Clinical and radiographic examination at 4 wk, 6–8 wk, 3 mo, 6 mo, 1 y and then yearly thereafter for at least 5 y, aiming to detect radiolucencies or signs of root resorptions. Intraoral parallel radiographs should be taken using positioning devices to allow imaging standardization essential to comparisons. Ankylosis is likely to occur, particularly after delayed replantation and must be taken into consideration.

Especially in children and adolescents, ankylosis is frequently associated with infraposition of the tooth.

Decoronation may be necessary when infra-position (> 2–3 mm) is seen and depending on the patient’s growth pattern.

Establishing good communication with the patient and guardian about this likely outcome and other possible post-traumatic complications is necessary to ensure their cooperation for careful follow ups.

Please also see follow-up Table 8.

Table 7 — Treatment Guidelines for Avulsed Permanent Teeth with Open Apex

Immediate treatment

Clinical situation A — Tooth has already been replanted

Leave tooth in place.
Clean affected area with water, saline or 0.12% chlorhexidine.
Verify normal position of the replanted tooth clinically and radiographically.
If the tooth or teeth were replanted in the wrong socket or rotated, consider repositioning the tooth/teeth into the proper location for up to 48 h after the trauma.
Apply a flexible and passive splint for 1–2 wk. In cases of associated alveolar or jawbone fracture, a more rigid splint is indicated and should be left for about 4 wk.
Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area.

Clinical situation B — Extra-oral dry time 60 minutes or less – or – extra-oral dry time 60 minutes or less and tooth kept in physiologic storage medium (milk, HBSS, saline) or saliva for several hours

If contaminated, clean the root surface and apical foramen with a stream of saline. Do not handle the root, hold the avulsed tooth by its crown.
Place or leave the tooth in a storage medium while taking the history, examining the patient clinically and radiographically and preparing the patient for the replantation.
Administer local anesthesia preferably without vasoconstrictor.
Irrigate the alveolar socket with saline.
Examine the alveolar socket. If there is a fracture of the socket wall, reposition the fractured fragment into its original position with a suitable instrument.
Removal of the coagulum with a saline stream may allow better repositioning of the tooth.
Replant the tooth slowly using slight digital pressure.
Verify normal position of the replanted tooth clinically and radiographically.
Apply a flexible and passive splint for 1–2 wk. In cases of associated alveolar fracture, a more rigid splint is indicated and should be left for about 4 wk.
Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area.

Clinical situation C — Extra-oral dry time longer than 60 minutes

Check the avulsed tooth and remove debris from its surface by gently agitating it in the storage medium. Alternatively, a stream of saline can be used to rinse its surface.
Place or leave the tooth in a storage medium while taking the history, examining the patient clinically and radiographically and preparing the patient for the replantation.
Administer local anesthesia preferably without vasoconstrictor. Irrigate the alveolar socket with saline.
Examine the alveolar socket. If there is a fracture of the socket wall, reposition the fractured fragment into its original position with a suitable instrument.
Removal of the coagulum with a saline stream may allow better repositioning of the tooth.
Replant the tooth slowly using slight digital pressure.
Verify normal position of the replanted tooth clinically and radiographically.
Apply a flexible and passive splint for 1–2 wk. In cases of associated alveolar fracture, a more rigid splint is indicated and should be left for about 4 wk.
Suture gingival and soft tissue lacerations, especially in the tooth’s cervical area.
Although in delayed replantation the outcomes tend to be less favorable due to increased likelihood of ankylosis and root resorption, the main goal is to temporarily maintain the child’s or adolescent’s tooth for esthetic, functional and psychological reasons and to preserve alveolar bone.

Radiographic assessment and findings (merged cell — applies to all three clinical situations)

Intraoral radiographs are recommended after an injury, for diagnostic purposes and as a baseline for follow-ups. Film-holders should be used, aiming for imaging standardization essential to future comparisons.

Three intraoral parallel periapical radiographs centered on the 2 central incisors, the right lateral incisor and the left lateral incisor.
One occlusal angulation radiograph (a periapical size film or sensor may be used, as its size is often sufficient to visualize the injured incisor area).

An intraoral parallel periapical and an occlusal radiograph can be taken to confirm the proper repositioning.

CBCT is usually not needed to confirm the proper repositioning of the avulsed tooth. CBCT may however be considered if there are clinical signs indicating a possible alveolar bone fracture and if the additional information it could provide will likely change the anticipated treatment plan. Limited FOV CBCT imaging may then be cautiously used as an additional exam. It is important to consider that current dental CBCTs can expose patients to a higher effective radiation dose than an intra-oral radiograph. Please read **

**Regarding CBCT Utilization: Although a CBCT study is inherently higher effective radiation dose than intraoral imaging, CBCT imaging maintains a higher diagnostic utility over traditional intraoral images. The practitioner should consider the benefits and risks of such three dimensional imaging modalities, given that traumatic dental injuries disproportionately affect children and adolescents under the age of 18 who are more susceptible to radiation during their physiologic growth. Therefore, the practitioner should make strong efforts towards individualized CBCT protocols which balance diagnostic efficacy with dose reduction aimed at dose optimization consistent with ALADA (as low as diagnostically acceptable)

As per the AAE and AAOMR Joint Position Statement on the use of cone-beam computed tomography in endodontics, CBCT should only be performed after a thorough history taking, clinical examination, and the need for imaging cannot be met by lower dose two-dimensional radiographs. Patients, especially children, should be properly instructed and positioned to prevent any movements during image acquisition to avoid the need for a repeat exposure(s). Practitioners should be aware of operator-dependent settings specific to their particular CBCT imaging machine with the appropriate resolution settings and smallest FOV selected for the given patient-specific factors. Practitioners might also consider obtaining informed consent from the patient or their legal guardian prior to proceeding with CBCT imaging.

Endodontic treatment and considerations (merged cell — applies to all three clinical situations)

The goal for replanting developing and immature teeth in children is to allow for possible spontaneous pulp space revascularization.

For teeth with open apex endodontic treatment should be avoided unless there are clinical and/or radiographic signs of endodontic infection or infection-related (inflammatory) external root resorption on follow-ups.

Apexification or regenerative endodontic treatment is indicated when the pulp of teeth with incomplete root formation becomes necrotic.

Endodontic treatment should be initiated immediately when there is evidence of infection-related (inflammatory) external root resorption. The canal should be medicated with calcium hydroxide for 3 wk, followed by its replacement every 3 mo until there is radiographic evidence of periradicular bone healing. Final obturation of the root canal system can then be performed. Gradual re-establishment of the lamina dura and periodontal ligament space with arrest of the resorption process usually ensues and should be monitored.

Antibiotics (merged cell — applies to all three clinical situations)

Clinicians can consider antibiotic use based on individual risk factors such as patient’s immune status, level of contamination during the tooth’ extra-alveolar time and the presence of severe gingival and soft tissue lacerations.

If the clinician deems systemic antibiotics necessary, penicillin class of antibiotics should be considered for 7 d at the appropriate dose according to patient’s age and weight.

If the avulsed tooth has been in contact with soil, and if tetanus coverage is uncertain, refer to a physician for a tetanus booster.

Patient instructions (merged cell — applies to all three clinical situations)

Avoid participation in contact sports for at least 2 wk.

Soft diet, brush teeth with a soft toothbrush after each meal, use a 0.12% chlorhexidine mouth rinse twice a day for 1–2 wk.

Follow-up (merged cell — applies to all three clinical situations)

Splint removal and clinical and radiographic examination after 1–2 wk.

Clinical and radiographic examination at 4 wk, 6–8 wk, 3 mo, 6 mo, 1 y, and then yearly thereafter for at least 5 y, aiming to detect radiolucencies or signs of root resorptions.

Intraoral parallel radiographs should be taken using positioning devices to allow imaging standardization essential to comparisons.

Ankylosis is likely to occur, particularly after delayed replantation and must be taken into consideration. Especially in children and adolescents, ankylosis is frequently associated with infraposition of the tooth.

Decoronation may be necessary when infraposition (> 2–3 mm) is seen and depending on the patient’s growth pattern.

Please also see follow-up Table 8.

Table 8 — Follow-up Procedures for Avulsed Permanent Teeth with Closed and Open Apices

Time	Closed apex — Extra-oral dry time 60 minutes or less – or – extra-oral dry time 60 minutes or less and tooth was kept in physiologic storage medium (milk, HBSS, saline) or saliva for several hours	Closed apex — Extraoral dry time > 60 minutes	Open apex — Regardless of extraoral dry time
2 wk	Endodontic treatment with placement of calcium hydroxide for up to 4 wk should be initiated. Clinical and radiographic examination. Splint removal. Weight and height measurements as a baseline for growth. This may become critical to determine the time of decoronation, if needed. Establishing good communication with the patient and guardian about likely outcomes such as ankylosis and other post-traumatic complications is necessary to ensure their cooperation for careful follow ups.		Clinical and radiographic examination. Splint removal. Continued root development is one of the favorable outcomes desired after replantation of an avulsed immature tooth and must be monitored. No endodontic treatment of an avulsed immature tooth should be initiated unless clinical or radiographic signs of pulp necrosis and infection and/or infection-related (inflammatory) external root resorption are evident on follow-ups. See box below "Regarding Infection-Related (Inflammatory) External Root Resorption" Endodontic treatment of necrotic immature teeth involves apexification or regenerative endodontic treatment. Weight and height measurements as a baseline for growth. This may become critical to determine the time of decoronation, if needed. Establishing good communication with the patient and guardian about likely complications such as pulp necrosis, infection-related (inflammatory) external root resorption and ankylosis is necessary to ensure their cooperation for careful follow ups.
4 wk	Clinical and radiographic examination. Endodontic filling may be carried out.	(merged with the Open apex column) Clinical and radiographic examination.	Clinical and radiographic examination.
6–8 wk	Clinical and radiographic examination.	Endodontic treatment should be initiated immediately when there is evidence of infection-related (inflammatory) external root resorption. The canal should be medicated with calcium hydroxide. See box below "Regarding Infection-Related (Inflammatory) External Root Resorption)
3 mo	Clinical and radiographic examination.
6 mo	Clinical and radiographic examination.
1 y	Clinical and radiographic examination.
Annually for at least 5 y	Clinical and radiographic examination.

(Blank cells = merged cells in the original; the merged cell’s statement applies to all the columns it spans.)

Important general considerations on follow-ups

Regarding radiographic examination:

Intraoral parallel radiographs should be taken. Positioning devices should be used, aiming for imaging standardization essential to comparisons.

Regarding infection-related (inflammatory) external root resorption:

Endodontic treatment should be initiated immediately when there is evidence of infection-related (inflammatory) external root resorption. The canal should be medicated with calcium hydroxide for 3 wk, followed by its replacement every 3 mo until there is radiographic evidence of periradicular bone healing, usually accompanied by gradual reestablishment of the lamina dura and periodontal ligament space with arrest of the resorption process. The final obturation of the root canal system can then be performed.

Regarding ankylosis (replacement root resorption):

Avulsed teeth are at high risk for ankylosis, particularly after delayed replantation.
Ankylosis and potential infra-positioning of the tooth should be monitored while considering patient’s overall growth pattern.
A decoronation procedure might become necessary when infra position (> 2–3 mm) is seen and depending on the patient’s growth pattern.

Practitioners should Inform the Patients (and/or their parents or guardians) about:

Potential post-traumatic complications
The necessity to comply with the follow-up regimen
Unfavorable outcomes requiring prompt endodontic treatment
The necessity to return to the clinic if they observe any unfavorable outcomes in the interval between follow-up visits

Notes on this conversion

The document is a facsimile of the printed article; page numbers of the original are marked with HTML comments (e.g. ).
Multi-column tables are reproduced as Markdown tables with the table’s field/row labels in the first column. Cells that were merged across several columns in the original are marked in place, and — for the time-based follow-up tables (Tables 2, 5, 8) — the merged statement is repeated in every column it covered, with blank cells left empty where the original cell was empty.
Tables 6 and 7 are presented as one "Immediate treatment" subsection per clinical situation, followed by the rows that were single cells merged across all three situations in the original.
In the printed PDF the "greater than" glyph in expressions such as "> 60 minutes", "> 7 mm" and "> 2–3 mm" does not survive text extraction; it has been restored here from the rendered page image. Italic emphasis on and in Table 1 is reproduced as it appears in the source.

附录 · 中文临床速查摘要

使用说明
本附录是上文英文全文的中文提炼与速查，不是逐字翻译。用药剂量、夹板时间、随访时点等关键数据均取自原文表格；凡涉及合并单元格的具体归属与措辞，请以英文正文（表 1–表 8）为准。
原文献为美国牙髓病医师协会（AAE）立场声明，内容基于 2020 年国际牙外伤学会（IADT）《牙外伤评估与处理指南》改编。文中"推荐"不等于"强制方案"，需结合患者年龄、全身状况、牙根发育程度与依从性个体化决策。

一、总则（适用于所有牙外伤）

急诊优先顺序：先排除颅脑、颌面骨折及软组织异物，再处理牙齿。唇、颊撕裂伤应拍片排查 embedded 牙碎片或异物。
影像学基线：伤后应拍摄并留存标准化影像，便于日后对比。建议一套共 4 张：
- 3 张平行投照根尖片（分别以两颗中切牙、右侧切牙、左侧切牙为中心）；
- 1 张咬合角度片（可用根尖片胶片或传感器）。
- 必须使用定位/持片装置，保证重复投照的一致性。
CBCT 指征：仅在病史采集、临床检查完成且二维影像无法满足诊断需要时使用；遵循 ALADA 原则（as low as diagnostically achievable，在可达到诊断目的前提下尽量低剂量），选择最小视野（FOV）与合适分辨率；儿童青少年尤须谨慎，必要时取得知情同意。
牙髓活力判断：外伤当时无反应≠牙髓坏死。成熟恒牙伤后 3 个月仍无反应，强烈提示牙髓坏死；牙齿变色本身不足以诊断坏死。
共同医嘱：软食；每餐后用软毛牙刷刷牙；0.12% 氯己定含漱液每日 2 次，连用 1–2 周。全脱位病例还需避免对抗性运动至少 2 周。
沟通义务：向患者（及家长/监护人）说明可能的并发症、必须依从的随访计划、出现何种情况需立即返诊。外伤牙不能保证永久保留。

二、牙体硬组织与牙槽突损伤（对应表 1、表 2）

2.1 简单冠折（釉质或釉质-牙本质折，未露髓）

项目	要点
诊断	釉质或釉质-牙本质折断，无牙髓暴露；牙髓活力多正常，无松动，叩诊不痛
处理	有牙片者：干燥保存的碎片先于水或生理盐水中复水 15–20 分钟，再粘接回位；无碎片：玻璃离子暂时覆盖暴露牙本质，或 bonding + 复合树脂做长期修复；暴露牙本质距牙髓 <0.5 mm（粉红色但无出血）时，垫氢氧化钙后以玻璃离子等覆盖
最终修复	采用公认的牙体修复材料完成永久修复

2.2 复杂冠折（釉质-牙本质折，伴牙髓暴露）

项目	要点
诊断	牙髓暴露、对刺激敏感；牙髓活力多正常；无松动，叩诊不痛；若叩痛需排查合并脱位或根折
处理（年轻恒牙，根尖未闭合）	保活髓为第一要务：直接盖髓或部分牙髓切断术，以保证牙根继续发育。氢氧化钙类与非变色硅酸钙水门汀均适用
处理（根尖已闭合）	上述保髓治疗同样是首选
牙片利用	盖髓/部分牙髓切断后可将复水后的牙片粘接回位
后续	必要时以修复材料完成最终修复；若需桩核固位（成熟牙），牙髓治疗为优选

2.3 冠根折

项目	要点
诊断	涉及釉质、牙本质、牙骨质，牙体组织缺损，折线位于龈缘以下；牙髓可暴露也可不暴露；牙髓活力多正常，叩痛，冠向碎片可能松动
处理	治疗计划未定前，可将松动碎片暂时粘接固定于邻牙或非松动部分数日（美观考虑）。未露髓：去除碎片，必要时切龈后修复；露髓 + 根尖未闭合：部分牙髓切断术保活髓；露髓 + 根尖闭合：牙髓治疗后桩核冠修复
其他选择	正畸牵引或手术牵引根向碎片以暴露边缘；成人可选择拔牙后即刻/延期种植冠、传统或粘接桥；牙根埋置、意向性再植（可旋转牙根）、自体牙移植亦为替代方案

2.4 根折

项目	要点
诊断	折线可位于根尖 1/3、根中 1/3 或颈部 1/3；冠向碎片可松动或移位，根向碎片通常不移位；龈沟可有出血；叩痛；牙髓初期可无反应（可为暂时性损伤）
急诊处理	冠向碎片已完全脱出牙槽窝者，按全脱位处理（表 6–8）。否则：生理盐水冲洗暴露的根面 → 尽早复位冠向碎片并拍片确认位置 → 弹性夹板固定 4 周；折线靠近牙颈部者延长固定（最长 4 个月）
成熟牙颈部折	若折线位于牙槽嵴顶以上、冠向碎片极松动：多需去除冠向碎片后行牙髓治疗 + 桩核冠；并可能需要正畸牵引根向片段、冠延长术、手术牵引甚至拔牙
牙髓处理	冠向半侧复位良好者，牙髓有较大机会存活或自行血运重建 → 不宜过早做牙髓治疗，待出现明确坏死/感染征象再行冠向片段至折线处的牙髓治疗；根向片段极少需要牙髓治疗。折线区暂时性内吸收属愈合过程，不需处理

2.5 牙槽突骨折

项目	要点
诊断	含牙骨段骨折并多松动；折线可自牙槽嵴顶至根尖任何水平；多牙受累时呈节段性松动；常因骨段错位出现咬合干扰；受累牙初期可无牙髓反应
处理	复位移位骨段 → 弹性被动夹板固定 4 周 → 缝合软组织撕裂。急诊时禁忌做牙髓治疗；监测所有受累牙牙髓状态，择期决定是否需牙髓治疗
影像	除常规 4 张片外，曲面体层有助于判断折线走向；CBCT 对判断腭侧/双皮质板受累有价值

2.6 上述损伤的共同医嘱与随访（表 1、表 2）

医嘱：软食、软毛牙刷、0.12% 氯己定每日 2 次 1–2 周。
随访：按表 2 —— 1 周、4 周、6–8 周、4 个月、6 个月、1 年，之后每年 1 次至少 5 年。
- 伤后即刻牙髓无反应者，应在 4 周时加做临床与影像复查。
- 根尖 1/3 与根中 1/3 根折在 4 周拆夹板；颈部根折在 4 个月拆夹板。
合并伤：冠折合并脱位性损伤者按表 5 随访；合并全脱位者按表 8 随访。

三、牙周组织损伤：震荡、亚脱位与各类脱位（对应表 3、表 4、表 5）

3.1 四型鉴别（表 4）

	牙震荡	亚脱位	脱位（脱出性、侧向）
叩诊疼痛	有	有	有
松动	无	有	有
移位	无	无	有

3.2 分型速查

类型	诊断要点	急诊处理
牙震荡	触/咬合痛；无移位、无异常松动；牙髓活力多正常；叩诊与触诊痛	无需处理
亚脱位	触/咬合痛；无移位但有松动、叩痛、触痛；牙髓初期可无反应（可恢复）	通常无需处理；为舒适可用弹性被动夹板固定 2 周
脱出性脱位	牙向冠方/切端移位，临床牙冠变长，过度松动；牙髓多无反应	生理盐水冲洗 → 轻柔推回牙槽窝 → 弹性被动夹板 2 周 → 缝合（尤其颈部）。应尽早复位；12–24 小时后可考虑正畸复位或（刮除牙槽窝后）意向性再植
侧向脱位	除轴向外的任意方向移位，常伴唇侧皮质骨骨折；牙"锁"在骨内、看似不动；牙槽突可触及骨折；牙髓多无反应	生理盐水冲洗 → 手法或拔牙钳轻牵出骨锁后复位（或触诊唇侧牙龈，一指压根尖向下，另一指旋转并推回牙槽窝）→ 弹性被动夹板 4 周 → 缝合。亦应尽早复位
嵌入性脱位	牙向牙槽骨内移位，呈部分或完全"临床短冠"、不动、锁死；叩诊呈高调金属音（骨性粘连）；牙髓多无反应	见下表 3.3 的复位策略；复位后弹性被动夹板 2 周（移位广泛者 4 周），并缝合

3.3 嵌入性脱位的复位策略（按牙根发育状态与嵌入深度）

牙根状态	嵌入深度	处理
根尖未闭合	≤7 mm	观察待其自然再萌；无移动则在 4 周内开始正畸复位
根尖未闭合	>7 mm	4 周内手术或正畸复位
根尖已闭合	≤3 mm	观察待其自然再萌；8 周仍无移动则在骨性粘连发生前手术或正畸复位
根尖已闭合	3–7 mm	手术或正畸复位
根尖已闭合	>7 mm	手术复位

3.4 牙髓处理原则（表 3）

类型	牙髓处理
牙震荡、亚脱位	监测牙髓反应，直至可作出明确牙髓诊断
脱出性、侧向脱位	根尖已闭合：牙髓坏死与感染常见，确诊即行牙髓治疗；根尖未闭合：密切观察牙髓活力
嵌入性脱位	根尖已闭合：牙髓多将坏死，应于伤后 2 周（或一旦可上橡皮障）开始牙髓治疗，清理消毒后氢氧化钙封药最长 4 周；根尖未闭合：密切观察牙髓活力
共性	根尖未闭合并牙髓坏死者可行根尖诱导成形术或再生性牙髓治疗；一旦出现感染相关的（炎症性）外根吸收，立即牙髓治疗：氢氧化钙封药 3 周，之后每 3 个月更换，直至影像学显示根周骨愈合，再完成根管充填

3.5 医嘱与随访（表 5）

医嘱同前（软食、软毛牙刷、0.12% 氯己定 1–2 周）。
随访：2 周、4 周、6–8 周、3 个月、6 个月、1 年，之后每年至少 5 年。
- 2 周：亚脱位者拆夹板；脱出性者拆夹板。
- 4 周：侧向脱位者拆夹板；嵌入牙经手术/正畸复位者拆夹板。
- 3 个月：若 6–8 周时牙髓仍无反应但无其他坏死征象，应安排 3 个月复查。
随访影像不常规使用 CBCT；仅在临床发现提示需要三维信息时考虑。

四、全脱位（牙撕脱）（对应表 6、表 7、表 8）

4.1 三种临床情形的即刻处理

情形	即刻处理要点
A. 牙已被再植	保留在口内；清水/生理盐水/0.12% 氯己定清洁受累区；临床 + 影像确认位置；若植入错误牙位或扭转，48 小时内可考虑重新复位；弹性被动夹板 1–2 周（合并牙槽突或颌骨骨折者改用较硬夹板约 4 周）；缝合软组织
B. 体外干燥 ≤60 分钟，或干燥 ≤60 分钟且保存于生理性介质（牛奶、HBSS、生理盐水）或唾液中数小时	置于保存介质中完成病史采集与检查 → 局麻（最好不含血管收缩剂）→ 生理盐水冲洗牙槽窝（窝壁骨折者复位骨片；冲洗清除血凝块以利复位）→ 持牙冠、以生理盐水轻洗根面与根尖孔 → 轻压缓速再植 → 临床 + 影像确认位置 → 弹性被动夹板 1–2 周（合并牙槽突骨折者较硬夹板约 4 周）→ 缝合
C. 体外干燥 >60 分钟	同上，但根面处理改为"在保存介质或生理盐水纱布中搅动以去除松散碎屑与可见污染"；年轻恒牙可另以生理盐水冲洗根面。即便是延期再植（预后较差、易发生骨性粘连与根吸收），主要目标仍是暂时保留患牙以维持美观、功能、心理需求并保存牙槽骨

注：根尖未闭合的患牙若已污染，清洗根面与根尖孔时只能持牙冠，不得触碰牙根。

4.2 成熟恒牙（根尖闭合）

牙髓治疗时机：再植后 7–14 天、拆夹板之前。
氢氧化钙根管内封药最长 4 周，随后完成根管充填。
出现感染相关（炎症性）外根吸收时按前述方案处理（氢氧化钙 3 周，每 3 个月更换直至骨愈合）。

4.3 年轻恒牙（根尖开放）

再植的根本目的是争取牙髓血运重建、牙根继续发育。
不做预防性牙髓治疗：仅在临床和/或影像出现牙髓坏死、感染或感染相关外根吸收征象时才干预。
牙髓坏死者行根尖诱导成形术或再生性牙髓治疗。

4.4 抗生素与破伤风

是否使用抗生素取决于个体风险（免疫状态、体外污染程度、严重牙龈与软组织撕裂）。
确需全身用药时：青霉素类 7 天，按年龄与体重给药。
牙曾接触土壤且破伤风免疫史不明者，转诊内科评估是否需加强接种。

4.5 随访（表 8，三种情形共用时间轴）

时间	根尖闭合，干燥 ≤60 分钟（或湿保存）	根尖闭合，干燥 >60 分钟	根尖开放（无论干燥时间）
2 周	开始牙髓治疗并氢氧化钙封药（最长 4 周）；临床 + 影像检查；拆夹板；记录身高体重作为生长基线（判断去冠时机）；与患者/家长沟通骨性粘连等预后	—	临床 + 影像检查；拆夹板；监测牙根继续发育；无坏死/感染/外根吸收征象者不做牙髓治疗；坏死年轻恒牙行根尖诱导成形或再生性牙髓治疗；记录身高体重；沟通牙髓坏死、外根吸收与骨性粘连风险
4 周	临床 + 影像检查；可完成根管充填	临床 + 影像检查	临床 + 影像检查
6–8 周	临床 + 影像检查	一旦发现感染相关外根吸收，立即牙髓治疗并以氢氧化钙封药	—
3 个月 / 6 个月	临床 + 影像检查	—	—
1 年 / 之后每年至少 5 年	临床 + 影像检查	—	—

"—"表示原表该单元格为空（原文中多为跨列合并单元格，已按原表样貌呈现）。

全脱位随访的特别提示

目标是尽早发现根周透射影与根吸收征象；应使用定位装置拍摄平行投照根片以便对比。
骨性粘连（替代性根吸收）风险高，延期再植者尤甚；儿童青少年常伴牙齿低位（infraposition）。
出现 >2–3 mm 的低位 且结合患者生长型，可能需行去冠术（decoronation）。
与患者及监护人充分沟通上述可能的结局，是保证长期随访依从性的前提。

五、关键数值速记

项目	数值
弹性被动夹板固定时间	亚脱位 2 周；脱出性脱位 2 周；侧向脱位 4 周；嵌入性（复位后）2 周（广泛移位 4 周）；根折 4 周（颈部折可延至 4 个月）；牙槽突骨折 4 周；全脱位 1–2 周（合并牙槽突/颌骨骨折约 4 周）；冠根折松动碎片仅需临时固定数日
牙髓治疗启动时机	全脱位（根尖闭合）：再植后 7–14 天且拆夹板前；嵌入性脱位（根尖闭合）：伤后 2 周；感染相关外根吸收：一经发现立即；牙槽突骨折：急诊期禁忌
氢氧化钙封药	全脱位与嵌入性脱位最长 4 周；感染相关外根吸收 3 周，之后每 3 个月更换直至根周骨愈合
系统性抗生素	青霉素类 7 天（按年龄、体重）
牙碎片复水	水或生理盐水 15–20 分钟（干燥保存者）
牙髓坏死判定	成熟恒牙伤后 3 个月仍无活力反应
去冠术指征	牙齿低位 >2–3 mm（结合生长型）
氯己定	0.12%，每日 2 次，1–2 周
运动限制	全脱位者避免对抗性运动 ≥2 周
随访总时长	至少 5 年（多类损伤为此要求）

六、中英术语对照

中文	English
简单冠折 / 复杂冠折	uncomplicated / complicated crown fracture
冠根折	crown-root fracture
根折	root fracture
牙槽突骨折	alveolar fracture
牙震荡	concussion
亚脱位	subluxation
脱出性脱位	extrusive luxation
侧向脱位	lateral luxation
嵌入性脱位	intrusive luxation
全脱位 / 牙撕脱	avulsion
弹性被动夹板	flexible and passive splint
直接盖髓 / 部分牙髓切断术	pulp capping / partial pulpotomy
根尖诱导成形术	apexification
再生性牙髓治疗（牙髓血运重建）	regenerative endodontic treatment
感染相关的（炎症性）外根吸收	infection-related (inflammatory) external root resorption
骨性粘连 / 替代性根吸收	ankylosis / replacement root resorption
去冠术	decoronation
意向性再植	intentional replantation
牙根埋置	root submergence
自体牙移植	auto-transplantation
牙周膜	periodontal ligament (PDL)
锥形束 CT	cone-beam computed tomography (CBCT)
生理性保存介质	physiologic storage medium（牛奶、HBSS、生理盐水、唾液）

七、易错点提醒

不要仅凭"外伤当时无牙髓反应"就做牙髓治疗——除牙槽突骨折急诊期禁忌外，多数损伤应先观察，待明确坏死/感染征象（表 1、表 3）。
牙槽突骨折在急诊时禁忌牙髓治疗，应复位、固定、缝合后监测。
根折不要急于做牙髓治疗；冠向半侧复位良好者牙髓可能存活或血运重建；折线区暂时性内吸收属正常愈合。
年轻恒牙全脱位不做预防性根管治疗，核心是争取血运重建与牙根继续发育。
全脱位（根尖闭合）的牙髓治疗须在再植后 7–14 天、拆夹板前完成，过早或过晚均不利。
延期再植不等于放弃：干燥 >60 分钟仍应再植，目的是维持美观、功能与牙槽骨，但需提前告知骨性粘连与去冠术的可能性。
牙齿变色与活力测试无反应都不能单独作为牙髓坏死的诊断依据；成熟恒牙以伤后 3 个月为关键观察点。
CBCT 不是常规复查项目，仅在需要三维信息且符合 ALADA 原则时使用，儿童青少年尤应权衡。

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