Traumatic Dental Injuries: Classification

The International Association of Dental Traumatology reports that one of every two children sustain a dental injury, most often between the ages of 8 and 12 years. They suggest that, in most cases of dental trauma, a rapid and appropriate treatment can reduce its impact from both an oral and aesthetic standpoint.
Traumatic dental injuries (TDI) have been classified according to a variety of factors, such as etiology, anatomy, pathology, therapeutic considerations, and degree of severity.

Ellis and Davey Classification

• Class I - Fracture involving only the enamel.
• Class II - Fracture involving enamel and dentin but not exposing the pulp.
• Class III - Fracture involving enamel, dentin and pulp.
• Class IV - Traumatic tooth becomes non-vital (with or without the loss of crown structure).
• Class V - Total tooth loss (Avulsion).
• Class VI - Root fracture, with or without the loss of crown structure.
• Class VII - Displacement of tooth, without crown or root fracture.
• Class VIII - Fracture of the crown en masse.
• Class IX - Traumatic injury to the deciduous teeth.

WHO Classification

• 873.60: Enamel Fracture.
• 873.61: Crown fracture involving enamel and dentin, without pulp exposure.
• 873.62: Crown fracture with pulp exposure.
• 873.63: Root fracture.
• 873.64: Crown-root fracture.
• 873.66: Luxation.
• 873.67: Intrusion or Extrusion.
• 873.68: Avulsion.
• 873.69: Other injuries like soft tissue injuries.

International Classification of Diseases to Dentistry and Somatology

Injuries to Hard Dental Tissues and Pulp

• N 502.50 Uncomplicated crown fracture: Enamel infraction, Enamel fracture.
• N 502.51 Uncomplicated crown fracture: Enamel-dentin fracture.
• N 502.52 Complicated crown fracture: Fracture involving enamel, dentin and pulp.
• N 502.53 Root fracture: Fracture involving dentin, cementum and pulp.
• N 502.54 Uncomplicated crown-root fracture: Fracture involving enamel, dentin and cementum but not exposing the pulp.
• N 502.54 Complicated crown-root fracture: Fracture involving the enamel, dentin and cementum and exposing the pulp.

Injuries to Periodontal Tissues

• N 503.20 Concussion.
• N 503.20 Subluxation (Loosening).
• N 503.20 Extrusive luxation (Peripheral dislocation, Partial avulsion).
• N 503.20 Lateral luxation.
• N 503.21 Intrusive luxation (Central dislocation).
• N 503.22 Avulsion (Exarticulation).

Injuries to Supporting Bone

• N 502.40 Comminution of the maxillary alveolar socket.
• N 502.60 Comminution of the mandibular alveolar socket.
• N 502.40 Fracture of the maxillary alveolar socket wall.
• N 502.60 Fracture of the maxillary alveolar process.
• N 502.40 Fracture of the maxillary alveolar process.
• N 502.60 Fracture of the mandibular alveolar process.
• N 502.42 Fracture of the maxilla.
• N 502.61 Fracture of the mandible.

Injuries to Gingiva or Oral Mucosa

• S 01.50 Laceration of gingiva or oral mucosa.
• S 00.50 Contusion of gingiva or oral mucosa.
• S 00.50 Abrasion of gingiva or or oral mucosa.

Important Terminologies

• Enamel infraction: An incomplete fracture (crack) of the enamel without loss of tooth structure.
• Concussion: An injury to the tooth-supporting structures without abnormal loosening or displacement of the tooth, but with marked reaction to percussion.
• Subluxation: An injury to the tooth-supporting structures with abnormal loosening, but without displacement of the tooth.
• Luxation: An injury to the tooth-supporting structures with abnormal loosening, and displacement of the tooth.
• Extrusive Luxation (Peripheral dislocation, Partial avulsion): Partial displacement of the tooth out of its socket.
• Lateral Luxation: Displacement of the tooth in a direction other than axially. This is accompanied by comminution or fracture of the alveolar socket.
• Intrusive Luxation (Central dislocation): Displacement of the tooth into the alveolar bone. This injury is accompanied by comminution or fracture of the alveolar socket.
• Avulsion (Exarticulation): Complete displacement of the tooth out of its socket.
• Abrasion: A superficial wound produced by rubbing or scraping of the mucosa leaving a raw, bleeding surface.
• Contusion: A bruise usually produced by impact with a blunt object and not accompanied by a break in the mucosa, usually causing submucosal hemorrhage.
• Laceration: A shallow or deep wound in the mucosa resulting from a tear, and usually produced by a sharp object.

References

• Andreasen J., Andreasen F., Andersson L. (Editors) - Textbook and Color Atlas of Traumatic Injuries to the Teeth (4th Editon) - Blackwell Munksgaard.
• McDonald and Avery's Dentistry for the Child and Adolescent (11th Edition) -Mosby (2021).
• Arathi Rao - Principles and Practice of Pedodontics (3rd Edition) - Jaypee Brothers Medical Publishers (P) Ltd.
• Nikhil Marwah - Textbook of Pediatric Dentistry (4th Editon)-Jaypee Brothers Medical Publishers Pvt. Ltd. (2018).

_{*This article is an excerpt from the above mentioned books and Medical Sutras does not make any ownership or affiliation claims.}