Open Apex (Immature Root): DO NOT START root canal treatment IMMEDIATELY (wait for revascularization). If necrosis develops during follow-up: Apexification / Revascularization. Closed Apex (Mature Root): Start root canal treatment within 7-10 days (while splinted). Keep calcium hydroxide in the canal for 4-8 weeks, then place the permanent filling.

(Goal: To preserve bone height and aesthetics, even temporarily) Open Apex (Immature Root): Revascularization is expected, but start apexification or root canal treatment as soon as necrosis/infection is observed. Closed Apex (Mature Root): Start root canal treatment within 7-10 days. Keep calcium hydroxide in the canal for 4-8 weeks, then place the permanent filling.

Priority Repositioning of the Socket: If a fracture in the alveolar socket wall is detected, the fractured bone fragment must be brought to its original position with an appropriate instrument before replanting the tooth. If resistance is encountered while seating the tooth, it indicates a labial alveolar bone fracture, and the alveolar socket should be repositioned before the tooth. Extension of Splint Time: This is the most important detail that changes the treatment protocol. In cases accompanied by a marginal bone (alveolar) fracture, the flexible splinting time, which is normally 2 weeks, should be extended to 3-4 weeks, and to exactly 4 weeks in avulsion cases. Healing (Clinical Note): Alveolar fractures seen together with root fractures usually heal without problems.

1. Diagnosis and Test Warning Radiograph: A single angle is not enough! At least 3 different angles (45°, 90°, 110°) should be taken to avoid missing the fracture line. Vitality: Not reliable for the first 2-6 months (Pulp healing can take up to 12 months, do not jump to root canal treatment immediately). 2. Emergency Intervention and Splint Times (The displaced coronal fragment is seated with finger/forceps pressure. If there is resistance, it might be a labial bone fracture, fix the alveolar socket first!) General Root Fractures: Seat it and apply a flexible splint for 2-4 weeks. (If there is no mobility, a splint might not be needed). Fractures in the Cervical (Neck) Third: If the fracture is far from the crest but close to the cervical, extend the splint time up to 4 months. Fractures at or Above the Crest Level: Poor prognosis. Extract the coronal (upper) fragment, plan orthodontic/surgical extrusion (pulling out) for the root (apical) fragment. 3. Advanced Treatment (If Necrosis Develops) If the pulp dies during follow-up (radiolucency, fistula, pain, etc.), root canal treatment is ONLY performed on the upper (coronal) fragment up to the fracture line. A hard tissue barrier is established at the root end of the upper fragment with Calcium Hydroxide or MTA. The lower (apical) fragment usually remains vital and obliterates itself, do not touch that part.

1. Clinical and Radiographic Picture Findings: The tooth is elongated out of its socket (coronally), is mobile, and bleeds from the gums. Vitality tests usually yield a negative response. Radiograph: The space at the root apex is significantly increased. 2. Emergency Intervention and Repositioning (Critical Distinction!) Early Presentation (<24 Hours): Gently push the tooth back to its normal position (reposition). Late Presentation (>24 Hours) or if Clot is Present: The tooth might have stabilized in its new position or the blood clot at the apex might prevent seating. Do not push with force! Instead, perform "intentional replantation" (Surgically extract the tooth and replant it within 10 minutes). Splint: In both cases, apply a flexible splint for 2 weeks after seating. 3. Advanced Treatment According to Apex Status Closed Apex (Mature Root): Nerve tissue always dies (necrosis is guaranteed). Start root canal treatment within 7-10 days after trauma without waiting to prevent infection. Open Apex (Immature Root): There is a chance of revascularization. Do not start root canal treatment immediately, observe. If the pulp dies during follow-up, perform apexification.

1. Clinical Picture Findings: The tooth is impacted into the bone. It is not mobile, gives a metallic/high-pitched sound on percussion. It is the luxation type with the worst prognosis. 2. Open Apex (Immature Root) Wait: Do not intervene immediately, wait for the tooth to erupt spontaneously for 3 weeks. If it doesn't erupt: Pull it out with orthodontic or surgical force. Pulp: Do not perform root canal treatment, monitor vitality. Perform apexification/revascularization only if necrosis develops. 3. Closed Apex (Mature Root) Do Not Wait: Extract the tooth from its socket with orthodontic or surgical extrusion immediately after trauma (within 2-3 weeks). (If you do surgical extrusion, apply a flexible splint for 4 weeks). Pulp (100% Necrosis Expected): DEFINITELY start root canal treatment within 2 weeks and place calcium hydroxide in the canal.

1. Clinical Picture Condition: The tooth is displaced out of the socket (mostly palatal/lingual direction). Mobility: It does not move because it is locked in the bone. Findings: It gives a high/metallic sound on percussion, vitality test is negative, bleeding from the gingival sulcus may be present. 2. Emergency Intervention Repositioning: Seat it with finger pressure under anesthesia and check with a radiograph. Difficulty: Do not use force if the tooth does not seat. Wait 2 weeks, then correct with a removable appliance. Splint: Apply a flexible splint for 4 weeks. Extend the time by 3-4 weeks if a marginal bone fracture is present. 3. Pulp Protocol Open Apex: Do not perform root canal treatment immediately, follow up. Perform apexification only if necrosis develops. Closed Apex: DEFINITELY start root canal treatment within 2 weeks in those developing necrosis. Resorption Prevention: Place calcium hydroxide in the canal against inflammatory resorption. If there is no lesion at the 3-month follow-up, complete the permanent filling.

1. Clinical Picture Condition: Fracture of the alveolar socket wall or alveolar process (the bone surrounding the tooth). Diagnosis: Detected when groups of teeth move together as a block (group mobility test). Course: Frequently seen together with root fractures or luxation (displacement) injuries. Alveolar fractures accompanying root fractures usually heal without problems. 2. Emergency Intervention Repositioning: If you encounter resistance while seating the traumatized tooth (e.g., labial alveolar bone fracture), first seat the alveolar socket (fractured bone fragment). Splint: Apply a flexible splint for 4 weeks to stabilize the fractured bone. If there is also a marginal bone fracture in a lateral luxation case, extend the splint time by another 3-4 weeks. 3. Pulp Protocol Follow-up: Apply open/closed apex rules of the main trauma type (avulsion, luxation, etc.) of the tooth accompanying the fracture and strictly monitor the vitality of the affected teeth regularly with vitality tests.

1. Clinical Picture Condition: There is no displacement or abnormal mobility in the tooth. Findings: There is increased sensitivity to percussion. It may not respond to pulp vitality tests initially. 2. Emergency Intervention Procedure: Do not apply specific treatment most of the time. Just slightly relieve the tooth from occlusion. Patient Warning: Advise the patient not to bite or chew with that tooth until the sensitivity decreases. 3. Pulp Protocol and Follow-up Follow-up: Always repeat pulp vitality tests at 1, 3, 6, and 12-month intervals. Complication Risk: Do not neglect regular check-ups as pulp necrosis or root canal obliteration may develop later.

First Step: Remove the mobile coronal fragment immediately under anesthesia. Surgical Procedure: Perform gingivectomy and, if necessary, osteotomy before restoration to expose the fracture line. Treatment: Restore the tooth according to its original function and aesthetics by protecting the exposed dentinal tubules and pulp.

Shallow Fracture (Limited to the cervical 1/3 of the root or less): Remove the fragment, expose the fracture line with osteotomy and gingivectomy. After gingival healing and root canal treatment, make a post-supported restoration. Deep Fracture - Surgical Extrusion (If the fracture line is deeper): Extract the tooth and replant it 1-3 mm above (coronally to) the alveolar bone. Splint the tooth, complete root canal treatment after 3-4 weeks, and perform a post-supported repair within 2 months. Deep Fracture - Orthodontic Extrusion: First, remove the coronal fragment. Perform cervical pulpotomy on an open apex tooth, or pulpectomy (root canal) on a closed apex tooth. Extrude the tooth for 4 weeks with orthodontic force. Then restore the tooth temporarily, splint to adjacent teeth for 6 months, and then proceed to permanent restoration.

Condition: Cracks occur in the enamel due to direct trauma, the risk of pulp necrosis is low. There may be no sensitivity in the tooth. Diagnosis: Use a parallel light source (transillumination) to examine the crack lines. Treatment: Cover the crack line with resins to prevent food staining, apply fluoride. Because pulp vasculature might be damaged, perform regular vitality tests for 5 years.

Condition: Enamel and dentin are fractured but the pulp is not exposed. There is no sensitivity to percussion and mobility is within normal limits. Treatment (Shallow Fracture): If remaining dentin thickness is >0.5 mm, restore with composite using acid etching and bonding. Alternatively, reattach the fractured crown fragment for aesthetics. Treatment (Deep Fracture): If remaining dentin is <0.5 mm, protect the pulp with a calcium hydroxide material and complete the restoration.

Condition: Fracture involves enamel and dentin, exposing the pulp to the oral environment. Open Apex (Immature Root): Try to keep the tooth vital; remove 1-2 mm of pulp tissue from the exposure site (partial pulpotomy) and cover with calcium hydroxide, MTA, or Biodentine. If >72 hours have passed, perform a total pulpotomy. Strictly avoid direct pulp capping as the success rate is low. If the tooth becomes necrotic, perform apexification or pulp revitalization (revascularization). Closed Apex (Mature Root): If only a composite restoration is sufficient, vital pulp therapies (partial/total pulpotomy) can be preferred. However, if a complex restoration requiring a crown-bridge or intra-radicular support is planned, perform pulpectomy (root canal treatment) directly. If the pulp is necrotic, perform root canal treatment without delay.