Dental Trauma Guide 2025: Managing Avulsion, Luxation & Fracture

Dental trauma is a common incident and can happen during sports, accidents, or even routine play.
The first few minutes after an injury determine whether a tooth can be saved or lost.

This guid​​e outlines evidence-based chairside emergency protocols for avulsion, luxation, and fracture aligned with the latest IADT 2020 Guidelines, AAPD, and AAE trauma recommendations^1,2.

Step 1: Assessment

Before you reach for instruments, stabilize the situation.

Key Assessment Checklist:

• Find out the time since injury, since it is critical for prognosis.
• Tooth condition and look if the tooth is avulsed, luxated, or fractured.
• Soft tissue & socket and check for embedded fragments or alveolar fractures.
• Consider medical factors and find out if there was any loss of consciousness, and if the tetanus shot is up to date.
• Take two angled periapicals or CBCT if root fracture suspected.

Clinical Tip: 

Always assess adjacent and opposing teeth. Secondary trauma is quite common but is often missed in the first exam³.

Step 2: Avulsion Management 

Avulsion is a true dental emergency. Prognosis depends entirely on how long the tooth stays dry¹.

Golden 15-Minute Window

• Replant immediately if <15 minutes passed, at the site if possible.
• If contaminated, you can rinse gently with saline or milk. Never scrub the root surface.
• Storage media (in order of preference):
  1. Hank’s Balanced Salt Solution (HBSS)
  2. Cold milk
  3. Saline
  4. Patient’s saliva. Store in buccal vestibule if conscious and cooperative

Chairside Replantation Protocol

1. Handle the crown only and avoid touching the root.
2. Irrigate the socket with saline and remove the visible clot gently.
3. Replant using light finger pressure.
4. Confirm position radiographically.
5. Apply flexible splint for 2 weeks. You can extend to 4 weeks if the dry time >60 min or an alveolar fracture is seen.
6. Prescribe systemic antibiotics like amoxicillin or doxycycline.
7. Update tetanus status if needed.

Endodontic Management

• Closed apex: Begin RCT 7–10 days post-replantation; before splint removal.
• Open apex: Monitor for revascularization before intervening.

Important note: Never replant avulsed primary teeth, as it increases the risk of damaging developing permanent buds.

Step 3: Luxation Injuries

Luxation includes a range of partial displacements. Quick repositioning and stabilization are key to saving the tooth⁴.

Chairside Tip: 

Use gentle digital pressure for repositioning without forcing it against alveolar resistance. Take post-reposition radiographs to check socket integrity.

Step 4: Managing Tooth Fractures

Fractures of teeth are common but manageable when approached methodically.

Enamel–Dentin Fracture

• Cover exposed dentin with calcium hydroxide or resin-modified glass ionomer.
• If a fragment is available, store it in saline and reattach.

Crown–Root Fracture

• Stabilize temporarily with fiber splint.
• Assess restorable margin and later on manage with crown lengthening or orthodontic extrusion.

Root Fracture

• Confirm with multiple angulated X-rays or CBCT.
• Reposition the coronal fragment, splint 4–6 weeks.
• Initiate RCT only if pulp necrosis develops.

Clinical Insight:
Always record mobility, color changes, and pulp response. These form your baseline for follow-up and medicolegal protection.

Step 5: Splinting & Follow-Up

Here is the protocol for splinting in different situations, along with the recommended follow-up schedule.

Follow-up Schedule: 

2 weeks → 4 weeks → 3 months → 6 months → 1 year → Annually

At each visit, evaluate mobility, vitality, color, radiographic signs of resorption, and ankylosis⁵.

Step 6: Communicate, Document, Educate

• Educate patients about possible complications that can be ankylosis, resorption, or discoloration.
• Maintain detailed photographs and radiographs at each visit.
• Reassure patients that success depends on time, handling, and follow-up, not luck.

Final Takeaway

A trauma case can really test your calm, not just your skill. If you act fast, replant smart, and stabilize correctly, you can save more natural teeth than ever before.

With CBCT imaging, bioceramic sealers, and fiber splints, outcomes in 2025 are more predictable, provided you do the right thing in the first 15 minutes.

References

1. Fouad AF, Abbott PV, Tsilingaridis G, Cohenca N, Rajasekaran M, Solomon E, et al. International Association of Dental Traumatology (IADT) Guidelines for the Management of Traumatic Dental Injuries: 2020 Update. Dent Traumatol. 2020;36(4):271-82.
2. American Academy of Pediatric Dentistry. Guidelines for the Management of Traumatic Dental Injuries in Pediatric Patients. Reference Manual. Chicago (IL): AAPD; 2024
3. American Association of Endodontists (AAE). Recommended Guidelines of the AAE for the Treatment of Traumatic Dental Injuries. AAE Clinical Resources. 2019;
4. Bourguignon C, Cohenca N, Lauridsen E, Flores MT, O'Connell A, Day PF, Tsilingaridis G, Abbott PV, Fouad AF, Hicks L, Andreasen JO, Cehreli ZC, Harlamb S, Kahler B, Oginni A, Semper M, Levin L. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dent Traumatol. 2020 Jun;36(4):314-330.
5. Levin L, Day PF, Hicks L, O'Connell A, Fouad AF, Bourguignon C, Abbott PV. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: General introduction. Dent Traumatol. 2020 May 30;36(4):309-313.