Pediatric dental trauma remains one of the most common emergencies in childhood, requiring fast, evidence-based intervention.
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PDF 🔽 Guidelines for the management of traumatic dental injuries in the primary dentition ... Dental traumas in pediatric patients represent 18% of all injuries and that is due to the activities of children, and they occur more frequently when they learn to crawl, walk or run.The IADT 2024–2025 guidelines provide updated recommendations on the diagnosis, management, and follow-up of injuries to both primary and permanent teeth in children. Understanding these updates is essential for preventing long-term complications such as pulp necrosis, enamel defects, and growth disturbances.
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1. Classification of Pediatric Dental Trauma
The IADT organizes trauma injuries into:
▪️ Enamel and enamel-dentin fractures
▪️ Crown-root fractures
▪️ Root fractures
▪️ Concussion, subluxation, luxation injuries
▪️ Intrusion, extrusion, avulsion
▪️ Alveolar fractures
Each injury requires a customized approach, especially in young patients whose teeth and bone structures are still developing.
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2.1 Clinical Assessment
The latest guidelines emphasize:
▪️ Careful evaluation of pulp vitality
▪️ Monitoring for color changes in primary teeth
▪️ Assessment of occlusion, mobility, and periapical tissues
▪️ Screening for associated injuries (lip, soft tissue, head trauma)
2.2 Radiographic Protocols
The IADT now recommends:
▪️ Periapical radiographs with different angulations
▪️ Soft-tissue radiographs for embedded fragments
▪️ CBCT only for complex cases, minimizing radiation in children
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Primary teeth require a conservative, non-aggressive approach to protect developing permanent successors.
➤ Key updates include:
▪️ Intrusion injuries: Spontaneous re-eruption is preferred.
▪️ Luxation injuries: Extraction only if the tooth poses a risk to permanent bud.
▪️ Avulsion: Primary teeth must not be replanted.
These recommendations aim to reduce complications such as enamel hypoplasia or eruption disturbances in permanent teeth.
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PDF 🔽 Reimplantation of avulsed dry permanent teeth after three days: A report of two cases ... The success of reimplantation depends on many factors among which are the time lapse before the tooth is reimplanted in the socket and the storage medium of the avulsed tooth.4. Management of Trauma in Permanent Teeth
The IADT 2024–2025 updates include:
▪️ Immediate replantation for avulsed permanent teeth whenever possible.
▪️ Use of flexible splints for 1–4 weeks depending on injury type.
▪️ Pulp therapy (partial pulpotomy, full pulpotomy, or pulpectomy) depending on apex development.
▪️ Emphasis on calcium silicate materials for pulpal healing.
▪️ Close monitoring for external inflammatory root resorption.
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Video 🔽 Webinar: Pediatric Dental Trauma and Odontogenic Infections - Dr. Kelly A. Kirtland DDS ... Understanding how to recognize, diagnose, and manage trauma early is crucial for preserving tooth vitality and preventing long-term complications in both primary and permanent dentition.5. Follow-Up Protocols
The guidelines stress structured follow-ups:
▪️ At 1 week, 4 weeks, 12 weeks, 6 months, and 1 year
▪️ Annually for up to 5 years in permanent teeth trauma
Vitality tests, radiographs when indicated, and clinical exams ensure early detection of complications.
📊 Comparative Table: Key Updates in IADT 2024–2025 Pediatric Trauma Guidelines
| Aspect | Advantages | Limitations |
|---|---|---|
| Conservative Primary Tooth Management | Protects permanent tooth germ; minimizes unnecessary extraction | Limited treatment options for severe trauma |
| Bioactive Pulp Therapies in Permanent Teeth | Promotes healing; reduces risk of root resorption | Requires clinician expertise and proper materials |
| Flexible Splinting Protocols | Improves healing outcomes; reduces ankylosis risk | Poor patient compliance may affect stability |
| Structured Long-Term Follow-Up | Enables early diagnosis of complications; ensures better prognosis | Requires consistent parental commitment |
The IADT 2024–2025 updates reflect a shift toward minimally invasive, biologically respectful care, especially in primary dentition. The emphasis on conservative management, use of bioactive materials, and systematic follow-up significantly improves long-term outcomes. Clinicians must remain vigilant, as delayed diagnosis or inadequate management can lead to pulp necrosis, ankylosis, root resorption, or esthetic issues that affect a child’s development and quality of life.
✍️ Conclusion
Pediatric dental trauma requires precise, evidence-based management. The IADT 2024–2025 guidelines offer updated, structured recommendations that help clinicians protect both primary and permanent teeth. Adhering to these protocols ensures optimal healing, preserves pulp vitality when possible, and reduces long-term complications.
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PDF 🔽 Reimplantation of avulsed permanent teeth after three days: Clinical case in a pediatric patient ... Dental avulsion consists of the total detachment of the tooth from the socket, as a consequence of a strong trauma that affects the oral cavity. Given this urgency, it is important to go to the dentist to be able to reimplant it.🔎 Recommendations
▪️ Follow IADT step-by-step protocols for each injury type.
▪️ Avoid over-treating primary teeth to protect permanent successors.
▪️ Prioritize bioactive materials for pulp protection in permanent teeth.
▪️ Educate parents about emergency care for avulsion and luxation.
▪️ Ensure long-term follow-up to detect complications early.
📚 References
✔ American Academy of Pediatric Dentistry. (2024). Guideline on Management of Acute Dental Trauma. AAPD Reference Manual. https://www.aapd.org
✔ International Association of Dental Traumatology. (2020). IADT guidelines for the evaluation and management of traumatic dental injuries. Dental Traumatology, 36(4), 314–330. https://doi.org/10.1111/edt.12589
✔ Levin, L., Day, P. F., Hicks, L., Cohenca, N., Kenny, D. J., & Trope, M. (2020). International Association of Dental Traumatology guidelines for management of traumatic dental injuries: General introduction. Dental Traumatology, 36(4), 309–313. https://doi.org/10.1111/edt.12578
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