Front tooth injuries in the permanent teeth can range from small or larger chipping from the tooth crown, to the loosening of teeth to full tooth loss. At the age of around 6 to 9 years, the roots of the permanent teeth have not yet fully formed. To assess the dental injury and the tooth root, the dentist must produce one or several x-ray images of the affected tooth and of the neighbouring teeth. In order to retain the tooth and also not to jeopardise the development of the tooth roots, it is necessary to initiate treatment without delay after the accident.
Most frequently occurring are so-called fractures of the tooth crown. The (pain-sensitive) fracture plane and if necessary the exposed tooth nerve must be promptly treated by the dentist. Root canal treatment can be avoided in this way in many cases. The aesthetic restoration of the original crown shape requires time and must not necessarily take place on the day of the accident. For this, pieces of tooth that are brought along can be stick on again or the tooth can be built up again with tooth-coloured plastic materials.
Teeth with a deep fracture that reaches far below the gum (so-called crown-root fracture), can only be retained under favourable conditions and often with extensive treatment work.
If, after the accident, the tooth is no longer aligned or has been loosened, the effected teeth are straightened again and splinted to the neighbouring teeth by means of a wire. The splinting remains for 2-4 weeks (in some cases longer) depending on the degree of severity. With this kind of injury, one should also expect impaired or even absent blood circulation of the dental nerve, so that root canal treatment may become necessary at a later point in time. This can be difficult and expensive and require several treatment sessions, especially in the case of teeth with roots that are still growing.
Permanent incisors that have been completely knocked out can normally be re-implanted. These too are stabilised with a splint for 1 to 2 weeks. The longer-term retention of such a tooth depends on different factors. The survival of the cells on the surface of the tooth root is decisive for complication-free healing. This survival is only ensured if the period of time up to re-implantation is as short as possible (a few minutes) or the knocked out tooth has been stored somewhere damp. The most favourable is a special nutrient solution, which is available from pharmacies as a "tooth rescue box" (see fig. below). It provides germ-free and damp storage for the knocked-out tooth for up to 24 hours. This way the tooth root fibres can be kept alive until "replantation".
