ELLIS CLASSIFICATION OF FRACTURE

CLASS I – ENAMEL FRACTURE

CLASS II – ENAMEL + DENTINE FRACTURE
 Treatment – Re-attachment of fractured fragment
 Or CaOH base (if sensitivity present) + composite build-up

CLASS III – ENAMEL + DENTINE FRACTURE + PULP EXPOSURE
a) Within 24 hrs
o Or if only pin-point exposure (less than 0.5mm) - DPC
b) More than 48 hrs / 2 days
o Or if exposure more than 0.5- 3mm - Pulpotomy
o Consider the age also i.e. young permanent tooth
c) More than 72 hrs / 3 days
o If young permanent tooth - Apexification
o If fully formed permanent tooth - RCT
NB: No IPC in fractured / trauma cases

CLASS IV – NON-VITAL DISCOLOURED TOOTH
a. If young permanent tooth - Apexification
b. If fully formed permanent tooth – RCT

CALSS V – AVULSION
FIVE FACTORS THAT DETERMINE THE SUCCESS
a. TIME
i. 30 MINS-1 HOUR – best prognosis
ii. MORE THAN 1 HOUR - ERR
b. STORAGE MEDIA (NB : Never use tap water)
iii. Viaspan - best option ( used in heart transplantation )
iv. HBBS - best option in clinical setup
v. Cold milk – most commonly used & readily available
vi. Physiologic saliva and saline
c. TOOTH SOCKET
vii. Should not be curetted or disrupted

Q. Should you irrigate the socket?
Ans. No irrigation required, but if necessary only mild irrigation acceptable. Vigorous irrigation is contraindicated.
d. SPLINT STABILIZATION
viii. Splint type – flexible splint – that will allow physiologic movement.
ix. Splint time – 2 weeks or 1-2 weeks – 7-10 days is ideal*
e. ROOT SURFACE
x. Should not be dried
xi. Should not be scrapped or manipulated with any chemicals

Q. How should the tooth be held?
Ans. Only at the crown portion. Never touch the root – might hamper the natural PDL.

Within 60mins
- Viability of PDL cells stays max up to 60mins only – that is the 1st priority of the treatment, re-implantation
- If dried beyond that time, pdl dies off
- Success rate depends on pdl viability i.e. extra-oral dry time
1. Rinse in tetracycline
2. Replace in socket & splint with adjacent teeth
3. Splint type – flexible splint
4. Splint time – 2 weeks or 1-2 weeks – 7-10 days
5. Start RCT after 2 weeks – if not external root resorption may happen
6. Here we expect normal PDL attachment over a period of 1 year
7. Until then CaOH is placed into the canals, which is replaced every 3 months for 1 year.
8. Possible complication here –– ankyloses or replacement resorption
9. But usually good prognosis