Describe tooth Fracture

Please select one Enamel only Enamel and dentin, fragment available Enamel and dentin, fragment lost Crown/root fracture Crown/root fracture with severe apical or vertical extension Root fracture without avulsion Root fracture with avulsion Mobile fractured bone segment containing the involved tooth/teeth

Describe Tooth Concussion

Please select one Tooth is tender to touch and/or percussion but it is not displaced or mobile Tooth is tender to touch and/or percussion and mobile, but not displaced Tooth displaced outwards or incisal Tooth displaced in any lateral direction except axially; fracture of the facial cortical bone suspected Tooth displaced inward and into the alveolar bone

Patient age?

Please select one Over 12 years old 12 years or younger

Describe apex condition?

Please select one Open Closed

Describe avulsed tooth storage?

Please select one Already replanted Stored dry for more than 60 minutes Stored in physiologic solution (milk, saline, HHBS),and/or stored dry for less than 60 minutes

Is the pulp exposed?

Please select one No Yes

How much is the intrusion?

Please select one less than 3 mm 3 to 7 mm more than 7 mm