W11 - Outcomes of Dental Trauma - Mistry

Question 1

What can outcome of trauma depend on (3)

Answer 1

Type and severity of injury

Stage of dental development

Type of treatment

Question 2

How/what to assess the extent of trauma

(clinical and what to ask)

Answer 2

Ask pt - symptoms

Soft tissues

Visual assessment + position of tooth

Colour of tooth

Mobility

Perio

Percussion (sound + pain)

Sensibility test

Radiograph

Question 3

Two significant diagnoses of periradicular bone that has become symptomatic

Answer 3

1. Acute apical periodontitis
2. Chronic apical periodontitis

Question 4

How to differentiate the diagnosis of AAP vs CAP

Answer 4

AAP - symptomatic tooth (TTP) with no radiolucency, intact lamina dura

CAP - bone loss adjacent to apex

Question 5

Possible outcomes relating to pulp (3)

Answer 5

• Discoloration
• Pulp obliteration
• Necrosis (arrested development, subsequent RR)

Question 6

Outcomes relating to PDL/root resorption (4)

Answer 6

• Infection-related resorption (external/internal inflammatory root resorption)
• Ankylosis / replacement resorption
• Surface Reparative resorption
• Transient apical breakdown

Question 7

3 reasons for tooth discoloration

Answer 7

Bruising

Pulp Canal obliteration

Pulp necrosis

Question 8

How do you know if the pulp canal is obliterated

Answer 8

Colour change - dark yellow

Reduced response to sensibility test

Question 9

Tx for pulp canal obliteration

Answer 9

Observation - No tx indicated if not infected

Question 10

How to tell if pulp is necrotic

Answer 10

Discolouration

Negative cold test

TTP

Sinus

Apical abscess

Radiographic LEO

Question 11

Treatment of necrotic pulp

Answer 11

RCT

Question 12

What causes inflammatory root resorption

Answer 12

Tissue colonisation of multinuclear giant cells due to microbial products

Question 13

Features of external root resorption

Answer 13

• Non vital teeth
• Damage to PDL (usually luxation injuries)
• Toxins from pulp space → dentine tubules → inflammation and resorption of root surface

Question 14

How to diagnose external root resorption

Answer 14

Radiographs

Question 15

Treatment of external root resorption

Answer 15

RCT

Question 16

What is cervical resorption?

Answer 16

Damage to root surface in cervical area

caused by infected pulp or periodontium

Question 17

How to diagnose cervical resorption (2)

Answer 17

Clinical - Pink area near cervical margin

Radiograph - resorption in cervical area

Question 18

Treatment of cervical resorption

Answer 18

if vital - curettage and MTA/CaOH lining followed by resto

non vital - RCT and then as above

Question 19

How to diagnose internal root resorption

Answer 19

Clinical: Pink discoloration of crown

Radiograph: resorption of pulp space, rounded symmetrical radiolucency

Question 20

Treatment of internal RR

Answer 20

RCT

Question 21

How does ankylosis / replacement resorption occur?

Answer 21

• Luxation injuries causes significant damage to PDL →
• PDL repair with bony replacement
• Rate of repair dictates rate of root replacement

Question 22

Other name of ankylosis

Answer 22

Replacement resorption

• Damaged PDL is replaced with bone

Question 23

How to diagnose ankylosis clinically (2)

Answer 23

Ankylotic sound - high pitched, solid sounding metallic tone

May appear to be submerging in growing child

Question 24

How to diagnose ankylosis radiographically

Answer 24

May show signs of replacement resorption

• Loss of PDL

Question 25

Treatment of ankylosis (3)

Answer 25

May leave to monitor and allow it to take over root Decoronation Non vital teeth: RCT and **dressing - no GP**

Question 26

How can trauma to primaries affect the permanent dentition? (7)

Answer 26

1. Enamel defects 2. Dilaceration 3. Malformation 4. Odontoma-like formation 5. Duplication 6. Arrested development 7. Eruption disturbances

Question 27

Why dont you put GP in ankylosed teeth?

Answer 27

Tooth root will eventually be replaced by bone → only CaOH **NO GP**

Question 28

What to do?

Answer 28

Tooth has completely intruded * Allow time for tooth to spontaneously re-erupt * Damage was already done to successor at time of trauma If doesnt come down, GA and remove before it gets ankylosed

Question 29

What do you do - tooth is mobile

Answer 29

Option 1: Do nothing - advise parents that tooth may fall out soon on its own Option 2: Extraction but usually parents will want to keep front tooth for longer

Question 30

What is happening?

Answer 30

Displacement and impaction of mx permanent incisors as a result of inflammation infection from primaries

Question 31

what is this and what caused it

Answer 31

Enamel defect as a result of injured primaries

Question 32

Answer 32

dilaceration

Question 33

When should RCT be performed following luxation injury?

Answer 33

When tooth has been intruded or avulsed, **neurovascular bundle is severed and PDL is affected** * If tooth has **complete root development** (apex intact) at time of injury, its assumed tooth will have pulpal necrosis → RCT to avoid external inflammatory root resorption IF tooth is IMMATURE (ex. child 9, root tip not closed) → give it a chance. NO ENDO (exo after 3 weeks if problematic)

Question 34

Potential outcomes related to root injury \*\* (4)

Answer 34

Transient apical breakdown Transient Marginal breakdown Gingival reattachment PDL reattachment

Question 35

Differenc between PDL healing/damage reaction vs pulpal

Answer 35

Pulpal a lot easier to manage → LEO can stay and not affect tooth PDL radiolucencies → “alarm bells” needs endo asap to save inflammatory root resorption

Question 36

Answer 36

External inflammatory root resorption * Toxins from pulp space entered tubules causing inflammation and resorption of root surface **In this particular pic both bone and PDL are being resorbed // URGENT**

Question 37

Describe the urgency for LEO alone vs PDL resorption

Answer 37

LEO alone - not urgent / PDL intact Luxation injuries causing PDL resorption = URGENT endo to save structure

Question 38

What injuries cause PDL resorption (urgent care)? (3)

Answer 38

Lateral luxation Intrusion Avulsion

Question 39

When to recall for PDL injuries What to look out for

Answer 39

3-4 weeks PDL resorption / inflammatory root resorption on lateral wall

Question 40

What to do for immature perm tooth (apex not formed) with punched out lesions on PDL

Answer 40

Extirpate * Once stability is achieved → reassess * If compromised, unrestorable → Exo * If OK → Apical barrier / MTA and dress

Question 41

What to do for primary tooth with punched out lesions on PDL

Answer 41

Extract

Question 42

How long after avulsion is the recall

Answer 42

one week

Question 43

How long to splint teeth after avulsion? What kind of splint?

Answer 43

Up to 2 weeks (7-10 days) Flexible splint * rigid splints lead to ankylosis

Question 44

How long to splint teeth following alveolar fracture

Answer 44

4 months