3 - Dental trauma II

Question 1

What can be used to sensibility test teeth?

Answer 1

• thermal (ethyl chloride or hot GP)
• electrical (EPT)

Question 2

What is a traumatic occlusion?

Answer 2

Can only bite on one displaced tooth

Question 3

How do you manage enamel fractures?

Answer 3

• bond fragment or smooth edges
• 2 periapicals to rule out luxation and root fracture
• follow up 8 weeks, 6 months, 1 year

Question 4

How do you manage enamel-dentine fractures?

Answer 4

• bond fragment or place composite bandage
• 2 periapicals to rule out luxation and root fracture
• sensibility testing
• definitive restoration
• follow up 8 weeks, 6 months , 1 year

Question 5

What do you assess on follow up radiographs of trauma?

Answer 5

• root development (width and length of canal)
• comparison with adjacent and contralateral teeth
• internal or external IRR
• periradicular pathology

Question 6

How do you complete a pulp cap?

Answer 6

• radiographic assessment
• LA / rubber dam
• clean area with water and disinfect with sodium hypochlorite
• apply dycal or MTA white to exposure
• restore with composite

Question 7

How do you complete a partial pulpotomy?

Answer 7

• radiographic assessment
• LA / rubber dam
• clean area with water and disinfect with sodium hypochlorite
• remove 2mm of pulp with hi-speed round diamond bur
• place saline soaked CW pellet to achieve haemostasis
• apply dycal or MTA white to exposure
• restore with composite

Question 8

What is the next step if you don’t achieve haemostasis in a partial pulpotomy?

Answer 8

Continue to a full coronal pulpotomy

Question 9

How do you complete a full coronal pulpotomy?

Answer 9

• begin with a partial pulpotomy
• if haemostasis not achieved or pulp necrotic proceed to full coronal
• remove all of coronal pulp
• place dycal in the chamber
• seal with GI liner and place composite restoration

Question 10

What is the aim of pulpotomy?

Answer 10

Maintain vital pulp tissue within the root canal to allow normal root growth and apexogenesis

Question 11

How are immature incisors root treated?

Answer 11

• no apical stop, therefore specialist treatment required
• MTA or BioDentine placed at apex of canal to form cement barrier (apical plugging)
• regenerative endodontic treatment to encourage hard tissue formation (encourage bleeding, not routine)

Question 12

What are the treatment options for uncomplicated crown-root fractures?

Answer 12

• fragment removal and restore
• fragment removal and gingivectomy
• orthodontic extrusion of apical portion
• surgical extrusion
• decoration
• extraction

Question 13

What are the treatment options for complicated crown-root fractures?

Answer 13

• temporise with composite
• fragment removal and gingivetcomy
• orthodontic/surgical extrusion of apical portion
• decoration
• XLA

Question 14

How do you manage enamel-dentine-pulp fractures?

Answer 14

• pulp cap (1mm exposure within 24hrs)
• partial pulpotomy (>1mm exposure or >24hrs)
• full coronal pulpotomy