4 - Dental trauma III Flashcards
What are the different impacts dental trauma can have on surrounding tissue?
- separation injury, cleavage of structures
- crushing injury, cells become damaged which leads to slower healing
What is the follow up for concussion injuries?
Clinical and radiographic follow up
- 4 weeks
- 1 year
What are the radiographic findings for a concussion injury?
No abnormality
What is the follow up for subluxation injuries?
Clinical and radiographic follow up
- 2 weeks (splint removal)
- 12 weeks
- 6 months
- 1 year
What are the radiographic findings for a subluxation injury?
No abnormality
What are the radiographic findings for an extrusion injury?
Increased PDL space, tooth not seated
What are the radiographic findings for a lateral luxation injury?
Widened PDL space
What are the radiographic findings for an intrusion injury?
PDL space not visible, CEJ more apical
What are the clinical findings for an extrusion injury?
- tooth appears elongated
- usually displaced palatally
- mobile
- bleeding from gingival sulcus
What are the clinical findings for a lateral luxation injury?
- tooth appears displaced in socket
- immobile (locked into bone)
- high ankylotic percussion note
- bleeding doom gingival sulcus
- root apex may be palpable in sulcus
What are the clinical findings for an intrusion injury?
- crown appears shortened
- bleeding form gingiva
- high ankylotic percussion note
- immobile
What is the treatment for a subluxation injury?
- no treatment
- splint if excessively mobile for 2 weeks, passive flexible
What is the treatment for an extrusion injury?
- reposition tooth under LA
- splint for 2 weeks, passive flexible
What is the treatment for a lateral luxation injury?
- reposition tooth under LA
- splint for 4 weeks, passive flexible
- endodontic evaluation at 2 weeks
What is the treatment for an intrusion injury?
Immature roots
- spontaneous repositioning
- if no re-eruption orthodontic repositioning
Mature roots
- <3mm, spontaneous repositioning (if no eruption, surgical or orthodontic repositioning)
- 3-7mm, reposition surgically or orthodontically
- >7mm, reposition surgically
- ALWAYS begin RCT within 2 weeks
How do you reposition an intrusion injury orthodontically?
Fixed orthodontic wire placed on adjacent teeth, orthodontic elastic placed on intruded tooth
How do you reposition an intrusion injury surgically?
Forceps and splint
What is the follow up for intrusion injuries?
Clinical and radiographic (as well as clinical photographs)
- 2 weeks
- 4 weeks (splint removal)
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for next 5 years
What is the follow up for lateral luxation injuries?
Clinical and radiographic
- 2 weeks (endodontic evaluation)
- 4 weeks (splint removal)
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for next 5 years
What is the follow up for extrusion injuries?
Clinical and radiographic
- 2 weeks (splint removal)
- 4 weeks
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for next 5 years
What are the clinical findings for an avulsion injury?
- tooth totally displaced from socket
- socket is empty or filled with coagulum
What are the critical factors in an avulsion injury and its treatment?
- extra alveolar dry time (EADT)
- extra alveolar time (EAT)
- storage medium
What is the advice you’d give when a tooth has been avulsed?
- ensure it is a permanent tooth
- hold by crown
- encourage replanting of the tooth immediately
- if the tooth is dirty rinse in milk or saliva
- bite on gauze to hold in place
- if not replanted, place in storage medium
What is the best storage medium?
- milk
- hank’s balance salt solution
- saliva
- saline
- water
Describe the management of a closed apex avulsion that has already been replanted.
- clean injured area
- verify position and apical status (radiograph)
- place passive, flexible splint for 2 weeks
- consider antibiotics
- check tetanus status
Describe the management of an open apex avulsion that has already been replanted.
- clean injured area
- verify position and apical status (radiograph)
- place passive, flexible splint for 2 weeks
- consider antibiotics
- check tetanus status
Describe the management of a closed apex avulsion with an EADT <60 mins.
- PDL cells may be viable
- remove debris
- Hx and examination with tooth in storage medium
- replant with LA
- place passive and flexible splint for 2 weeks
- consider antibiotics
- check tetanus status
Describe the management of an open apex avulsion with an EADT <60 mins.
- potential for spontaneous healing
- remove debris
- Hx and examination with tooth in storage medium
- replant with LA
- place passive and flexible splint for 2 weeks
- consider antibiotics
- check tetanus status
Describe the management of a closed apex avulsion with an EADT >60 mins.
- PDL cells likely non-viable
- remove debris
- Hx and examination with tooth in storage medium
- replant with LA
- place passive and flexible splint for 2 weeks
- consider antibiotics
- check tetanus status
Describe the management of an open apex avulsion with an EADT >60 mins.
- PDL cells likely non-viable and ankylosis related root resorption highly likely
- remove debris
- Hx and examination with tooth in storage medium
- replant with LA
- place passive and flexible splint for 2 weeks
- consider antibiotics
- check tetanus status
Describe the endodontic treatment of a permanent tooth with a closed apex after being replanted.
- 2 weeks
- intracanal medicament placed
- calcium hydroxide up to 1 month
- or corticosteroid/antibiotic paste for 6 weeks
What is the follow up for avulsion (closed apex) injuries?
- 2 weeks (splint removal, endodontic treatment begins)
- 4 weeks
- 12 weeks
- 6 months
- 1 year
- annually for 5 years
What is the follow up for avulsion (open apex) injuries?
- 2 weeks (splint removal)
- 1 month
- 2 months
- 3 months
- 6 months
- 1 year
- annually for 5 years
When is it suitable to not replant avulsed teeth?
- child immunocompromised
- other more urgent injuries requiring emergency treatment
- very immature apex with EAT > 90 mins
- very immature lower incisor
What is the prognosis for avulsion injuries that are replanted 5 years post trauma?
Open apex - low chance of pulp survival
Closed apex - no chance of pulp survival
Both frequently experience root resorption
What are the clinical findings associated with dento-alveolar fracture?
- complete fracture from buccal to palatal bone in the maxilla or buccal to lingual surface of mandible
- segment mobility, several teeth moving together
- occlusal disturbance
- gingival laceration
Describe the management of a dento-alveolar fracture.
- reposition displaced segment
- stabilise with passive and flexible splint for 4 weeks
- suture any lacerations
- monitor pulp condition of all teeth
What is the follow up for dento-alveolar fracture?
- 4 weeks (splint removal)
- 6-8 weeks
- 4 months
- 6 months
- 1 year
- annually for 5 years
What advice do you give for dento-alveolar fractures?
- soft diet for 7 days
- no contact sports
- careful oral hygiene including chlorohexidine mouthwash 0.12%
What is the splint time for subluxation?
2 weeks
What is the splint time for extrusive luxation?
2 weeks
What is the splint time for intrusive luxation?
4 weeks
What is the splint time for avulsion?
2 weeks
What is the splint time for lateral luxation?
4 weeks
What is the splint time for root fracture (mid root)?
4 weeks
What is the splint time for root fracture (apical third)?
4 weeks
What is the splint time for root fracture (cervical third)?
4 months
What is the splint time for dento-alveolar fracture?
4 weeks
What are the different types of chair side splints?
- composite and wire*
- titanium trauma split*
- composite
- orthodontic brackets and wire
- acrylic
What are the different types of lab made splints?
- vacuum formed splint
- acrylic
Describe a composite and wire splint.
- stainless steel wire (0.4mm diameter)
- must be passive
- flexible = 1 tooth either side of traumatised teeth
Describe titanium trauma splints.
- rhomboid mesh structure
- allow physiological movement
- 0.2mm thick
- secured with composite
What are the main post-trauma complications?
- pulp necrosis and infection
- pulp canal obliteration
- root resorption
- breakdown of marginal gingiva and bone
Describe pulp canal obliteration.
- response of a vital pulp
- progressive hard tissue formation within pulp cavity
- gradual narrowing of chamber and canal, can be partial or total
- common in luxation
What are the different types of root resorption?
External
- surface
- IRR
- cervical
- ankylosis RRR
Internal
- IRR
Describe external surface resorption.
- superficial resorption lacunae that are repaired with new cementum
- response to localised injury
- not progressive
Describe external IRR.
- infection related resorption
- non-vital tooth
- initiated by PDL damage
- diagnosed by indistinct root surface with canal intact
- rapid
How do you treat external IRR?
- remove stimulus
- endodontic treatment
- non setting CaOH for 4-6 weeks
- obturate with GP
Describe ankylosis RRR.
- replacement root resorption
- initiated by severe damage to PDL
- bone cells repair faster than PDL fibroblasts
- common in severe luxation or avulsion
- no obvious PDL space on radiograph
How do you treatment ankylosis RRR?
Plan loss
Describe internal IRR.
- caused by progressive pulp necrosis
- radiographically, ballooning of canals, root surface intact
How do you treat internal IRR?
- remove stimulus
- endodontic treatment
- non setting CaOH for 4-6 weeks
- obturate with GP
- if progressive, plan loss
