Assessment, classification and management of crown fractures

Question 1

what percentage of school children experience dental trauma? (1)

Answer 1

25%

Question 2

what percentage of damaged teeth go untreated? (1)

Answer 2

70%

Question 3

What type of damage is most common in the primary dentition? (1)

Answer 3

Luxation

Question 4

What type of damage is most common in the permanent dentition? (1)

Answer 4

Crown Fracture

Question 5

What is the risk associated with having an overjet greater than 9mm? (1)

Answer 5

Doubles the likelihood of tooth trauma

Question 6

falls account for what percentage of permanent tooth trauma? (1)

Answer 6

50%

Question 7

Biking and skateboarding accounts for what percentage of permanent tooth trauma? (1)

Answer 7

17-35%

Question 8

Sports account for what percentage of tooth trauma? (1)

Answer 8

14-25%

Question 9

fights account for what percentage of tooth trauma? (1)

Answer 9

3%

Question 10

What extra oral injuries would you look out for from someone who has just experienced dental trauma? (6)

Answer 10

• lacerations
• Haematomas
• Haemorrhage/CSF
• Subconjunctival haemorrhage
• Bony step deformities
• Facial/jaw fractures

Question 11

Which intra oral features would you assess from someone who just experienced dental trauma? (4)

Answer 11

• lacerations on soft tissues
• Alveolar bone movement
• is the occlusion affected?
• are any other teeth affected?

Question 12

How would you check for the presence of foreign bodies within wounds if you could not see with the naked eye? (1)

Answer 12

Soft tissue radiograph

Question 13

tooth mobility may indicate? (3)

Answer 13

• displacement of tooth
• Root fracture
• Bone fracture (more than on mobile tooth)

Question 14

what different tests are there to assess tooth damage? (3)

Answer 14

Thermal - ethyl chloride
electrical - electric pulp tester
percussion - duller note may indicate tooth fracture

Question 15

what is meant by traumatic occlusion? (1)

Answer 15

when patient cant put teeth into occlusion normally

Question 16

whats the purpose of a trauma sticker? (1)

Answer 16

Helps monitor the progress and status of a traumatised tooth for the duration of treatment.

Question 17

How long should you continue using sensibility tests following an injury? (1)

Answer 17

2 years

Question 18

why would you test an adjacent non-injured tooth as well as an injured tooth? (1)

Answer 18

To compare reactions and strengthen evidence of tooth sensitivity

Question 19

what are the classifications of fractures? (6)

Answer 19

• enamel fracture
• Enamel-dentine fracture
• enamel-dentine-pulp fracture
• root fracture -apical 1/3 middle 1/3 coronal 1/3
• uncomplicated crown root fracture
• complicated crown root fracture

Question 20

the prognosis of traumatised teeth depends on what? (5)

Answer 20

• Stage of root development
• Type of injury
• If PDL is damaged
• Time between injury and treatment
• Presence of infection

Question 21

Ultimately what do you aim to achieve by emergency treatment? (5)

Answer 21

• Retain vitality of any damaged or displaced teeth
• Treat exposed pulp tissue
• reduction and immobilisation of displaced teeth
• Tetanus prophylaxis
• Consider antibiotics

Question 22

what intermediate treatment would you consider? (2)

Answer 22

• +/- pulp treatment

* is a restoration required?

Question 23

how could you manage an enamel fracture? what is the tooths prognosis of pulp necrosis? (4)

Answer 23

• bond fragment to tooth or simply grind sharp edges
• Take 2 periapical radiographs to rule out root fracture or luxation
• Follow up: 6-8 weeks, then 6 months, then 1 year
• 0% risk

Question 24

how could you manage an enamel-dentine fracture? what is the tooths prognosis of pulp necrosis? (7)

Answer 24

• account for fragment
• Either bond fragment to tooth or place composite bandage
• Take 2 periapical radiographs to rule out root fracture or luxation
• radiograph any lip or cheek lacerations to rule out embedded fragment
• Sensibility testing and evaluate tooth maturity
• Definitive restoration
• Follow up 6-8weeks, 6 months, 1 year
• 5% risk

Question 25

How do open and closed apex’s compare when considering pulp survival? (1)

Answer 25

Closed apex’s (mature teeth) have a lower chance of survival than teeth with an open apex

Question 26

How would you manage an Enamel-Dentine-Pulp Fracture? (4)

Answer 26

• evaluate exposure: Size of pulp exposure, time since injury, associated PDL injuries
• Choose either Pulp Cap (exposure less than 1mm in size and less than 24 hours exposure), Partial Pulpotomy (exposure bigger than 1mm and over 24hrs), Full coronal pulpotomy.

Question 27

How would you carry out a pulp cap? (5)

Answer 27

• Trauma sticker (should not be TTP) and radiograph assessment
• LA & Rubber Dam
• Clean area with water then disinfect with sodium hypochlorite
• Apply calcium hydroxide
• restore tooth with composite

Question 28

How would you carry out a partial pulpotomy? (7)

Answer 28

• trauma sticker and radiograph assessment
• LA and Dental Dam
• Clean area with saline then disinfect with sodium hypochlorite
• Remove 2mm of pulp with highspeed
• Place saline soaked cotton wool pellet until haemostasis is achieved
• If there wasn’t any bleeding to begin with or bleeding wont stop then carry out full coronal pulpotomy
• Place calcium hydroxide then glass ionomer then restore with quality composite resin

Question 29

What is the purpose of choosing a pulpotomy instead of a RCT in immature teeth?

Answer 29

Retains pulp in the canal to allow Apexogenesis which will allow normal root growth

Question 30

What is the issue with providing a RCT with an open apex tooth? (1)

Answer 30

No apical barrier to pack gutta percha against

Question 31

How can you overcome an open apex tooth which needs a RCT? (3)

Answer 31

• Place Calcium hydroxide in canal to induce hard tissue barrier
• Mineral trioxide aggregate (cement) at apex of canal to create barrier
• regenerative endodontic technique to encourage hard tissue formation at apex. promoting stem cells to come into canal and differentiate into odontoblasts (experimentive)