Assessment, classification and management of crown fractures Flashcards
what percentage of school children experience dental trauma? (1)
25%
what percentage of damaged teeth go untreated? (1)
70%
What type of damage is most common in the primary dentition? (1)
Luxation
What type of damage is most common in the permanent dentition? (1)
Crown Fracture
What is the risk associated with having an overjet greater than 9mm? (1)
Doubles the likelihood of tooth trauma
falls account for what percentage of permanent tooth trauma? (1)
50%
Biking and skateboarding accounts for what percentage of permanent tooth trauma? (1)
17-35%
Sports account for what percentage of tooth trauma? (1)
14-25%
fights account for what percentage of tooth trauma? (1)
3%
What extra oral injuries would you look out for from someone who has just experienced dental trauma? (6)
- lacerations
- Haematomas
- Haemorrhage/CSF
- Subconjunctival haemorrhage
- Bony step deformities
- Facial/jaw fractures
Which intra oral features would you assess from someone who just experienced dental trauma? (4)
- lacerations on soft tissues
- Alveolar bone movement
- is the occlusion affected?
- are any other teeth affected?
How would you check for the presence of foreign bodies within wounds if you could not see with the naked eye? (1)
Soft tissue radiograph
tooth mobility may indicate? (3)
- displacement of tooth
- Root fracture
- Bone fracture (more than on mobile tooth)
what different tests are there to assess tooth damage? (3)
Thermal - ethyl chloride
electrical - electric pulp tester
percussion - duller note may indicate tooth fracture
what is meant by traumatic occlusion? (1)
when patient cant put teeth into occlusion normally
whats the purpose of a trauma sticker? (1)
Helps monitor the progress and status of a traumatised tooth for the duration of treatment.
How long should you continue using sensibility tests following an injury? (1)
2 years
why would you test an adjacent non-injured tooth as well as an injured tooth? (1)
To compare reactions and strengthen evidence of tooth sensitivity
what are the classifications of fractures? (6)
- 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
the prognosis of traumatised teeth depends on what? (5)
- Stage of root development
- Type of injury
- If PDL is damaged
- Time between injury and treatment
- Presence of infection
Ultimately what do you aim to achieve by emergency treatment? (5)
- Retain vitality of any damaged or displaced teeth
- Treat exposed pulp tissue
- reduction and immobilisation of displaced teeth
- Tetanus prophylaxis
- Consider antibiotics
what intermediate treatment would you consider? (2)
- +/- pulp treatment
* is a restoration required?
how could you manage an enamel fracture? what is the tooths prognosis of pulp necrosis? (4)
- 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
how could you manage an enamel-dentine fracture? what is the tooths prognosis of pulp necrosis? (7)
- 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
How do open and closed apex’s compare when considering pulp survival? (1)
Closed apex’s (mature teeth) have a lower chance of survival than teeth with an open apex
How would you manage an Enamel-Dentine-Pulp Fracture? (4)
- 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.
How would you carry out a pulp cap? (5)
- 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
How would you carry out a partial pulpotomy? (7)
- 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
What is the purpose of choosing a pulpotomy instead of a RCT in immature teeth?
Retains pulp in the canal to allow Apexogenesis which will allow normal root growth
What is the issue with providing a RCT with an open apex tooth? (1)
No apical barrier to pack gutta percha against
How can you overcome an open apex tooth which needs a RCT? (3)
- 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)
