Assessment of Crown Fractures

Question 1

What percentage of school children experience trauma to permanent teeth?

Answer 1

25%

Question 2

What percentage of adults experience permanent tooth trauma before 19?

Answer 2

33%

Question 3

What is the most common permanent dentition trauma?

Answer 3

Enamel-dentine crown fractures

Question 4

How does an overjet affect the likely hood of permanent dentition trauma?

Answer 4

Makes it more common
OJ > 9mm doubles the incidence of trauma

Question 5

Name common causes of trauma to permanent teeth

Answer 5

Falls - most common
Bike, skateboard, RTA
Sport
Fights

Question 6

What may tooth mobility in an examination indicate?

Answer 6

Displacement of tooth
Root fracture
Bone fracture

Question 7

Describe how a probe should be used for tactile testing in an examination?

Answer 7

Look for fracture lines - horizontal or vertical, transillumination can help
Look for pulpal involvement

Question 8

What tests can be carried out in a trauma examination?

Answer 8

ECL or warm gutta percha
EPT
Percussion - dull note indicates root fracture
Occlusion - traumatic occlusion demands urgent treatment
Radiographs

Question 9

When should sensibility tests be carried out after injury?

Answer 9

Continually for 2 years after injury

Question 10

How should sensibility testing be carried out?

Answer 10

Compare injured tooth with the adjacent non-injured tooth
Never make clinical judgements on sensibility tests alone

Question 11

What affects the prognosis of a fracture?

Answer 11

Stage of root development
Type of injury
If PDL is damaged too
Time between injury and tx
Presence of infection

Question 12

What are the different classifications of fractures?

Answer 12

Enamel fracture
Enamel-dentine fracture
Enamel-dentine-pulp fracture
Uncomplicated crown root fracture
Complicated crown root fracture
Root fracture - apical third, middle third, coronal third

Question 13

What are the aims and principles of emergency tx?

Answer 13

Aim to retain vitality of any damaged or displaced tooth by protecting exposed dentine by an adhesive dentine bandage
Treat exposed pulp tissue
Reduction and immobilisation of displaced teeth
Tetanus prophylaxis
Antibiotics recommended within guidance

Question 14

What are the aims and principles of intermediate treatment?

Answer 14

Ongoing management of sequelae
Pulp treatment
Restoration - minimally invasive

Question 15

What are the aims and principles of permanent treatment?

Answer 15

Apexogenesis
Apexification
Root filling and root extrusion
Gingival and alveolar collar modification if required
Coronal restoration