Biological Response to Traumatic Dental Injuries Flashcards
What type of trauma is this?
Enamel infraction
What type of trauma is this?
Enamel fracture
What type of trauma is this?
Enamel-dentin fracture
What type of trauma is this?
Enamel-dentin-pulp fracture
What type of trauma is this?
Root fracture
What type of trauma is this?
Alveolar fracture
What type of trauma is this?
Crown root fracture without pulp involvement
What type of trauma is this?
Crown root fracture with pulp involvement
In terms of periodontal trauma define concussion
Injury without abnormal loosening or displacement there is a reaction to percussion
In terms of periodontal trauma define subluxation
Injury with abnormal loosening
No displacement of tooth
In terms of periodontal trauma define extrusive luxation
Partial displacement of tooth
In terms of periodontal trauma define intrusive luxation
Displacement into alveolar bone
In terms of periodontal trauma define lateral luxation
Displacement (not axial)
Associated with alveolar bone fracture
In terms of periodontal trauma define avulsion
Complete displacement of tooth
What are the contents of the dental pulp?
Fibroblasts
Odontoblasts (line outer layer)
Progenitor/Stem cells
Inflammatory cells
Vascular & Nerve cells
Loose connective tissue
Giant cells
Name the inflammatory cells present in the dental pulp
Polymorphs
T Lymphocytes
Macrophages
Dendritic antigen-presenting cells
What things can be obsereved visually to suggest dental trauma?
Soft tissue lacerations
Swelling or bruising (indicative of inflammation)
Abscess formation
Mobility/displacement of tooth
Crown fractures
Tooth discoloration
How can sound help diagnose dental trauma?
Percussion test can be carried out and if dull or high-pitched metallic sounds compared to neighbouring teeth then trauma may be suggested
On percussion a tooth makes a high-pitched metallic sound what dental trauma could this suggest?
On percussion a tooth makes a high-pitched metallic sound what dental trauma could this suggest?
Intrusion or lateral luxation
How do pulp sensibility and pulp vitality tests differ?
What type of tests are Endo-frost and EPT?
Pulp sensibility assessing pulpal nerve supply
Pulp vitality which assesses blood flow
Sensibility
Comment on sensibility during root development
Level of pulp sensibility DECREASES with INCREASED root development
UNTIL full root development (closed apex) where sensibility increases to highest
What are the different reactions the pulp can have post trauma?
Pulp survival
Pulp canal obliteration
Pulp necrosis
Inflammatory internal resorption
Replacement internal resorption
Describe what occurs biologically for pulp survival post dental trauma
- Mild trauma occurs
- Tertiary/Reactionary dentine laid down by odontoblasts
Describe what occurs biologically for pulp canal obliteration post dental trauma
- Extensive trauma occurs
- Odontoblasts die
- These are replaced by progenitor cells which secrete Reparative dentine
Clinically what may you see in a tooth that has undergone pulp canal obliteration?
Discolouration of tooth (Yellow)
What do you see in this radiograph?
Pulp canal oblitertation
Reduction in/loss of visible pulp
What clinically can be obsereved in a patient which has pulp necrosis following trauma?
Discolouration of tooth (Grey/Black as haemoglobin broken down into hemosiderin)
What radiographically can be obsereved in a patient which has pulp necrosis following trauma?
Periapical radiolucency (Abscess/Cyst formation)
Biologically what occurs to a tooth during an Inflammatory Internal Resorption post dental trauma?
Inflammation occur which which leads to infiltration of polymorphs and giant cells
Which then leads to resorption of the pulp and dentine
What radiographically can be obsereved in a patient which has inflammatory internal resorption following trauma?
Radiolucent expansion seen in the pulp canal
What are the two types of inflammatory internal resorption?
Transient (reversible)
Permanent (non-reversible/progressive)
Biologically what occurs to a tooth during replacement internal resorption post dental trauma?
Stem cells in pulp differentiate into osteoblasts & areas are replaced with bone tissue
Define ankylosis
Fusion between the tooth surface (cementum) & alveolar bone
What are the diffrent types of periodontal reactions following dental trauma?
Normal healing
External resoption
* Surface ER
* Inflammatory ER
* Replacement ER
What are the diffrent types of gingival reactions following dental trauma?
Normal Healing
Loss of attached gingivae
What are the diffrent types of root development reactions following dental trauma?
Continuous
Disrupted
Arrested
What are the different factors influencing pulp survival post-trauma?
- Severity of damage to blood supply
- Area exposed (size of pulp exposure/trauma)
- Length of exposure
- Stage of root development
Which types of dental trauma are the most and least destructive to the tooths blood supply?
Comment on the role of elastin in blood vessels in preventing damage?
Least with concussion & most with avulsion & intrusive luxation
Subluxation & Extrusion have less blood vessel damage due to elastin in blood vessels, allows for some leeway as tooth moves away (vs. being pushed in)
Which types of dental trauma are the most and least destructive to the tooths blood supply?
Comment on the role of elastin in blood vessels in preventing damage?
Least with concussion & most with avulsion & intrusive luxation
Subluxation & Extrusion have less blood vessel damage due to elastin in blood vessels, allows for some leeway as tooth moves away (vs. being pushed in)
Comment on the relationship between apical pulp width and replantation
Larger the apical pulp width = Higher chance of pulpal revascularisation after replantation
How should teeth needing to be replanted be kept?
The longer a tooth is in dry storage before being replanted = Less chance of pulpal revascularisation
Therefore, wet storage (saliva/saline/milk)
Outline a Cvek partial pulpotomy
- Administer LA & isolate w/rubber dam
- Remove 1-2mm of exposed pulp with high-speed diamond bur w/water
- Control haemorrhage w/saline (or chlorhexidine) soaked cotton pellet
- Cover pulp w/layer of non-setting CaOH then seal w/layer of Setting CaOH
- Restore the tooth w/ Composite
- Revaluate tooth in 6-8 weeks and then 1 year to monitor tooth vitality & root development
A 10 year old patient presents with a fracture in his upper permanent central incisor (enamel and dentine with minor pulp exposure)
How would you treat this immediately?
Clinical decision is dependant on maturity of tooth.
If the tooth is immature (apex not fully formed): carry out pulp cap or partial pulpotomy. Use Ca(OH)2
If the tooth is mature: carry out RCT or pulp cap/pulpotomy
Then restore the tooth with restorative materials or with the bonded tooth fragment
