CDH 4.5 Flashcards
What is the diagnosis of external inflammatory resorption?
Root surface intact but tramlines of root canal are distinct
What is the treatment of external inflammatory resorption?
Endo
If progressive conducer iodoform paste (vitapex) or CaOH every 6 months and plan for prosthetic
What is the diagnosis of internal inflammatory resorption?
Tramlines of root canal indistinct, root surfaces intact, radiolucency in pulp chamber, pink ‘cervical’ discolouration
What is replacement resorption (ankylosis)?
Initiated by severe PDL damage
Where bone directly fuses to dentine
What is the management of lateral luxation and extrusion?
Reposition under LA as very mobile
Flexible splint for 4 weeks
What are the current strategies for treatment for intrusion with closed apices?
0-3mm = allow spontaneous re-eruption, no movement after 3 weeks do ortho traction 3-7mm = disimpact and reposition with ortho and flexible splint for 2 weeks >7mm = disimpact and surgically reposition and flexible splint for 2 weeks
What are the current strategies for treatment for intrusion with open apices?
<7mm = allow for spontaneous re-eruption >7mm = disimpact and move ortho or surgically reposition and flexible splint for 2-4 weeks
What does MTA stand for?
Mineral Trioxide Aggregate
What advice would you give to a patient ringing about an avulsed tooth and why?
Hold tooth by crown
Rinse under saline or milk - not water as can cause PDL cells to lyse
Do not rub root
Replant, bite on tissue and go straight to dentist
If can’t be replanted - store in saliva/ saline/ milk/ tooth rescue box
How long can PDL cells survive outside of the mouth and in what environment?
Can survive 2-6hrs in pH 6.5-7.2
What milk is best to store an avulsed tooth in?
Chilled fresh low fat milk
What is the likely scenario of when the PDL cells are most likely to be viable?
Replanted immediately/ in 15 mins
What is the likely scenario of when the PDL cells are most likely to be viable but compromised?
Tooth in storage medium and extra oral dry time <60mins
What is the likely scenario of when the PDL cells are most likely to be compromised?
Total extraoral dry time >60mins
What is the managed treatment of an avulsed tooth with closed apices within 2 weeks after injury?
ENDO
What is the managed treatment of an avulsed tooth with open apices after injury?
Leave to revascularise, only endo if loss of vitality or beginning of inflammatory root resorption
What is the management avulsed tooth with an extra oral dry time well over 60 mins?
Open apex = do not replant or decorate and retain - best for ankylosed
Closed apex = encourage ankylosis, scrap off PDL and replant and splint for 2-3 months
What is the sound of an ankylosed tooth?
Metallic sound to percussion
Name 3 splinting techniques?
- Lead Foil + sutures
- Acrylic and wire – useful when few abutment teeth
- Composite and wire
- Composite mesh
- Gumshield – OH poor
- Mouthguard + perforations and cement
- Arch bar – may be too rigid
- Ortho brackets and wire
- Trauma Titanium Splint – flexible wire, put in place with composite
What is the only rigid splint used for and how long?
Alveolar fracture = 4 weeks
What is the flexible splinting time for subluxation?
2 weeks
What is the flexible splinting time for extrusion?
2 weeks
What is the flexible splinting time for avulsion?
2 weeks
What is the flexible splinting time for lateral luxation?
4 weeks
What is the flexible splinting time for root fracture (mid 1/3)?
4 weeks
What is the flexible splinting time for root fracture (cervical 1/3)?
4 months
