Classification and Management of Crown Fractures Flashcards
How should an enamel fracture be managed?
Either bond fragment to tooth or grind sharp edges
Take 2 periapicals to rule out root fracture or luxation
Follow up 6-8 weeks, 6 months and 1 year
What is the prognosis of an enamel fracture?
0% risk of pulp necrosis
How should an enamel-dentine fracture be managed?
Account for the fragment
Either bond fragment to tooth or place composite bandage
Take 2 periapicals 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 6-8 weeks, 6 months and 1 year
Line the restoration if the fracture is close to the pulp
What is the prognosis of an enamel-dentine fracture?
5% risk of pulp necrosis at 10 years
How should crown fractures be reviewed?
Use trauma sticker for clinical review
Check radiographs for:
- root development - length and width of canal
- comparison with other side
- internal and external inflammatory resorption
- periapical pathology
How does the apex of a tooth affect the chances of pulpal survival?
An open apex has a higher chance of survival
How are enamel-dentine-pulp fractures managed?
Evaluate exposure - size of pulp exposure, time since injury, associated PDL injuries
Choose from the following options:
- pulp cap
- partial pulpotomy (Cvek)
- full coronal pulpotomy
Aim to preserve pulp vitality
When should a direct pulp cap be carried out?
Tiny exposure (1mm) in a 24 hour window
Tooth should be non-TTP and positive to sensibility tests
Describe a direct pulp cap
Trauma sticker and radiographic assessment
LA and rubber dam
Clean area with water then disinfect area with sodium hypochlorite
Apply CaOH (Dycal) or MTA White to pulp exposure
Restore tooth with quality composite restoration
When should a partial pulpotomy be carried out?
Larger exposure (>1mm) or 24+ hours since trauma
Describe a partial pulpotomy
Trauma sticker and radiographic assessment
LA and rubber dam
Clean area with saline then disinfect with sodium hypochlorite
Remove 2mm of pulp with high speed round diamond bur
Place saline soaked CW pellet over exposure until haemeostasis achieved
Apply CaOH then GU (or white MTA) then restore with quality composite resin
When should a partial pulpotomy become a full coronal pulpotomy?
If no bleeding or can’t arrest bleeding
Describe a full coronal pulpotomy
If pulp hyperaemic or necrotic, proceed to remove all of the coronal pulp
Place CaOH in pulp chamber
Seal with GIC lining and quality coronal restoration
What is the success rate of a partial pulpotomy?
97%
What is the the success rate of a full coronal pulpotomy?
75%
