Crown Fractures Flashcards
What type of trauma usually results in crown fracture?
A direct frontal impact
What are most common aetiological factors of a crown fracture?
Falls, contact sports, road traffic accidents, and objects striking teeth
What features might you expect “typical” patient presenting with this type of trauma to have?
Boys presumably due to an increase in sporting injuries and individuals with increased overjets especially if they do not have good lip coverage
What might you expect to be predisposing factors to dental trauma?
What are aims of treatment?
Pain relief, preservation of vitality, promotion of root maturation, restoring function and aesthetics
What factors determine whether or not a tooth can be restored immediately?
Size of fracture and proximity of pulp
What is risk of pulp death where a periodontal/luxation injury has also occurred?
25%
What is another source of irritation to a pulp that has already been insulted?
Acid etchant
What is management of enamel fractures?
Composite resin build-up or reattachment of crown fragment
What should all fragments be stored in?
Physiologic saline/tap water until bonding to prevent discoloration and/or infractions due to dehydration
What is restoration of uncomplicated fractures and no con-comitant luxation injury?
Bonding can be performed immediately
What is restoration of concomitant luxation injury with tooth displacement?
A period of temporary restoration, corresponding to splinting period after luxation
What is temporisation?
To create provisional restorations that are required in short- or mid-term
What is temporisation in uncomplicated fractures?
Exposed fracture surface (enamel and dentin) is disinfected and then covered with a glass ionomer cement
What is temporisation in complicated fractures?
Pure calcium hydroxide is placed over exposure and enamel and dentin of fracture surface are then covered with glass ionomer cement
What is temporisation in concomitant luxation injuries?
Temporary restoration should stabilise fractured tooth in order to avoid migration of injured incisor/its antagonists
What are conditions for pulp capping and partial pulpotomy?
Tooth should have been free of inflammation prior to injury and any associated injury to PDL must not have compromised vascular supply
What should pulp capping be primarily used for?
Small exposures soon after injury (possibly within first 24 hours) and where a restoration can be placed which provides a tight seal against bacterial invasion
What should pulpotomy be primarily used for?
Longer post-trauma intervals to a depth of 2mm
What should amputation site be covered with?
Either hard setting calcium hydroxide cement followed by a thin layer of glass ionomer cement/MTA and tooth restored using a dental adhesive to ensure a bacteria-tight seal
What are follow-up procedures for crown fractured teeth?
1 and 2 months and 1 year after injury
What are signs of pulp necrosis?
Loss of pulpal sensibility, coronal discolouration, and periapical radiolucency and persistent tenderness to percussion
What are key features when determining appropriate treatment?
Tooth maturity, pulp vitality, associated periodontal injury, size of exposure, and age of exposure
What is tooth maturity?
Does tooth have a completed apex?
When is a tooth considered immature?
If apical foramen is greater than 1mm in diameter on periapical radiograph
What increases chance of pulp death?
Large exposures, old exposures and associated periodontal injuries
What must pulp be if it is to respond to calcium hydroxide therapy?
Vital
When should pulp capping be carried out?
Closed apex, provided pulp is vital i.e. looks red and healthy/positive vitality test
What should you do if cap falls off?
If pulp cap fails you can always extirpate pulp and root treat, thus clean injuries within 24 hours
When should partial pulpomoty be carried out?
Open apex, vital pulp, provided amputation site looks red and healthy
What should you do if amputation site does not look red and healthy?
Exposure site should be deepened until healthy pulp is reached
When should cervical pulpotomy be carried out?
Immature tooth, compromised pulp, and dirty wound
What is treatment where amputation site does not look healthy?
Still prefer to use this older technique where you remove coronal pulp and dress with calcium hydroxide at point where crown meets root
What instrument is used for a pulpotomy?
Air rotor
What is water supply in an air rotor?
Not sterile, it is also a hypotonic solution
How can water supply in air rotor become an isotonic solution?
Turn it off and irrigate with saline, use lots of it
What material is preferred when dressing wound?
Hard setting calcium hydroxide
What is pulp capping procedure?
Isolate pulp exposure, cover pulp with a calcium hydroxide material (either hard-setting cement/pure calcium hydroxide paste), restore tooth immediately with a bacteria-tight restoration, later assessment of hard tissue barrier implies risk of renewed exposure to bacteria, thereafter, hard tissue barrier is re-covered with glass ionomer cement/a composite resin retained with a dental bonding agent; and thereafter tooth can be restored
What is pulpotomy procedure?
Isolate pulp exposure, amputate pulp to a level approximately 2 mm below exposure site/to where fresh bleeding is seen, if immediate restoration is desired, cover exposure with a hard-setting calcium hydroxide cement (e.g. Dycal/Life), if later assessment of hard tissue barrier is desired, cover exposure with pure calcium hydroxide paste, cover entire fracture surface (enamel and dentin) with a hard-setting calcium hydroxide cement and a temporary restoration for a period of 3 months, at that time, uncover amputation site, remove necrotic pulp tissue immediately above hard tissue barrier and restore with a bacteria-tight restoration
