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Dental Trauma (Permanent Dentition) > Crown Fractures > Flashcards

Crown Fractures Flashcards

1
Q

What type of trauma usually results in crown fracture?

A

A direct frontal impact

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2
Q

What are most common aetiological factors of a crown fracture?

A

Falls, contact sports, road traffic accidents, and objects striking teeth

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3
Q

What features might you expect “typical” patient presenting with this type of trauma to have?

A

Boys presumably due to an increase in sporting injuries and individuals with increased overjets especially if they do not have good lip coverage

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4
Q

What might you expect to be predisposing factors to dental trauma?

A
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5
Q

What are aims of treatment?

A

Pain relief, preservation of vitality, promotion of root maturation, restoring function and aesthetics

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6
Q

What factors determine whether or not a tooth can be restored immediately?

A

Size of fracture and proximity of pulp

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7
Q

What is risk of pulp death where a periodontal/luxation injury has also occurred?

A

25%

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8
Q

What is another source of irritation to a pulp that has already been insulted?

A

Acid etchant

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9
Q

What is management of enamel fractures?

A

Composite resin build-up or reattachment of crown fragment

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10
Q

What should all fragments be stored in?

A

Physiologic saline/tap water until bonding to prevent discoloration and/or infractions due to dehydration

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11
Q

What is restoration of uncomplicated fractures and no con-comitant luxation injury?

A

Bonding can be performed immediately

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12
Q

What is restoration of concomitant luxation injury with tooth displacement?

A

A period of temporary restoration, corresponding to splinting period after luxation

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13
Q

What is temporisation?

A

To create provisional restorations that are required in short- or mid-term

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14
Q

What is temporisation in uncomplicated fractures?

A

Exposed fracture surface (enamel and dentin) is disinfected and then covered with a glass ionomer cement

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15
Q

What is temporisation in complicated fractures?

A

Pure calcium hydroxide is placed over exposure and enamel and dentin of fracture surface are then covered with glass ionomer cement

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16
Q

What is temporisation in concomitant luxation injuries?

A

Temporary restoration should stabilise fractured tooth in order to avoid migration of injured incisor/its antagonists

17
Q

What are conditions for pulp capping and partial pulpotomy?

A

Tooth should have been free of inflammation prior to injury and any associated injury to PDL must not have compromised vascular supply

18
Q

What should pulp capping be primarily used for?

A

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

19
Q

What should pulpotomy be primarily used for?

A

Longer post-trauma intervals to a depth of 2mm

20
Q

What should amputation site be covered with?

A

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

21
Q

What are follow-up procedures for crown fractured teeth?

A

1 and 2 months and 1 year after injury

22
Q

What are signs of pulp necrosis?

A

Loss of pulpal sensibility, coronal discolouration, and periapical radiolucency and persistent tenderness to percussion

23
Q

What are key features when determining appropriate treatment?

A

Tooth maturity, pulp vitality, associated periodontal injury, size of exposure, and age of exposure

24
Q

What is tooth maturity?

A

Does tooth have a completed apex?

25
Q

When is a tooth considered immature?

A

If apical foramen is greater than 1mm in diameter on periapical radiograph

26
Q

What increases chance of pulp death?

A

Large exposures, old exposures and associated periodontal injuries

27
Q

What must pulp be if it is to respond to calcium hydroxide therapy?

A

Vital

28
Q

When should pulp capping be carried out?

A

Closed apex, provided pulp is vital i.e. looks red and healthy/positive vitality test

29
Q

What should you do if cap falls off?

A

If pulp cap fails you can always extirpate pulp and root treat, thus clean injuries within 24 hours

30
Q

When should partial pulpomoty be carried out?

A

Open apex, vital pulp, provided amputation site looks red and healthy

31
Q

What should you do if amputation site does not look red and healthy?

A

Exposure site should be deepened until healthy pulp is reached

32
Q

When should cervical pulpotomy be carried out?

A

Immature tooth, compromised pulp, and dirty wound

33
Q

What is treatment where amputation site does not look healthy?

A

Still prefer to use this older technique where you remove coronal pulp and dress with calcium hydroxide at point where crown meets root

34
Q

What instrument is used for a pulpotomy?

A

Air rotor

35
Q

What is water supply in an air rotor?

A

Not sterile, it is also a hypotonic solution

36
Q

How can water supply in air rotor become an isotonic solution?

A

Turn it off and irrigate with saline, use lots of it

37
Q

What material is preferred when dressing wound?

A

Hard setting calcium hydroxide

38
Q

What is pulp capping procedure?

A

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

39
Q

What is pulpotomy procedure?

A

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

Dental Trauma (Permanent Dentition) (10 decks)

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