Crown injuries

Question 1

most important queations to ask during trauma history

Answer 1

how
when
any LOC/other symps
fragments

Question 2

important conditions relevant in MH

Answer 2

rheumatic fever
immunosuppression
cardiac condition (congenital heart defect)

Question 3

aspects of e/o exam

aspects of i/o exam

Answer 3

E/O-lacerations/haematomas/haemorrhage/bony step -defects/mouth opening/subconjunctiival haemorrhage
I/O - occlusion/soft tissues/alveolar bone/teeth

Question 4

prognosis of a traumatised tooth depends on?

Answer 4

maturity of tooth/age of patient
type/extent of injury
other injuries present - PDL damage
how long until presentation
presence of inf

Question 5

emergency principles of treatment

Answer 5

Aim to retain vitality of any
damaged or displaced
tooth by protecting
exposed dentine by an
adhesive ‘dentine
bandage’
• Treat exposed pulp tissue
• Reduction and
immobilisation of displaced
teeth
• Tetanus prophylaxis
• Antibiotics?

Question 6

intermediate principles of treatment

Answer 6

\+/- Pulp treatment
• Restoration
– Minimally invasive
e.g. acid etch
restoration

Question 7

permanent principles of treatment

Answer 7

Apexigenesis
• Apexification
• Root filling +/-
root extrusion
• Gingival and
alveolar collar
modification if
required
• Coronal
restoration

Question 8

how to manage an E#

Answer 8

where’s the fragment - inh?
-clinical and radiograph exam (trauma stamp)
-bond fragment back on/smooth with abrasive discs
-take 2 PA -parallax
-review - 4w-8w/yearly
0% PULP NECROSIS RISK

Question 9

how to manage ED#

Answer 9

where’s fragment

• clinical and radiograph exam (parallax) -trauma stamp
• Rg soft tissues for fragment
• bond fragment or place composite bandage
• evaluate root maturity
• definitive restoration
• review - 4-8week, yearly

Question 10

what should be checked for on a Rg following trauma

Answer 10

continued root devlopment (comparison)
external/internal inflam resorption
periapical pathology
root canal - sclerosis

Question 11

factors that affect the management of a EDP#

pulp management options

Answer 11

size of exposure
length of time left
associated PDL injury

-pulp cap/cvek pulpotomy/full coronal pulpotomy

Question 12

direct pulp cap - when

-how is this carried out

Answer 12

exposure <1mm/<24hr

• Apply dam and LA
• clean with saline, disinfect with NaOCl
• apply CaOH/white MTA
• definitive restoration
• review 6-8 week, yearly

Question 13

cvek pulpotomy - when

• success rate
• how is it caried out

Answer 13

exposure >1mm/24hr
97% SUCCESS RATE
-Apply dam and LA
-clean (saline) and disinfect NaOCl
-remove 2mm pulp (ss/se) evaluate haemostasis
-apply saline coated cotton pellet for 20s-1min
-if no bleed/dark blood (hyperaemic) - complete full
-if not apply CaOH, vitrebond, restore with composite
-review 6-8w, yearly

Question 14

full coronal pulpotomy
success rate
how to complete

Answer 14

• 75% success
• Apply dam and LA
• clean (saline) and disinfect NaOCl
• remove 2mm pulp (ss/se) evaluate haemostasis
• apply saline coated cotton pellet for 20s-1min
• no bleed/hyperaemic
• remove ALL coronal pulp
• seal with GIC lining and restore

Question 15

what’s the aim of a pulpotomy

Answer 15

The aim of Pulpotomy is to keep vital pulp
tissue within the canal to allow normal root
growth (apexogenesis) both in the length of
the root and the thickness of the dentine.

Question 16

pulpectomy of open apex

Answer 16

Rubber dam
• Access
• Haemorrhage control - LA / sterile water
• Diagnostic radiograph for WL
• File 2mm short of estimated WL
• Dry canal, Non-setting Ca(OH)2 , CW in pulp
chamber
• Glass-ionomer temporary cement in access
cavity and evaluate calcium hydroxide fill
level with radiograph

Question 17

treatment options for CR# with no pulp exposure

Answer 17

ortho extrusion
XLA
surgical extrusion
fragment removal and restore
fragment removal and gingivectomy
decoronation

Question 18

treatment option for CR# with pulpal exposure

Answer 18

XLA
decoronation
surgical extrusion
ortho extrusion
fragment removal and gingevectomy