Crown Root Fractures of the Young Permanent Dentition Flashcards
What investigations should be carried out during the assessment of trauma?
Radiographs Pulp tests Mobility Tendedrness to percussion Displacements
What aspects should be included in the trauma history of a presenting child?
Relevant medical, dental, social and family history Trauma: Cause. How? Where? When? How has the tooth been managed?
What is the ultimate aim in the management of fractured immature permanent teeth and why?
Maintainence of pulp vitality as this promotes continued root dvelopment and maturation and reduces the risk of root fracture.
Also, complicated endodontics can be avoided.
What are the investigations to be performed with an uncomplicated crown fracture?
Basline PA Account for the lost fragment Mobility Ttp Pulp test
What are the possible consequences of an uncomplicated crown fracture?
Ingestioon/inhalation of crown fragment
Loose fragment embedded in wound
Soft tissue lacerations
Exposure of dentinal tubules
How should an uncomplicated crown fracture be restored?
Restored as such
1) Enamel only: CR or trim sharp edges
2) Composite or GIC bandage
3) Reattachment of fragment
4) Composite strip crown
5) Full crown in future
How should an uncomlicated crown fracture be managed?
Restore
Instruct for soft diet
Review 3, 6 and then 12 months and yearly (pulp test and PA each visit)
What is a complicated crown fracture and what investigations should be carried out when presented with one?
A crown fracture involvving enamel, dentine and pulp.
Invvestigations include accounting for the lost ffragment, baseline PAs and mobility
How can a complicated crown fracture be managed?
1) Direct pulp cap. If exposure > 1.5mm, success is greatly reduced
2) Cvek pulpotomy to maintain pulp vitality
What are the steps involved in a Cvek Pulpotomy?
1) Isolate w/ RD
2) Remove inflamed tissues (HS under water) and irrigate with saline. Keep going until no more bleeding.
3) Place barrier forming material (CaOH or MTA)
4) Restoratice seal necessary
5) review 3-6 monthly with vitality tests and PAs to assess hard tissue barrier formation and continued root development
What is a crown-root fracture and what investigations would indicate one?
Fracture of the enamel +/- dentine +/- pulp and cementum INvvestigations: account for any lost fragments baseline PAs mobility pulp tests
How should a crown-root fracture be managed?
Aim: to convert to a crown fracture either by root lengthening or orthodontic extrrusion to eensure a good restorative seal
If margins too far subgingivally, extraction or root burial
what factors determine the healing ppotential of a rroot fracture?
1) Site of fracture
2) Stage of root development
3) Coronal displacement
4) Repositioning and type of splint
5) PEriodontal health
What are the healing events that occur after a root fracture?
1) Hard tissue healing
2) Interposition of fibrous CT
3) Interposition of fribrous CT and bone
4) Granulation tissue
5) Pulp necrosis
