Dental Trauma Flashcards
Most dental trauma occurs in what age range
7-14 age
Most trauma occurs in the _____ region of the maxilla & mandible
anterior region
If a tooth is avulsed, do you put it back?
No
Does trauma go away or is it with you for life?
For life
NO PROBLEM IF VITAL:
RELAX AND RESTORERE
CALL AND TEST VITALITY
Uncomplicated crown fracture
TREATMENT OPTIONS:
- Pulp Cap: least successful LONG TERM (better now using bioceramics)
- Pulpotomy: preferred if open apex
- RCT: preferred if apex closed or post necessary.
Complicated crown
Take CBCT
Anesthetize
Remove FX element
Determine Pulpal Exposure & Restorability
If no exposure –restore; If exposed VPT or RCTif open apex -VPT; RCT if apex closed
Be certain there is NOT a 2nd component of FX
Crown root fractures
In all trauma, the primary purpose of our treatment is to keep the pulp vital if the apex is open (immature).
Vital Pulp Therapy (VPT)
Does J lesion always mean VRF?
Not always
Treatment for confirmed VRF is ______
Extraction
The _____is often easily visualized on the radiograph
Seldom if ever occurs on posterior teeth.
XS Mobility also a good clue
horizontal FX
If a HRF occurs in the apical 1/3 of root, what portion is more likely to have necrotic pulp?
Coronal portion
Option selection and prognosis with ___ depends on:
- Level of FX
- Restorability-Periodontal Health
- Vitality of Pulp
- Stage of Root Development
- Time since injury
- Age of patient
- Cooperation of patient
- Availability for follow-up
- Approximation opportunities
- Stabilization options
HRF
If someone has HRF how long should the tooth be splinted?
2-4 days
If someone has HRF when should you take sensibility tests?
30 days
The bone segment containing the involved tooth is mobile. Splinting is required for 4-6 weeks Complicates healing (slower) Discomfort may be greater/longer lasting Should not affect final result in most cases
Alveolar Fracture
\_\_\_\_ Luxation injury: •Least severe of Luxation injuries •No displacement of tooth nor mobility •Tooth tender to touch “Bruised PDL” •No radiographic abnormalities •VIP!!! Assess vitality in 2&4 wks & follow
Concussion
____ luxation injury
•Tooth tender to touch & slightly mobile (1+) but not displaced
•Possible hemorrhage from gingival crevice
•No radiographic abnormalities
•Damage to supporting structures? (not really)
•VIP!!! Assess vitality in 2&4 weeks & follow
Subluxation
_____ luxation injury:
•Displaced laterally & often locked in bone
•Not tender to touch, not mobile
•Alveolus fractured
•Percussion test: high metallic sound (ankylosis)
•Increased PDL space best seen on eccentric or occlusal radiographs
•Anesthetize & reposition + Flexible splint MANDATORY 4 weeks
•VIP!!! Assess vitality in 2&4 weeks & follow
Lateral Luxation
What happens when PDL cells are exposed to MO?
Resorption
Do you take baseline for lateral and extrusive luxation on day of or day after trauma treatment?
Day after
____ luxation injury
•Elongated mobile tooth–Cl. II mobility or greater
•Radiographs show increased apical periodontal space
•Manually reposition
•Flexible splint MANDATORY 7-14 days
•VIP!!! Assess vitality in 2&4 weeks & follow
Extrusive luxation
•Most severe of luxations* Tooth appears shorter: displaced into alveolar bone•PDL destruction/alveolar crushing) Beware of ankylosis/resorption/ •pulp necrosis is all but certain in mature teeth*•Not tender to touch, not mobile•Percussion test: high metallic sound•Radiographs not always conclusive•Slightly luxate with forceps or band and move orthodontically ASAP.•Splinting is not usually necessaryUNLESS…tooth is loosened by luxation–Tooth with open apex mayspontaneously re-erupt.–100% RCT intervention
Intrusive Luxation
•Tooth is knocked completely out of mouth
•Viability of the PDL must be preserved for success
•Extra-oral dry time is CRITICAL 30-60 minutes for survival of PDL***
•Must be replaced in socket immediately or ASAP (15-20”) in order to..
–Prevent ankylosis
–Prevent external root resorption
Avulsion
TX is aimed at minimizing the inflammation from the two mainconsequences of avulsion: 1. attachment damage2. pulpal necrosis & infection that usually results The SINGLE most important factor in achieving a favorable outcome is the SPEEDat which a cleantooth is properlyreplanted (viable PDL) 15”Keeping the attached PDL moist is paramount*
Replant of Avulsion
Save a tooth Via span Milk or green tea Contact lens Place in mouth
Avulsed teeth transport
What antibioitic is used for avulsed teeth?
Doxycycline
If the pulp canals are sclerosed, how will the tooth respond to cold and EPT? How to treat?
NR Thermal
Normal to EPT
No treatment
A change of the odontoblasts of the Pulpto a “-clastic” type cell resulting from pulpal injury. (generally traumatic, even w/ ortho)
•Destruction of dentin beginning at the pulpal interface.
•Excellent prognosis for resolution IFRCT done B4 perforation occurs.
•Internal resorption depends upon vital pulp tissue to progress. Removal of pulp positively halts
•Radiographically looks like an “aneurysm” w/in the RCS. The form of the pulp canal is altered.
Internal resorption
- A change in the cells of the PDL from formative to destructive cells often as a result of trauma (occasionally ideopathic).
- Destruction of tooth structure at the cervical area.
- Generally very POOR prognosis for resolution (difficult to restore & resorption often may recur)
- appears ragged, asymmetrical and you can follow the canal through the defect.*
External resorption
•A problem following trauma and long term rigid splinting
•Tooth is solidly fixed and has a high metallic ring when percussing.
Does not erupt with other teeth
•May lead to massive external replacement resorption & loss of tooth
•Internal= appearance of “aneurysm”
Ankylosis
____ are used to prevent ankylosis and associated resorption following trauma by allowing some small tooth movement
Splint
Are more rigid or more flexible splints better?
More flexible
-Allows physiologic movement of the teeth in order to minimize ankylosis-In the past, .028 gauge ortho wire bonded to tooth for 1-2 weeks unless alveolar FX had occurred. Then 4-6 wksOR: 4-6# fishing line bonded to teeth
Flexible splint
