Dental Trauma Flashcards
Most dental trauma occurs in — age range
7-14
Most trauma occurs in the — region of the maxilla & mandible
anterior
Perm. Dentition injuries
greater importance
Primary Dentition injuries?
(3)
– Prevent injury to succedaneous tooth
– Patient comfort
– Avulsed primary teeth seldom replaced
PRIME RULES OF DENTAL TRAUMA
(4)
- TRAUMA IS NEVER PLANNED
- TIMELY TREATMENT IS BASIC TO SUCCESS
- OCCURS AT THE LEAST CONVENIENT TIME
- TRAUMA is for LIFE
Patient (2)
Parents are (2)
Both want — ACTION
— expectations unrealistic
— OUTCOME demanded
FRIGHTENED and in PAIN
EMOTIONAL/IRRATIONAL
IMMEDIATE
ESTHETIC
PERFECT
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www.aae.org
* Search: “—”
* Choose: “—”
* Download:
The Treatment of Traumatic Dental Injuries
(Colleagues for Excellence Summer 2014)
Trauma Resources
The Biological Basis for Endodontics
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Outline: Permanent Dentition
(8)
I. Crown Fractures
2. Crown-Root Fractures
3. Vertical/Horizontal Root Fractures
4. Alveolar Fractures
5. Luxation Injuries:
*Concussion
*Subluxation
*Extrusion
*Lateral
*Intrusive
6. Avulsion
7. Other Potential Results of Trauma
*- Effects on Pulpal Spaces
- Resorption
*- Ankylosis
8. Prevention of Dental Trauma Injuries
Permanent dentition
—%
Primary dentition
—%
Adolescents 12 y/o —%
15.2
22.7
18.1
Epidemiology
Children 5 years of age
(3)
1/3 injuries
in primary
dentition
Luxation
(More
common)
Luxation
(More
common)
Males more
frequent
than females
Epidemiology
Adolescents 12 years of age
(3)
20 al 30% will
suffer dental
trauma
Uncomplicated
crown fracture
(More common)
Uncomplicated
crown fracture
(More common)
Males more
frequent than
females
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Traumatic injuries classification
Concussion
Subluxation
Intrusion
Extrusion
Lateral
luxation
Avulsion
Crown fracture
Crown-root fracture
Root fracture
Bone fracture
Uncomplicated Crown Fractures
Crown FX without Pulp exposure
Uncomplicated Crown Fractures
NO PROBLEM IF
VITAL:
(2)
RELAX AND RESTORE
RECALL AND TEST
VITALITY
Complicated Crown FX (Pulp Exposure)
TREATMENT OPTIONS:
(3)
- Pulp Cap: Use Bioceramic
materials - Pulpotomy: preferred if
open apex - RCT: preferred if apex closed
Crown-Root Fractures
Crown-Root FX: often fractures at an
angle
Crown-Root Fractures
Crown-Root FX: often fractures at an angle
(6)
Anesthetize
Remove FX element
Determine Pulpal Exposure & Restorability
If no exposure – restore; If exposed VPT or RCT
if open apex - VPT; RCT if apex closed
Be certain there is NOT a 2nd component of FX
Crown-Root Fractures
Crown-Root FX: often fractures at an angle
Fracture Line
may NOT be
clearly seen…
Take several
angled X-rays
varying both
vertical &
horizontal
VRF & HRF
Vertical FX of Crown>Root
VRF & HRF
Vertical FX of Crown>Root
Remember, the ‘J” lesion is not always seen
with a cracked root AND ‘J’ lesion, if present,
does not always mean root is cracked. But
always seriously CONSIDER cracked root if J
Methods of documenting VERTICAL ROOT FRACTURE
(3)
Transillumination
Restoration Removal + Staining
Surgical Exposure
Horizontal Root Fracture
(4)
The horizontal FX is often easily visualized
on the radiograph
Seldom if ever occurs on posterior teeth.
XS Mobility also a good clue
Is this salvageable?
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HRF Treatment Decisions:
Multifactorial
Option Selection &
Prognosis with HRF depends upon:
(10)
- 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-
upApproximation
opportunities
Stabilization options
Treatment Options are determined on a
Case by
Case Basis
Root FX (Horizontal)
What do you do here? Try to reposition and
splint — wks, check for vitality q — days
2-4
30
ALVEOLAR FRACTURE
(5)
The bone segment containing the involved tooth is mobile.
Splinting is required for 4-6 weeks
Complicates healing (slower)
Discomfort may be greater/longerlasting
Should not affect final result in most cases
Luxation Injuries(MOST COMMON OF ALL DENTAL INJURIES)
- Pathways
(5)
Concussion
Subluxation
Extrusion
Lateral
Intrusive
30-44%
Concussion
Subluxation
Extrusion
Lateral
Intrusive
ARRANGED IN ORDER OF
LEAST TO GREATEST DAMAGE
Concussion Luxation Injury
(5)
- 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
Subluxation Injury
(5)
- Tooth tender to touch &
slightly mobile (1+) but not
displaced - Possible hemorrhage from
gingival crevice - No radiographic
abnormalities - Damage to supporting
structures? - VIP!!! Assess vitality in 2&4
weeks & follow
Lateral Luxation Injury
(6)
- Displaced laterally & often locked in bone
- Not tender to touch, not mobile
- Alveolus fractured
- 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
What is a flexible splint?
-Allows physiologic movement of the teeth
in order to minimize ankylosis
-In the past, .020 or 18 gauge ortho wire
bonded to tooth for 1-2 weeks unless
alveolar FX had occurred. Then 4-6 wks
OR: 4-6# fishing line bonded to teeth
Extrusive Luxation Injury
(5)
- Elongated mobile tooth
– Cl. II mobility or greater - Radiographs show
increased apical
periodontal space - Manually reposition
- Flexible splint
MANDATORY 14 days - VIP!!! Assess vitality in
2&4 weeks & follow
Intrusive Luxation Injury
External root resorption likely
- 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: sounds different
- Radiographs not always conclusive
- Slightly luxate with forceps or band and move orthodontically ASAP.
- Splinting is place 14 days or more if alveolar fx is present.
- Tooth with open apex may spontaneously re-erupt depending on the depth of penetration. (Less than 7mm)
– 100% RCT intervention
Avulsion
*Definition
* Viability of the — must be
preserved for success
* Extra-oral dry time is CRITICAL
* Must be replaced in socket
immediately or ASAP (15-20”) in
order to..
(2)
Tooth is knocked completely out of
mouth
PDL
0-15
minutes for survival of PDL***
– Prevent ankylosis
– Prevent external root resorption
To replant or not? should be
“useful permanent tooth”: Little point in replanting
THIS one or deciduous tooth.
Replant?
TX is aimed at minimizing the inflammation from the two main
consequences of avulsion:
(2)
- attachment damage
- pulpal necrosis & infection that usually results
The SINGLE most important factor in achieving a favorable outcome is
the — at which a clean tooth is properly replanted (viable PDL) —
SPEED
15”
Keeping the attached PDL — is paramount*
moist
First Aid Instructions
If not, transport in appropriate medium
(5)
“Save-a-
tooth”
(Hank’s
Balanced
Salt Solution)
“Via Span”
(if available)
milk or
Green Tea if
above not
available
contact lens
solution
place in
vestibule
(saliva) &
Report to
dental office
ASAP
Be PROACTIVE: Provide
instructions & transport
media to area schools and sports facilities –
Practice Builder
Handle by
— only
Pick off
debris with
—
—- tooth at the
site if
possible
crown
tweezers
Replant
Once in Dental office:
*Take films to make sure
there is no alveolar FX
(cone beam) & that
adjacent teeth are OK
Do Not
(3)
Allow tooth to dry
Scrub root
Handle by root
Other Potential Results of Trauma
(“Down the Road” Possibilities)
* SOME TRAUMA OUTCOMES ARE NOT
— *
(3)
FOREVER
- Effects on Pulpal Spaces
- Resorption
- Ankylosis
Trauma: Effects on Pulpal
Spaces
Note the
completely
sclerosed pulp
canals in the
traumatized
central
incisors. No
caries.
Placed on
recall; No
Treatment FOLLOW UP
Trauma may stimulate 2 different
pulpal responses
Trauma to a tooth can
stimulate the pulp to
generate massive amounts
of tertiary dentin End
Result is a sclerosed &
non negotiable canal.
The same trauma may
cause the pulp to
discontinue development
and remain at the stage
present at the time of
injury. This may provide a
clue as to the age of the
patient at the time of the
injury.
Ankylosis
(4)
- A problem following trauma and long term rigid splinting
- Tooth is solidly fixed and has a high different ring when percussing. Does
not erupt with other teeth - May lead to massive external replacement resorption & loss of tooth
- Internal = appearance of “aneurysm” w/in canal.
Replacement ERR:
(2)
- Patients are generally asymptomatic
- Typically a history of avulsion or intrusion injury
Bone may replace dentin in cases of PDL injury.
Ankylosis occurs and may be identified by
(4)
XR + lack of normal
mobility + High pitched “metallic ring” during percussion
or possibly by “submergence” (not erupting with other
normal teeth)
EDUCATION
- Our professional responsibility includes educating
our patients and the community regarding the
dangers of trauma as well as appropriate preventive
measures and therapeutic opportunities:
– Talk to school nurses
– Coaches
– Youth groups, Scouts, etc.
MOUTH GUARDS
(5)
- Our professional responsibility includes educating
our patients and the community regarding the
benefits of the use of mouth guards during sports
activity.
– Make appropriate mouth guards available at an affordable cost to
the community.
– Talk to coaches and youth sponsors.
– Sponsor a Team in your area.
– Volunteer your services (Music Theatre, etc.)
