dental trauma Flashcards
most comman ages of trauma
7-14
most common location trauma
anterior of both arches
perm vs primary dentition injuries
- Perm. Dentition injuries greater importance
- Primary Dentition injuries?
– Prevent injury to succedaneous tooth
– Patient comfort
– Avulsed primary teeth seldom replaced
PRIME RULES OF DENTAL TRAUMA
- TRAUMA IS NEVER PLANNED
- TIMELY TREATMENT IS BASIC TO SUCCESS
- OCCURS AT THE LEAST CONVENIENT TIME
- TRAUMA is for LIFE
pt/parent emotions and demands
Patient FRIGHTENED and in PAIN
Parents are EMOTIONAL /IRRATIONAL
Both want IMMEDIATE ACTION
ESTHETIC expectations unrealistic
PERFECT OUTCOME demanded
perm, primary and adolescents % trauma
% children in USA that will have trauma
4-14%
Epidemiology
EpidemiologyChildren 5 years of age
Epidemiology
EpidemiologyAdolescents 12 years of age
Traumatic injuries classification
Uncomplicated Crown Fractures
Crown FX without Pulp exposure
NO PROBLEM IF VITAL:
RELAX AND RESTORE
RECALL AND test vitality
tx options?
Complicated Crown FX
pulp exposure
TREATMENT OPTIONS:
- Pulp Cap: Use Bioceramic materials
- Pulpotomy: preferred if open apex
- RCT: preferred if apex closed
crown root fractures
often fractures at an angle
crown root fracture tx
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
can crown root fractures be clearly seen
Fracture Line may NOT be clearly seen.
Take several angled X-rays varying both vertical & horizontal
VRF
Vertical FX of Crown>Root
j shaped radiographic lesion
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 present
Methods of documenting VERTICAL ROOT FRACTURE
Transillumination
Restoration Removal + Staining
Surgical Exposure
Horizontal Root Fracture
visualized?
Seldom occurs where?
what is a good clue?
The horizontal FX is often easily visualized on the radiograph
Seldom if ever occurs on posterior teeth.
XS Mobility also a good clue
Option Selection &
Prognosis with HRF depends upon:
Level of FX
- Restorability
- Periodontal Health
- Vitality of Pulp
- Stage of Root Development
- TX OPTIONS ARE DETERMINED CASE BY CASE
factors of HRF tx and prognosis non tooth related
Time since injury
Age of patient
Cooperation of patient
Availability for follow-up Approximation opportunities
Stabilization options
root HRF tx?
Try to reposition and
splint 2-4 wks, check for vitality q 30 days
possible outcomes of HRF tx
s
ALVEOLAR FRACTURE
The bone segment containing the involved tooth is?
Splinting req for how long?
Complicates?
Discomfort?
Should not?
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
most common of all dental injuries
luxation
least to greatest damage?
Luxation Injuries types
Concussion
Subluxation
Extrusion
Lateral
Intrusive
(ARRANGED IN ORDER OF
LEAST TO GREATEST DAMAGE)
Concussion Luxation Injury
- severity?
- displacement/mobility?
- tender?
- radiographic app?
- vitality assessment?
- 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
* tender? mobility?
* hemorrhage? where?
* radiographic app?
* Damage to?
* vitality assessment
- 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
* displaced?
* tender/mobility?
* what can be fractured?
* radiographic app?
* tx?
* vitality assessment?
- 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
* mobility/app?
* Radiograph app?
* tx?
* vitalitiy assessment
- 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
* severity? app of tooth? why?
* what event is likely?
beware of what results?
* tender/mobility?
* Percussion test?
* Radiographs?
*tx?
* Tooth with open apex may?
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
- Tooth is knocked completely out of mouth
in avulsion what must be preserved for success
- Viability of the PDL must be
preserved for success
prevent what?
extraoral dry time for avulsion/replant time?
- Extra-oral dry time is CRITICAL 0-15
minutes for survival of PDL*** - Must be replaced in socket
immediately or ASAP (15-20”) in
order to..
– Prevent ankylosis
– Prevent external root resorption
what teeth should be replanted in avulsion
any useful permanent tooth
replant tx of avulsion aimed at minimizing what effects?
aimed at minimizing the inflammation from the two main consequences of avulsion:
1. attachment damage
2. pulpal necrosis & infection that usually results
PDL should be kept in what state?
The SINGLE most important factor in achieving a favorable outcome is:
The SINGLE most important factor in achieving a favorable outcome is the SPEED at which a clean tooth is properly replanted (viable PDL) 15”nKeeping the attached PDL moist is paramount*
appropriate mediums of avulsed tooth transport
how to handle an avulsed tooth during replantation
with tooth replanted what is next step in office?
take radiogrpahs to ensure there is no alveolar fx and adjacent teeth are ok
why would you take radiographs of the lips?
to see if any fx pieces are in the lip soft tissue
steps to replantation when in office
what not to do with avulsed teeth
handle by root
scrub root
put in water (cell lysis)
allow tooth to dry
Other Potential Results of Trauma
(“Down the Road” Possibilities)
- SOME TRAUMA OUTCOMES ARE NOT FOREVER *
- Effects on Pulpal Spaces
- Resorption
- Ankylosis
Trauma: Effects on Pulpal
Spaces
completely sclerosed pulp canals in the
traumatized central incisors. No caries.
Placed on recall; No Treatment, FOLLOW
2 possible pulpal responses to trauma
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
Ankylosis
* A problem following?
* Tooth is? percussing? eruptin with others?
* May lead to?
* Internal appearence ?
- 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 of avulsed tooth ext root resorb
symptoms?
hx of?
what can occur?
id by?
- 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 XR + lack of normal mobility + High pitched “metallic ring” during percussion
or possibly by “submergence” (not erupting with other normal teeth)
educating others on trauma
educating our patients and the community regarding the dangers of trauma as well as appropriate preventive measures and therapeutic
what can be used to reduce trauma
mouth guards
