DENTAL TRAUMA

Question 1

Patient presents to the clinic with a tooth that is displaced with no mobility. It appears to be out of normal occlusion with a buccal bulge. On TTp, you hear a high metallic sound. Which trauma is this most likely?

(A) Intrusion
(B) Lateral luxation
(C) Extrusion
(D) Root fracture

Answer 1

B

Question 2

A 7 year old patient presents to the clinic with trauma to his 11. On examination, you come to the diagnosis of an extrusive luxation.
a) What symptoms would allow you to reach this conclusion
b) What would be the best management of this tooth?
c) What is most likely outcome of this tooth?

Answer 2

a) Tooth infraposition, bleeding from socket, sensibility testing likely to be negative
b) Reposition the tooth and splint for 2 weeks. Review:
- 2 weeks
- 4 weeks
- 6-8wks
- 6 months
- Yearly for 5 years
c) Pulpal obliteration (tooth is immature)

Question 3

What is the management of an intrusive luxation in an immature vs mature tooth? What is most likely outcome of each

Answer 3

Immature
- Allow for spontaneous eruption for 3 weeks
- Consider surgical or orthodontic exposure and splinting for 4 weeks if tooth hasn’t erupted for 3 weeks
- Outcome = Revascularisation

Mature
- Surgical or orthodontic exposure and splinting for 4 weeks. RCT asap within 2 weeks (will be necrotic 2-3wks after repositioning)
- Outcome = Pulpal necrosis with surface, inflammatory or replacement resorption
- Review: 2 weeks, 4 weeks, 6 weeks, 6 months, Yearly for 5 years

Question 3

What is the management of an avulsed tooth for dry time < 60 minutes

Answer 3

1. Soak tooth in saline
2. Reimplant under LA
   - Flexible splint for 2 weeks
   - Systemic abx = Doxycycline 100mg x 1 for 7 days
   - Check tetanus
   - Post op
   > No contact sports for 6 weeks
   - Soft diet for up to 2 wks
   - Good OH
   - Chx 2x daily for 2 weeks
3. Review in 7-10 days and cmmence endo if required
4. Follow up
   - 2 weeks
   - 4 weeks
   - 3 months
   - 6 months
   - Yearly for 5 years

Question 4

When is pulp necrosis usually evident after trauma?

Answer 4

2-4 weeks –> Decide whether RCT required

Question 5

Summarise splinting times for the key trauma cases.

Answer 5

Subluxation, extrusion, avulsions (extraoral dry time < 60mins) → 2 weeks
Mobile = Splint for additional 1 wk
Immobile = Remove splint

Lateral luxation, intrusion, root (apical and mid third) and alveolar fractures → 4 weeks

Root fracture (cervical third) → 4 months

Question 6

What two types of trauma generally cause resorption?

Answer 6

Lateral luxation and intrusive luxation

Question 7

What are signs of pulpal necrosis?

Answer 7

• Change in colour
• Radiographic = Root resorption, radiolucency, failure of root development
• Sensibility tests remains negative
• TTP = Increasing overtime

Question 8

What are the challenges in RCT for open apex?

Answer 8

• Creating apical seat with good root filling (no extrusion)
• Dentinal walls are thinner
• Higher chance of fracture intraoperatively due to thin walls
• ## Younger patients –> Difficult pain history and sensibility testing not reliable = Dx difficult