Dental Trauma

Question 1

fracture that does NOT involve the pulp

Answer 1

uncomplicated fracture

Question 2

Uncomplicated fracture treatment:

Enamel only –>
Enamel and dentin involved –>

Answer 2

Enamel only –> smooth the edges of the tooth to prevent future damage

Enamel and dentin involved –> tooth restoration

Question 3

fracture that involve pulp

Answer 3

complicated fracture

Question 4

Treatment of a complicated fracture is according to timing:

Less than 24h
+/- 24h
+/- 72h

Answer 4

Less than 24h –> direct pulp cap
+/- 24h –> partial pulpotomy (Cvek)
+/- 72h –> pulpotomy

Question 5

type of fracture in which the apical segment remains in place but there is displacement of the coronal segment

Answer 5

horizontal root fracture

Question 6

type of fracture which requires minimum 3 PAs + 1 occlusal radiograph

Answer 6

horizontal root fracture

(fracture along one plane will need several radiographs at different angulations to visualize the fracture)

Question 7

heals by calcific metamorphosis to fuse close fragments through calcification

Answer 7

horizontal root fracture

Question 8

Treatment of a horizontal root fracture:

If tooth is necrotic –>
If tooth is vital –>

Answer 8

Necrotic –> RCT

Vital –> splint teeth immediately based on fracture on root
- Apical: flexible splint for 4 weeks
- Middle: flexible splint for 4 weeks
- Coronal: flexible splint for 4 months

Question 9

Name the luxation injury:
- minor injury, no tooth displacement or mobility
- PDL inflamed and sore
- no tx needed, let tooth rest

Answer 9

concussion

Question 10

Name the luxation injury:
- no tooth displacement, slight mobility
- PDL inflamed, may rip and bleed
- closed apices = 6% chance of necrosis
- open apices have better prognosis
- tx –> flexible splint for up to 2 weeks

Answer 10

subluxation

Question 11

Name the luxation injury:
- displacement of tooth from socket in an extrusive direction
- closed apices = 65% of necrosis

Answer 11

extrusion

Question 12

Tx of a tooth that has been extruded if apices are closed vs open

Answer 12

Closed apices –> reposition, flexible splint for up to 2 weeks, follow-up

Open apices –> reposition, flexible splint, RCT if necessary

Question 13

Name the luxation injury:
- tooth displaced from its long axis with apical end usually displaced labially and coronal end palatally
- fracture of alveolar bone may occur in severe cases
- close apices = 80% chance of necrosis
- tx: flexible splint, 4 weeks

Answer 13

lateral luxation

Question 14

tx for lateral luxation

Answer 14

flexible splint, 4 weeks

Question 15

Name the luxation injury:
- tooth pushed into socket/apical displacement of tooth
- 95% chance of necrosis due to severing of blood vessels

Answer 15

intrusive luxation

Question 16

Tx for an intrusive luxation injury:
Closed apices –>
Open apices –>

Answer 16

Closed apices –> reposition, flexible splint, or root canal

Open apices –> monitor and wait for tooth to re-erupt on its own

Question 17

Name the luxation injury:
- tooth completely displaced from the alveolus
- extra-alveolar dry time (EADT) should be monitored (time the tooth has been dry and out of the mouth)

Answer 17

avulsion

Question 18

Treatment for avulsion:

Answer 18

• re-implant tooth asap
• flexible splint for up to 2 weeks

Question 19

internal vs external resorption

Answer 19

Internal resorption
- damage to odontoblastic layer initiates resorption in root canal system
- inflammatory response to bacteria and their byproducts traveling from necrotic pulp to dentinal tubules, causing internal resorption
- does not move with radiograph angle change, margins well defined and sharp

External resorption
- damage to cementoblastic layer initiates resorption in the periodontium
- radiographically moves with radiograph angle change, margins poorly defined and irregular
- three subcategories (replacement resorption, inflammatory root resorption, cervical resorption)

Question 20

Which has a better prognosis? internal or external root resorption

Answer 20

internal root resorption

Question 21

Tx for internal root resorption

Answer 21

RCT to obturate and seal the canal

Question 22

type of external root resorption in which the PDL is replaced with bone (ankylosis), can result from splints being too rigid or being placed too long

Answer 22

replacement resorption

Question 23

type of external root resorption in response to bacteria and their byproducts traveling from necrotic pulp to dentinal tubules

Answer 23

inflammatory root resorption

Question 24

type of external root resorption due to trauma or non-vital bleaching causing subepithelial sulcular infection

Answer 24

cervical resorption

Question 25

odontoblasts producing large amounts of reparative dentin into the pulp space, induced by trauma, results in canal obliteration, yellow-orange

Answer 25

calcific metamorphosis

Question 26

Ellis classification (trauma)

Answer 26

Class I- enamel only involved
Class II- enamel + dentin involved
Class III- enamel, dentin, and pulp involved
Class IV- tooth is non-vital from trauma
Class V- luxation injury
Class VI- avulsion

Question 27

steps in response to a recent traumatic tooth injury

Answer 27

TRAVMA
1) Tetanus booster within 48 hrs (for avulsions only)
2) Radiographs
3) Antibiotics (for avulsion, only if tooth is contaminated)
4) Vitality tests
5) More appts (3 weeks, 3-, 6-, and 12-month follow-ups)

Question 28

Appropriate storage media for an avulsed tooth:

Answer 28

• milk
• saline
• Hank’s balanced salt solution (BEST)
• avoid storage in water, hypotonic

Question 29

Dental protocol for avulsion of permanent tooth, depending on apices and EADT

Answer 29

Closed, EADT < 1h –> reimplant + splint

Open, EADT < 1h –> reimplant + splint, apexification if pulp infected, no root canal

Closed, EADT > 1h –> reimplant + splint, root canal

Open, EADT > 1h –> reimplant + splint, root canal, or implants