Dental Trauma 2

Question 1

what is the most common injury in the primary dentition

Answer 1

luxation

Question 2

what is the most common injury in the permanent dentition

Answer 2

crown fractures
enamel-dentine

Question 3

what are the MH aspects to be aware of in trauma

Answer 3

rheumatic fever
congenital heart defects
immunosupression

Question 4

what do you look for when using the probe

Answer 4

fracture lines
pulpal involvement

Question 5

what should be included in a detailed intraoral exam

Answer 5

sensibility tests
percussion
occlusion
radiographs

Question 6

how do you conduct a sensibility test

Answer 6

compare injured tooth with adjacent non-injured tooth and opposing teeth
continue for at least 2 years after injury

Question 7

what does a complicated fracture mean

Answer 7

pulpal involvement

Question 8

what does prognosis depend on

Answer 8

stage of root development
type of injury
if PDL is damaged
time between injury and treatment
presence of infection

Question 9

what are the general aims of emergency treatment

Answer 9

retain vitality
treat exposed pulp tissues
reduction and immobilisation of displaced teeth
tetanus prophylaxis

Question 10

what are the general aims of intermediate treatment

Answer 10

possible pulp treatment
restoration

Question 11

what are the general aims of permanent treatment

Answer 11

apexigenesis
apexification
root filling
gingival and alveolar collar modification
coronal restoration

Question 12

how do you manage an enamel fracture

Answer 12

bond fragment to tooth or grind sharp edges
take 2 periapicals to rule out root fracture
6-8week follow up then 6 months then 1 year

Question 13

how do you manage enamel-dentine fracture

Answer 13

account for fragment
bond fragment/composite bandage
2 periapicals for root fracture
radiograph lip/cheek lacerations
sensibility tests
definitive restoration
follow up 6-8wks, 6months, 1 year

Question 14

what do you use at the clinical review

Answer 14

trauma sticker
check radiographs for root development, compare with other side, periapical pathology, resorption

Question 15

what injury has a 0% chance of pulp survival

Answer 15

intrusion

Question 16

how do you manage enamel-dentine-pulp fractures

Answer 16

pulp cap
partial pulpotomy
full coronal pulpotomy

Question 17

what is the procedure for direct pulp cap

Answer 17

take trauma sticker and radiographs (non TTP)
LA and rubber dam
clean with water, disinfect with sodium hypochlorite
apply calcium hydroxide or MTA to exposure
restore with composite
review

Question 18

when would you do a direct pulp cap

Answer 18

when tooth non TTP and is positive on sensibility tests

Question 19

when would you do a partial pulpotomy

Answer 19

larger exposure (>1mm) or 24+ hours since trauma

Question 20

what is the partial pulpotomy procedure

Answer 20

trauma stamp and radiograph
LA and dental dam
clean with saline, disinfect with sodium hypochlorite
remove 2mm of pulp with hi speed round diamond bur
place saline soaked CW pellet over exposure until haemostasis
apply CaOH then GI then restore with quality composite resin

Question 21

what do you do if you cannot achieve haemostasis with partial pulpotomy

Answer 21

if no bleeding/cant get haemostasis then full coronal pulpotomy

Question 22

when do you do a full coronal pulpotomy

Answer 22

if hyperaemic or necrotic during partial pulpotomy

Question 23

what is the aim of a pulpotomy

Answer 23

keep vital pulp tissue within canal to allow normal root growth both in length of root and thickness of dentine

Question 24

when is a full pulpectomy required

Answer 24

non-vital tooth

Question 25

what is the clinical problem with a full pulpectomy with immature incisors

Answer 25

no apical stop to allow obturation with GP

Question 26

how do you overcome the problem with a full pulpectomy with no apical stop in immature incisors

Answer 26

CaOH in canal to induce apexification
MTA placed at apex of canal to create cement barrier

Question 27

what is the procedure for pulpectomy with open apex tooth

Answer 27

rubber dam
access cavity
haemorrhage control with LA/water
diagnostic radiograph for WL
file 2mm short of estimated WL
dry canal, place non-setting CaOH in canal and cotton wool in pulp chamber
glass ionomer temporary cement and evaluate with radiograph

Question 28

what is used for final restoration after pulpectomy

Answer 28

bonded composite

Question 29

what are the treatment options for crown-root fractures with no pulp exposure

Answer 29

fragment removal only and restore
fragment removal and gingivectomy
orthodontic extrusion of apical portion
surgical extrusion
decoronisation
extraction

Question 30

what guidelines are important with trauma

Answer 30

international association for dental trauma