Dental Trauma 2 Flashcards
what is the most common injury in the primary dentition
luxation
what is the most common injury in the permanent dentition
crown fractures
enamel-dentine
what are the MH aspects to be aware of in trauma
rheumatic fever
congenital heart defects
immunosupression
what do you look for when using the probe
fracture lines
pulpal involvement
what should be included in a detailed intraoral exam
sensibility tests
percussion
occlusion
radiographs
how do you conduct a sensibility test
compare injured tooth with adjacent non-injured tooth and opposing teeth
continue for at least 2 years after injury
what does a complicated fracture mean
pulpal involvement
what does prognosis depend on
stage of root development
type of injury
if PDL is damaged
time between injury and treatment
presence of infection
what are the general aims of emergency treatment
retain vitality
treat exposed pulp tissues
reduction and immobilisation of displaced teeth
tetanus prophylaxis
what are the general aims of intermediate treatment
possible pulp treatment
restoration
what are the general aims of permanent treatment
apexigenesis
apexification
root filling
gingival and alveolar collar modification
coronal restoration
how do you manage an enamel fracture
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
how do you manage enamel-dentine fracture
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
what do you use at the clinical review
trauma sticker
check radiographs for root development, compare with other side, periapical pathology, resorption
what injury has a 0% chance of pulp survival
intrusion
how do you manage enamel-dentine-pulp fractures
pulp cap
partial pulpotomy
full coronal pulpotomy
what is the procedure for direct pulp cap
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
when would you do a direct pulp cap
when tooth non TTP and is positive on sensibility tests
when would you do a partial pulpotomy
larger exposure (>1mm) or 24+ hours since trauma
what is the partial pulpotomy procedure
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
what do you do if you cannot achieve haemostasis with partial pulpotomy
if no bleeding/cant get haemostasis then full coronal pulpotomy
when do you do a full coronal pulpotomy
if hyperaemic or necrotic during partial pulpotomy
what is the aim of a pulpotomy
keep vital pulp tissue within canal to allow normal root growth both in length of root and thickness of dentine
when is a full pulpectomy required
non-vital tooth
what is the clinical problem with a full pulpectomy with immature incisors
no apical stop to allow obturation with GP
how do you overcome the problem with a full pulpectomy with no apical stop in immature incisors
CaOH in canal to induce apexification
MTA placed at apex of canal to create cement barrier
what is the procedure for pulpectomy with open apex tooth
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
what is used for final restoration after pulpectomy
bonded composite
what are the treatment options for crown-root fractures with no pulp exposure
fragment removal only and restore
fragment removal and gingivectomy
orthodontic extrusion of apical portion
surgical extrusion
decoronisation
extraction
what guidelines are important with trauma
international association for dental trauma
