Dental Trauma 3 Flashcards
what are important considerations with soft tissue trauma
impact of injury on surrounding bone, neurovascular bundle and root surface
nature of trauma - separation/crushing
what is concussion
injury to tooth supporting structures without abnormal loosening or displacement of tooth
what are clinical findings of concussion
pain on percussion
what is the treatment for concussion
none
what is follow up for concussion
clinical and radiographic after 4 weeks then 1 year
what is subluxation
injury to tooth supporting structures with abnormal loosening but without tooth displacement
what are clinical findings of subluxation
increased mobility
tender to percussion
bleeding from gingival crevice may be present
what is treatment for subluxation
none
splint if excessive mobility or tenderness when biting
what is follow up for subluxation
2 weeks
12 weeks
6 months
1 year
how do you monitor concussion and subluxation
trauma stamp
sensibility tests
radiographs
what do you look for on follow up radiographs
root development
comparison with contralateral tooth
resorption
what is on the trauma stamp
sinus
colour
mobility
TTP percussion
ethyl chloride
EPT
radiograph
what is extrusion
an injury in which the tooth suffers axial displacement partially out of socket
what are the clinical findings of extrusion
tooth appears elongated
displaced palatally
tooth mobile
bleeding from gingival sulcus
how do you treat extrusion
reposition tooth by gently pushing back into socket under LA
splint
what is follow up for extrusion
2 weeks
1 month
2 months
3 months
6 months
1 year
annually for 5 years
what is lateral luxation
displacement of a tooth in a socket in a direction other than axially, accompanied by comminution or fracture or alveolar bone plate
what are the clinical findings of lateral luxation
tooth appears displaced in socket
tooth immobile
high ankylotic percussive tone
may be bleeding from gingival sulcus
root apex palpable in sulcus
what is lateral luxation treatment
reposition under LA
splint for 4 weeks
monitor
what happens if a tooth with incomplete root formation has lateral luxation
spontaneous revascularisation can occur
if necrotic pulp and inflammatory external resorption then endo treatment
what happens if a tooth with complete root formation has lateral luxation
necrotic pulp so start endo treatment
place corticosteroid antibiotic into canal or calcium hydroxide as intra canal medicament
what is follow up for lateral luxation
2 weeks
4 weeks - splint removal
2 months
3 months
6 months
1 year
annually for 5 years
what is intrusion
tooth forced into socket in axial direction and locked in bone
what is clinical findings with intrusion
crown appears shortened
bleeding from gingivae
ankylotic high, metallic percussion tone
how do you treat an intruded tooth with immature root formation
spontaneous repositioning
if no eruption within 4 weeks then ortho
monitor pulp
necrotic pulp = endo
how do you treat an intruded tooth with mature root formation
if <3mm then spontaneous repositioning
if no eruption within 8 weeks the surgical reposition and splint for 4 weeks or ortho reposition
if 3-7mm then surgical/ortho reposition
if >7mm then reposition surgically
how do you treat an intruded tooth with complete root formation
start endo treatment at 2 weeks
what is follow up for intrusion
2 weeks
4 weeks
2 months
3 months
6 months
1 year
annually for 5 years
what is avlusion
tooth totally displaced from socket
what is clinical findings with avulsion
socket empty or filled with coagulum
what are the critical factors for an avulsed tooth
extra alveolar dry time
extra alveolar time
storage medium
what emergency advice do we give for avulsed teeth
ensure permanent tooth
hold by crown
place immediately into socket
rinse in milk/saline/saliva
bite on gauze to hold in place
seek immediate dental advice
what do you store an avulsed tooth in
milk
HBSS
saliva
saline
water
what factors influence management of avulsed tooth
maturity of root
PDL cells condition
how do you manage an avulsed tooth with closed apex
clean injured area
verify tooth position and apical status
place splint
suture gingival lacerations
consider antibiotics and check tetanus
post op instructions
follow up
at what extra alveolar dry time will the PDL cells likely be non-viable
> 60mins
when do you start endo treatment on avulsed tooth with closed apex
2 weeks
what medication is placed inside an avulsed tooth when doing RCT
calcium hydroxide up to 1 month
corticosteroid/antibiotic paste for 6 weeks
what is follow up for avulsed teeth
2 weeks
4 weeks
3 months
6 months
1 year
annually for 5 years
what is emergency treatment for open apex avulsed tooth
clean injured area
verify position
place splint
suture lacerations
consider antibiotics and check tetanus
provide post op instructions
follow up
what happens to an avulsed open apex tooth if EAT >60 mins
PDL cells non-viable
ankylosis related root resorption
what is the goal with open apex avulsed teeth
revascularisation
what is follow up for open apex avulsed tooth
2 weeks
1 month
2 months
3 months
6 months
1 year
annually for 5 years
when would you not replant an avulsed tooth
immunocompromised
very immature apex
EAT >90mins
very immature lower incisors
what is alveolar fracture
fracture of alveolar bone which may or may not involve alveolar socket
what are the clinical findings with alveolar fracture
complete alveolar fracture extending from buccal to palatal bone in maxilla and buccal to lingual bone in mandible
segment mobility and displacement with several teeth moving together
occlusal disturbance
gingival laceration
how do you treat alveolar fracture
reposition any displaced segment
stabilise by splinting
suture gingival lacerations
monitor pulp condition of all teeth
what is the follow up for alveolar fracture
monitor clinically and radiographically
4 weeks
6-8wks
4 months
6 months
1 year
annually for 5 years
what advice do you give for alveolar fractures
soft diet for 7 days
avoid contact sport whilst splint in place
careful oral hygiene with use of chlorhexidine mouthwash
when would you splint a tooth for 2 weeks
subluxation
extrusion
avulsion
when would you splint a tooth for 4 weeks
intrusion
lateral luxation
root fracture - mid root and apical third
dento alveolar fracture
when would you splint a tooth for 4 months
root fracture in cervical third
what are the types of chairside splint
composite and wire
composite
orthodontic brackets and wire
acrylic
titanium trauma splint
what are the types of lab made splint
vacuum formed
acrylic
what is a composite and wire splint
stainless steel wire 0.4mm
passive
flexible
when is an acrylic splint useful
when few abutment teeth
what are the main post trauma complications
pulp necrosis and infection
pulp canal obliteration
root resorption
breakdown of marginal gingiva and bone
what is pulp canal obliteration
progressive hard tissue formation within pulp cavity
gradual narrowing of pulp chamber and pulp canal
what are the types of external root resorption
surface
inflammatory resorption
cervical
ankylosis
what is internal root resorption
internal infection related inflammatory root resorption
what is external surface resorption
superficial resorption lacunae repaired with new cementum
response to localised injury
not progressive
what is external infection related inflammatory root resorption
non-vital tooth
initiated by PDL damage
indistinct root surface
happens rapidly
how do you manage external infection related inflammatory root resorption
remove stimulus
endodontic treatment
what is ankylosis related root resorption
initiated by severe damage to PDL and cementum
bone repair does not occur
severe luxation or avulsion
root remodels
how do you treat ankylosis related root resorption
plan for loss
what is internal infection related inflammatory root resorption
due to progressive pulp necrosis
can see symmetrical expansion of root canal walls and tramlines are indistinct
how do you treat internal infection related inflammatory root resorption
remove stimulus and do endodontic treatment
