Dental Trauma 3 Flashcards
Name all displacement injuries in order of increasing severity and their key distinguishing clinical features.
- Concussion: No displacement, no mobility, only TTP
- Subluxation: No displacement, increased mobility with bleeding
- Lateral luxation: Non-axial displacement, immobile tooth, fractured alveolar bone
- Extrusion: Axial displacement out of socket, mobile, appears elongated
- Intrusion: Axial displacement into socket, immobile, appears shortened
- Avulsion: Complete displacement from socket
List all fracture injuries in dental trauma classification.
Enamel fracture (Uncomplicated crown fracture)
Enamel-dentine fracture (Uncomplicated crown fracture)
Enamel-dentine fracture with pulp exposure (Complicated crown fracture)
Crown-root fracture +/- pulp exposure
Root fracture
Alveolar fracture
What is the simple post-operative advice?
- Not to bite on traumatised teeth
- Soft diet
- Meticulous oral hygiene
- Analgesia
- Who to call if problems
– Next appointment and details
What are important considerations?
Impact of injury on:
1. Surrounding bone
2. Neurovascular bundle
3. Root surface
Nature of trauma:
1. Separation injury
2. Crushing injury
A patient presents with a traumatized tooth showing no obvious signs except pain on percussion. What additional radiographic views are needed and why?
Radiographs needed: Periapical +/- if other injuries suspected
Reasoning:
No displacement means standard periapical may be sufficient
Additional views only if clinical examination suggests other injuries
Radiographs will appear normal in concussion
Used mainly to rule out other injuries
A patient presents with a traumatized tooth that shows no displacement but has bleeding from the gingival crevice. What is the likely diagnosis and how does it differ from concussion?
Likely diagnosis is subluxation. Key difference from concussion:
Subluxation shows increased mobility and gingival bleeding
Concussion has no mobility and no bleeding, only tenderness to percussion (TTP)
Compare and contrast the clinical findings, treatment, and follow-up schedule for subluxation versus concussion.
Subluxation:
Clinical: Increased mobility, TTP, gingival bleeding
Treatment: Splint only if excessive mobility (2 weeks)
Follow-up: 2 weeks, 12 weeks, 6 months, 1 year
Concussion:
Clinical: Only TTP, no mobility
Treatment: None required
Follow-up: 4 weeks, 1 year
Detail the radiographic findings and repositioning technique for an extruded or a laterally luxated tooth.
Radiographic findings:
Need 2 views
Widened PDL space (apical and lateral)
Socket outline may be visible
Repositioning technique:
Use local anesthetic
Hold crown and use watch-winding motion
Apply firm pressure in apical direction
Confirm position
Place flexible splint for 2 weeks
What makes lateral luxation unique among displacement injuries, and what specific endodontic considerations exist at 2 weeks post-injury?
Unique features:
Tooth is immobile (unlike other displacement injuries)
High ankylotic percussion tone
Comminution or fracture of alveolar bone plate
Root apex may be palpable in sulcus
Endodontic considerations at 2 weeks:
1.Open Apex:
Monitor for spontaneous revascularization
Start endodontic treatment if necrosis/inflammatory resorption occurs
2.Closed Apex:
Likely pulp necrosis
Start endodontic treatment
Use corticosteroid-antibiotic or calcium hydroxide as intra-canal medicament
Describe the complete management protocol for intrusion based on root development and intrusion severity.
Immature Root (Open Apex):
Allow spontaneous repositioning
If no re-eruption in 4 weeks → orthodontic repositioning
Monitor pulp condition
Consider endodontic treatment if necrosis occurs
Mature Root (Closed Apex):
1.<3mm intrusion:
Wait for spontaneous repositioning
If no movement in 8 weeks → surgical or orthodontic repositioning
2.3-7mm intrusion:
Surgical repositioning preferred (4-week splint)
Alternative: orthodontic repositioning
3.7mm intrusion:
Surgical repositioning only
4-week splint
Start endodontic treatment at 2 weeks
For a tooth with a closed apex, arrange the following injuries in order of 5-year pulp survival rates (highest to lowest): Lateral luxation, Intrusion, Subluxation, Avulsion, Concussion, Extrusion
Concussion (95%)
Subluxation (85%)
Extrusion (45%)
Lateral luxation (25%)
Intrusion (0%)
Avulsion (0%)
For closed apices, what happens to a tooth during intrusion?
Pulp almost always becomes necrotic
Start endodontic treatment at 2 weeks or as soon as tooth position allows if closed apex
aims to prevent the development of inflammatory (infection-related) external resorption
A patient presents with an avulsed permanent tooth with closed apex and 70-minute dry time. Detail the complete management protocol.
1.PDL cells likely non-viable
2.Emergency management:
- Remove debris
- Replant under local anesthetic
- Place flexible splint for 2 weeks
- Suture gingival lacerations if present
- Consider antibiotics and check tetanus status
3.Endodontic treatment:
Start within 2 weeks
Use calcium hydroxide (up to 1 month) OR corticosteroid/antibiotic paste (6 weeks)
4.Long-term:
Poor prognosis expected
Ankylosis-related replacement resorption likely
Consider referral for interdisciplinary management
What are the critical factors of an avulsed permanent tooth?
– Extra-alveolar dry time (EADT)
– Extra-alveolar time (EAT)
– Storage medium
How do the critical time factors affect treatment decisions in avulsion cases?
- Immediate replantation: Best prognosis
- EADT <60 minutes: PDL cells may be viable but compromised
- EADT >60 minutes: PDL cells likely non-viable
- Different protocols for open vs. closed apex teeth
- Endodontic treatment timing varies based on apex status
What is the emergency advice for an avulsed permanent tooth?
- Ensure permanent tooth
- Hold by crown
- Encourage attempt to place tooth immediately into socket - If the tooth dirty, rinse it gently in milk, saline or in the patient’s saliva and replant
- Bite on gauze/handkerchief to hold in place once replanted
- Seek immediate dental advice
For each displacement injury, what is the recommended splinting time and why might it vary?
- Subluxation: 2 weeks (if needed)
- Extrusive luxation: 2 weeks
- Lateral luxation: 4 weeks (due to bone healing)
- Intrusive luxation: 4 weeks (if surgical repositioning)
- Avulsion: 2 weeks
- Special case: Root fractures
Mid-root/Apical third: 4 weeks
Cervical third: 4 months
What are the five critical properties of an ideal dental trauma splint, and which specific type of splint best fulfills these criteria?
Properties:
Flexible and passive
Easy placement/removal
Allows sensibility testing/clinical monitoring
Facilitates oral hygiene
Aesthetic
Best option: Titanium Trauma Splint (TTS) because:
0.2mm thick rhomboid mesh structure
Secured with composite resin
Provides flexibility while maintaining stability
Allows for easy cleaning and monitoring
More aesthetic than traditional wire-composite splints
List in order of preference the storage media for an avulsed tooth and explain why milk is often recommended over water.
Storage media (best to worst):
HBSS (Hank’s Balanced Salt Solution)
Milk
Saliva
Saline
Water
Milk is preferred over water because:
Compatible osmolarity with PDL cells
Neutral pH
Contains nutrients
Water causes osmotic lysis of PDL cells
Readily available in most situations
Name three absolute contraindications to replantation of an avulsed tooth and explain the rationale for each.
1.Severe immunocompromise:
Risk of infection outweighs benefits
Compromised healing capacity
2.Very immature apex with >90 min extra-alveolar time:
Extremely poor prognosis
High likelihood of ankylosis
May complicate future treatment planning
3.Severe medical trauma requiring emergency care:
Other life-threatening conditions take priority
Dental trauma management can be delayed
