Dental Trauma 4 Flashcards
What basic post-operative advice should be given to all trauma patients?
- Not to bite on traumatised teeth
- Maintain a soft diet
- Practice meticulous oral hygiene
- Take analgesia as needed
- Know who to call if problems arise
- Schedule and attend follow-up appointments
What is an infraction and what are its clinical characteristics?
An incomplete fracture running through enamel
Runs parallel to enamel rods and stops at ADJ
No loss of tooth structure
Clinically appears as crazing of enamel
What is the treatment protocol for infraction and its prognosis?
- Treatment options: Either no treatment or seal with unfilled resin
- Purpose of sealing: Prevent staining and bacterial ingress
- Follow-up: None required
- Prognosis: Very good, with low pulp necrosis risk (0-3.5%)
What are the key diagnostic features and imaging requirements for enamel fracture?
- Loss of tooth substance confined to enamel only
- No dentine exposure
- Must account for lost fragments
- Radiographs: One parallel periapical view
- Additional soft tissue views if fragment unaccounted for
What are the treatment options for enamel fracture and what is its prognosis?
Treatment options:
Smooth fracture margins
Reattach available fragment
Composite resin restoration if fragment unavailable
Prognosis:
Follow-up: 6-8 weeks and 1 year
Pulp necrosis risk: Low (0.2-1%)
Higher risk of complications if associated with luxation injury
What distinguishes an enamel-dentine fracture from other fractures and what are its management options?
Characteristics:
Loss of tooth substance in enamel and dentine
No pulp exposure
Must account for lost fragments
Treatment options:
Fragment reattachment if available
Composite resin restoration
Temporary composite bandage or glass ionomer if immediate treatment not possible
Consider lining restoration if fracture is close to pulp
What radiographs are taken for enamel-dentine fractures?
– 1 parallel periapical +/-others as indicated
– Soft tissues views if fragment unaccounted for and soft tissue lacerations
What is the follow-up protocol and prognosis for enamel-dentine fractures?
Follow-up: 6-8 weeks and 1 year
Pulp necrosis risk: Low (2-6%)
Higher risk of complications if associated with luxation injury
What are the treatment options for pulp exposure, their success rates and their follow up period?
enamel-dentine fractures
Partial (Cvek) Pulpotomy:
Success rate: 97%
Removes 1-3mm of pulp
Coronal Pulpotomy:
Success rate: 75%
Removes all coronal pulp
Follow-up:
6-8 weeks
12 weeks
6 months
1 year
What are the steps for a Cvek pulpotomy?
- Administer LA and place dental dam
- Clean with saline and disinfect with sodium hypochlorite
- Remove 1-3mm pulp with high-speed round diamond bur
- Place saline-soaked cotton wool until hemostasis achieved
- Apply calcium hydroxide then glass ionomer
- Restore with composite resin or reattach fragment
- If bleeding cannot be controlled, proceed to full coronal pulpotomy
What are the options for endodontic treatment in immature incisors?
non vital, no apical stop
If tooth is non-vital, pulpectomy is required BUT no apical stop to allow conventional obturation with gutta percha
Options:
1. Calcium hydroxide placed in canal aiming to induce hard-tissue barrier to form (apexification)
2. Bioceramic (e.g. MTA,BioDentine) placed at apex to create cement barrier
3. Regenerative Endodontic Technique (RET) to encourage hard tissue formation at apex
What are the key characteristics and diagnostic features of crown-root fractures?
Characteristics:
Involves enamel, dentine, and cementum
Extends subgingivally
May or may not involve pulp
Fracture usually begins supragingivally on labial aspect
Coronal fragment usually mobile
Tooth often tender to percussion
What are radiographs that are taken for a crown-root fracture?
– 2 views
– CBCT may be of benefit
* Visualisation of fracture path, its extent, its relationship to marginal bone; help determine crown root ratio
What is the emergency treatment for a crown-root fracture?
Emergency: Temporary stabilisation of the loose fragment to adjacent tooth/teeth or non-mobile fragment
What are the definitive treatment options for crown-root fractures and their follow up period?
Options:
Orthodontic extrusion of apical fragment
Surgical extrusion
Endodontic treatment and restoration
Root submergence
Intentional replantation
Extraction
Autotransplantation
Follow-up:
1 week
6-8 weeks
3 months
6 months
1 year
What are the key features and management principles of root fractures?
Characteristics:
- Involves dentine, pulp, and cementum
- Can be horizontal, oblique, or combination
- Classified by position: apical, middle, or coronal third
- May show transient crown discoloration
- Bleeding from gingival sulcus possible
Management:
- Reposition displaced coronal fragment under LA
- Splinting duration:
Apical/mid third: 4 weeks
Cervical fracture: up to 4 months
What radiographs are taken for root fractures?
– 2 views
– Easy to miss
– CBCT may be indicated
What should you avoid doing for root fractures at emergency visits?
remove coronal fragment - cervical fractures have potential to heal
What part of fractured root commonly remains vital?
apical
What are the types of root fracture healing and prognosis?
Healing patterns:
- Calcified tissue
- Connective tissue
- Bone & connective tissue
- Inflammatory tissue/non-healing
Prognosis:
- Pulp necrosis: 20-40%
- Pulp canal obliteration: 25%
- Follow-up: 4 weeks, 6-8 weeks, 4 months, 6 months, 1 year
What are the diagnostic features and imaging requirements for alveolar fractures?
Clinical features:
- Involves alveolar bone and may extend to adjacent bones
- Segment mobility and displacement
- Multiple teeth moving together
- Occlusal disturbance
Imaging:
- Two views
- Consider panoramic radiograph or CBCT
- Fracture lines visible at any level
- Lines move with x-ray beam angle changes
What is the management protocol and prognosis for alveolar fractures?
what is follow up
Management:
- Reposition displaced segment under LA
- Apply firm digital pressure
- Flexible splint for 4 weeks
- Suture any gingival lacerations
Prognosis:
- Pulp necrosis: 35%
- Pulp canal obliteration: 25%
- Follow-up: 4 weeks, 6-8 weeks, 4 months, 6 months, 1 year
What elements are included in the TRAUMA STAMP assessment?
T - Tooth (specific teeth involved)
S - Sinus (+/-)
M - Mobility (+/-)
C - Color (Normal/Grey/Yellow/Pink)
T - Tenderness to Percussion (TTP) (+/-)
P - Percussion Note (Normal/Dull)
E - Ethyl Chloride (+/-)
EPT - Electric Pulp Test (numerical values)
R - Radiograph (+/-)
