Dental traumatology Flashcards
What are two different types of ankylosis?
1.With replacement resorption – bone is replacing dentine
2.Without replacement resorption - no bone replacing den
What are the steps of pathology for a transverse root fracture?
1.Facial trauma, frontal force
2.Transverse fracture – occurs if dentine, cementum and pulp involved, if enamel is also involved – it is a crown root fracture
3.Take radiograph and do all of the test
4.Reparative tissue in a form of tertiary dentine is laied down in the fracture area
5.Over time – root canal stenosis may occur – pulpal tissue will be replaced with deposited hard tissue through “buldging hard tissue” with prior joining of fracture line with fibrous connective tissue - this is done primarily by the pulp - the reparative capacity of dental hard tissue should not be underestimated
What the three different types of healing following transverse root fracture?
- Through deposition of reparative hard tissue
- Fibrous hard tissue
- Bone and periodontal ligament
- No healing and pulp necrosis of the coronal portion (trick question) - this one is pretty rare
What is apexification?
it is a method of inducing a calcified barrier at the apex of a non-vital tooth with incomplete root formation. Originally calcium hydroxide is used for coagulation necrosis of remaining pulpal tissues
What can be result of apixification?
- Formation of calcified dome in the tooth
- Formation of pulp-like tissue and formation and growth of roots
- Rejection
What are the indications for MTA?
- Vital Pulp Therapy
- Immature apices
- Perforations - lateral and furcation
- Retrograde root canal filling
What is the current flavour of the month when it comes to triggering apixification?
Biodentine from Septodont
What is apexogenesis?
A vital pulp therapy procedure performed to encourage physiological development and formation of the root.
What is guided endodontic repair?
It is the combination of stem cells, scaffold and growth factors that allows for repair of immature permanent teeth. It is not very effective so just use calcium hydroxyde.
What are the options for a tooth with replacement resorption?
- Decoronation and submergence of the tooth
- Extraction, orthodontics and implantation
- Translpalantation
What is enamel infraction? What is the treatment?
It is an incomplete fracture of the enamel, without loss of tooth structure.
Treatment: usually, no treatment but if needed etching and sealing with bonding resin should be considered.
What is an uncomplicated, enamel only crown fracture? What is the treatment?
It is a coronal fracture involving enamel only with loss of tooth structure
Treatment: if tooth fragment is available, bond back on. Alternatively smooth the edges and restore them if needed
What is an uncomplicated, enamel-dentine crown fracture? What is the treatment?
It is a coronal fracture involving enamel and dentine without pulp exposure.
Treatment: if the tooth fragment available, soak it in saline for 20 minutes, use GIC or resin to bond it. If 0.5mm away from pulp, place an indirect pulp cap with calcium hydroxide.
What is a complicated crown fracture? What are the treatments?
It is a fracture confined to enamel and dentin with pulp exposure
Treatments:
Immature roots: partial pulpotomy or pulp capping to preserve pulpal health and cause apexogenesis (vital pulp therapy)
Mature roots: partial pulpotomy and if post required to restore, root canal treatment should be considered
What is an uncomplicated crown-root fracture? What are the treatments?
It is a fracture involving enamel, dentin and cementum.
Treatment: Temporary stabilisation of the loose fragment to adjacent teeth or non-movng fragment
And after one or multipel of the following:
1. Orthodontic extrusion
2. Surgical extrusion
3. Root canal treatment and restoration if pulp becomes necrotic
4.Root submergence
5. Intentional replantation
6. Extraction
7. Autotransplantation
What is a complicated crown-root fracture? What are the treatments?
It is a fracture involving enamel, dentin, cementum and the pulp.
Treatment: temporary stabilisation to the non-mobile fragment or adjacent teeth
In immature teeth: Partial pulpotomy
In mature teeth: Pulp extirpation
Then one of the following:
1. Completion of root canal treatment
2. Orthodontic extrusion
3. Surgical extrusion
4. Root submergenbce
5. Intentional replantation
6. Extraction
7. Autotransplantation
What is a root fracture? What is the treatment?
Root fracture is a type of fracture that involves dentine, pulp and cementum.
Treatment:
- Always reposition the coronal segment ASAP and check radiographically
- Stabilise the coronal segment with a passive and flexible splint for 4 weeks. If cervical, for 4 months
- No endo immediately
- Endo might be needed for the coronal aspect with use of apexification
- In mature teeth with cervical fractures above the alveolar crest
What is alveolar fracture? What is the treatment?
It is the fracture that involves the alveolar bone and may extend to adjacent bones.
Treatment:
- Reposition any displaced segment
- Stabilise the segment by splinting the teeth with a passive and flexible splint for 4 weeks
- Suture gingival lacerations
- No root canal treatments
- Monitor the pulp contion of all teeth involved
What is a dental concussion? What is the treatment?
It is when tooth is hit and concussed. It is tender to percussion but otherwise okay
Treatment: No treatment just monitor
What is subluxation? What is the treatment?
An injury to the tooth-supporting structures with abnormal loosening, but without displacement.
Treatment:
- Usually no treatment
- A passive and flexible splint to stabilize the tooth for up to 2 wk if there is excessive mobility
What is extrusive luxation? What is the treatment?
It is the displacement of the tooth out of its socket in an incisal/axial direction.
Treatment:
1. Reposition the tooth by gently pushing it back into the socket
- Stabilise with 2 week using a passive and flexible splint
- Monitor pulp. If necrotic, start treatment appropriate for the stage of tooth maturation
What is lateral luxation? What is the treatment?
It is the displacement of the tooth in any lateral direction, usually associated with a fracture or compression of the alveolar socket wall.
Treatment:
1. Reposition the tooth digitally by disengaging it from its locked position and gently reposition it into its original location under LA
- Stabilised the tooth for 4 weeks with passive and flexible splint
- Monitor and at 2 weeks make an endodontic evaluation
- For immature teeth - might need endodontic procedure IF THE PULP IS NOT NORMAL. Similar for mature teeth
What is intrusive luxation? What is the treatment?
It is displacement of the tooth in an apical direction into the alveolar bone.
Treatment:
For immature teeth:
1. Allow re-eruption without intervention
- if no re-eruption within 4 weeks, initiate orthodontic repositioning
- Monitor pulp
- IF PULP BAD THAN TREAT
- Parents must know that follow up visits are essential
For mature teeth:
1. Allow for re-eruption without intervention if intrusion is less than 3 mm. If does not happen after 8 weeks, surgical reposition and splint for 4 weeks or reposition orthodontically before ankylosis develops
- If the tooth is intruded 3-7mm, reposition surgically (prefered) or orthodontically
- If the tooth is intruded beyond 7mm, reposition surgically
- Endo treatment will be probably needed
Your patient comes in with an avulsed tooth that has already been re-implanted. The tooth is believed to have a closed apex. What are the steps for management?
- Leave tooth in place
- Clean affected are with water, saline or 0.1% CHx
- Suture all lacerations
- Varify normal position of the replanted toothr adiographically
- Apply flexible splint for upto 2 weeks
- Immidiatley or shortly after replatation, apply corticosteroid+antibacterial dressing (e.g. odontopaste) to the tooth for atr leats 2 weeks