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 internal surface resorption?
It is a type of resorption that is defined as minor areas of resorption of the dentin walls of the root canal. It is believed to be transient and self-limiting.
What is internal inflammatory resorption? What is the treatment?
It is a type of resorption defined as an inflammatory process within a section of the pulp/root canal that results in loss of dentin commencing at the root canal wall and progressing towards cementum. A radiographic oval shape appearance is very common
This can be caused by traum or caries.
Treatment: Root canal treatment with corticosteroid and antibiotic + calcium hydroxide after
What is internal replacement resorption? What is the treatment?
Internal replacement resorption is a process where the pulp and dentin are replaced with bone. It usually begins within the pulp/root canal and on the root canal walls and it progresses towards the cementum. Clinical appearance may be normal or discolored.
Usually as a result of insult to the pulp.
Treatment: observation and eventual extraction. If diagnosed early, root canal treatment may be feasible.
What is external surface resorption? What is the treatment?
External surface resorption is a self-limiting process which is usually caused by a localized to the involved part of the cementum and/or PDL.
Treatment: self-limiting so no treatment.
What is external inflammatory resorption? What is the treatment?
External inflammatory resorption occurs when the tooth has an infected root canal system and there has been damage to the external surface or communication between the pulp and external surface.
Can occur at the apex or lateral surface of the root.
Treatment: preventative approach: after external injury, utilise systemic antibiotics + corticosteroid based root canal treatment. Interceptive approach: when the resorption is already evident use corticosteroid based root canal treatment
What is external replacement resorption? What is the treatment?
External replacement resorption is the process where cementum and dentin are resorbed and replaced by bone.
Aetiology: can occur after external injuries
Treatments: lower the amount of time out of the socket after avulsion
What is external invasive resorption? What is the treatment?
It is a process that is not fully understood. It commences at the sub-gingival location and spreads through out the tooth in all directions.
According to Prof Heithersay, it can be classified as Class I-IV using a PA.
Class I-II are better treated with trichloroacetic acid (TCA) to the resorbing tissues followed by curettage of the defect and restored with glass ionomer cement. Result are usually quite good.
Class III might need adjunt treatment such as root canal treatment.
Class IV have undpredictable outcomes and patient need to be made aware of future issues and probable extraction
What is external pressure resorption? What is the treatment?
It is a resorptive process that occurs when there is pressure applied to the external surface of a tooth root.
Can be caused by impacted teeth or pathologies such as cysts.
Treatment: Removal of impacted tooth or removal of pathology or removal of resorbing tooth and extrusion of the impacted tooth with ortho
What is orthodontic resorption? What is the treatment?
Orthodontic resorption is the process by which the apical part of one or more teeth undergo resorption, resulting in a shortened root.
Treatment: when ortho stops, resorption stops. Monitor and treat when other conditions occur.
What is physiological resorption? What is the treatment?
It is the physiological resorption is the resorptive process that primary teeth undergo as they exfoliate. It is normal.
Treatment: monitoring exfoliation or extraction of primary teeth
What is idiopathic resorption? What is the treatment?
It is resorption with no apparent causes. Typically it involves multiple teeht with shorter roots.
Treatment: determining systemic causes through general health checks and after monitoring.
What is TAB?
Transient apical breakdown (TAB) is a phenomenon that indicates temporary apical periodontal destruction and root resorption after tooth luxation injuries, followed by the healing process of the dental pulp.
This is why in luxation injuries, root canal treatment is usually needed in mature teeth but not always. WATCH FOR SYMPTOMS.
