Dentoalveolar Injuries Flashcards
What are TDI’s?
Acute transmission of energy to tooth and supporting structures resulting in tissue damage
Describe the incidence of TDI’s
More common in
- males than females
- prev history of TDI
- class 2/1 incisor relationship
Which teeth are most commonly affected by TDI?
Upper incisors
What type of TDIs mainly affect primary teeth ?
Luxation
What type of TDIs mainly affect adult teeth ?
Fractures
What is the normal size of overjet?
3mm
>6mm there is a 3x risk of TDI
What are the overall stages of managing TDIs?
Triage Fact finding Clinical exam Radiograph exam Photographic Acute management Medium term management Long term managing
What would form part of the Acute management of TDI?
Soft tissue trauma
Pain management
Reposition teeth
What would form part of the medium term management of TDI?
Repairing fractures / RCT
What would form part of the long term management of TDI?
Attempting to retain teeth esp children
As part of the fact finding stage what would you ask in management of TDI?
When/where/ how
Patient details
History of trauma
If teerh / fragments broken avulsed are they accounted for
What are you assessing during the clinical exam following TDI?
Soft tissue trauma
Occlusion
Broken/ missing teeth
Vitality tests
What would signs of Diplopia mean?
Possible orbital fracture
What aspects would you record as part of teeth assessment during trauma ?
Colour Fracture Mobility TTP Cold EPT
When would you consider a DPT in TDI?
Suspected condylar or mandibular fracture
What are the traumatic dental injuries that exist ?
Enamel infraction Crown fracture Crown root fracture Root fracture Luxation
What are the types of luxation injuries?
Concussion Subluxation Lateral luxation Extrusive luxation Intrusive luxation Avulsion
Why do luxation injuries more commonly occur in primary teeth ?
Cancellous bone is more spongey
What are the soft tissue injuries
Contusion
Abrasion
Laceration
What are the alveolar injuries
Fracture of socket wall or process
What are the features of enamel infraction ?
Crack in enamel with no loss of structure
No treatment needed
Normal pulp tests
What are the features of complicated crown fracture ?
Pulp exposed
Exposed pulp sensitive to stimuli eg cold/probing
What are the management principles of complicated crown fracture ?
Immature root -Cvek pulpotomy
Adult root : VPT or RCT
Management for crown root fractures ?
Remove broken fragment
Immature teeth try to preserve pulp
Consider extrusion at later stage
RCT as required
In root fractures pulp tests are usually?
Negative initially indicative of transient or permanent damage
What direction do root fractures tend to occur?
Transverse or oblique
If on the X-ray following root fracture you see a radiolucent line what may this indicate with regards to pulp vitality ?
The coronal portion may necrose
Where do you RCT in root fractures ?
To fracture line
Can place CaOH barrier
How long do you splint for in root fracture cases?
4 weeks to 4 months
What may indicate the presence of alveolar fracture ?
Occlusal disturbance
Misalignment of fracture portion
Teeth in the fracture alveolar bone are like to respond how to pulp tests ?
Negative
How long to splint in alveolar fractures ?
4 weeks
In concussion injuries which tissues are damaged ?
Neurovascular bundle
PDL is unaffected
How would you manage a subluxation injury ?
Splint if required
Review and monitor pulp
How would you manage a lateral luxation injury ?
Reposition and splint 4 weeks
What are the risks of lateral luxation?
Resorption
What other injury is often associated with lateral luxation?-
Alveolar fracture
What junction exposure is indicative of extrusive luxation ?
CDJ visible
What sound would TTP be in an intrusive luxation?
Metallic
How would you define subluxation
Damage resulting in loosening but not displacements
How would you define concussion
TDI with no loosening or displacement but TTP
How long would you splint an extruded tooth for?
2 weeks
How would you manage an intruded tooth?
Immature tooth: allow to erupt if more than 8 weeks - ortho req
Mature root: 3mm allow spontaneous 3-7mm ortho req and 7+mm surgucal reposition
At what timeframe would you carry out RCT in intruded cases?
2 weeks
What is transient apical breakdown?
Resorption what takes places in apical region to allow for new blood vessels to come in- mimics path.
Seen more commonly in lateral and extrusion luxations
How long for transient apical breakdown to resolve ?
12 months
In extrusion what happens to PDL?
Severing
In subluxation what happens to PDL?
Stretched
In lateral luxation what happens to PDL?
Crushing causing death
The management and success of avulsed tooth heavily dependant upon?
Extra oral dry time (EOT)
Ideally less than 60 mins
If EOT is greater than 60 mins how do you manage this?
Soak in 2% sodium fluoride for 20 mins
How long do you splint an avulsed tooth?
EOT <60 mins 2 weeks
EOT >60 mins 4 weeks
In what circumstances do you carry out RCT in avulsed cases?
Closed apex
Open apex with EOT > 60 mins
When should you start RCT by in avulsion?
7-10 days
What are the main types of resorption likely to develop following avulsuon?
Replacement
Inflammatory
Following avulsion patients also require what medication?
Antibiotics
What types of splint exist ?
Rigid
Physiological
What are the functions of splints ?
Allow for physiological tooth movement preventing anyklosis
Immobilises tooth into the correct position
What are some examples of splints?
TTS
Wire
Composite resin
What is the benefit with the TTS?
Allows for movement in vertical and horizontal plane
How far should splint extend?
One tooth either side of trauma
In which TDI cases are you more likely to see replacement resorption?
Excessive damage causing clastic cells to dominate
In which TDI cases are you more likely to see inflam resorption?
Damaged PDL + infection
Which two healing options exist following root fracture?
Regeneration of orginal tissue
Repair of tissue with fibrous
What has occurred for regeneration during healing to be preferred over repair ?
Less trauma
Ability to stimulated stem cells been greater
With regards to the apex what indicates the best outcome for TDI’s?
Open apex due to presence of thicker neurovascular bundle
Which injuries have worst outcomes?
Intrusion
What are the potential outcomes for pulp and apical tissues following trauma ?
Vital
Obliteration
Transient apical breakdown
Necrosis
How will the occlusion be affected in intruded teeth?
Infraocclusion
When carrying out Cvek pulpotomy what should you avoid using?
Adrenaline in LA
What is the benefit of using MTA/Biodentine in complicated crown fractures ?
Odontoblast like cells are not innervated
In trauma cases what is the benefit of placing a MTA or putty if apically?
If surgery needed later easier to perform
How long does it take for odontblasts to lay down dentine bridge?
2-3 weeks
What are the management strategies for open apex RCT?
Apexification
Regeneration by placing cocktail of AB and promotion stem cells
Apexogenesis
What is another name for pulp canal obliteration?
McCabe and Dummer 2011
Calcific metamorphosis
Which traumatic events most commonly lead to obliteration?
McCabe and Dummer 2011
Concussion
Subluxation
Why does obliteration occur ?
McCabe and Dummer 2011
Damage to neurovascular bundle
What colour do crowns of teeth go following obliteration?
McCabe and Dummer 2011
Yellowish hue due to calcification of pulp
Obliteration can be partial or total? T/F
McCabe and Dummer 2011
T
