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ENDO > Dentoalveolar Injuries > Flashcards

Dentoalveolar Injuries Flashcards

1
Q

What are TDI’s?

A

Acute transmission of energy to tooth and supporting structures resulting in tissue damage

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2
Q

Describe the incidence of TDI’s

A

More common in

  • males than females
  • prev history of TDI
  • class 2/1 incisor relationship
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3
Q

Which teeth are most commonly affected by TDI?

A

Upper incisors

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4
Q

What type of TDIs mainly affect primary teeth ?

A

Luxation

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5
Q

What type of TDIs mainly affect adult teeth ?

A

Fractures

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6
Q

What is the normal size of overjet?

A

3mm

>6mm there is a 3x risk of TDI

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7
Q

What are the overall stages of managing TDIs?

A 
Triage
Fact finding 
Clinical exam
Radiograph exam
Photographic
Acute management
Medium term management 
Long term managing
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8
Q

What would form part of the Acute management of TDI?

A

Soft tissue trauma
Pain management
Reposition teeth

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9
Q

What would form part of the medium term management of TDI?

A

Repairing fractures / RCT

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10
Q

What would form part of the long term management of TDI?

A

Attempting to retain teeth esp children

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11
Q

As part of the fact finding stage what would you ask in management of TDI?

A

When/where/ how
Patient details
History of trauma
If teerh / fragments broken avulsed are they accounted for

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12
Q

What are you assessing during the clinical exam following TDI?

A

Soft tissue trauma
Occlusion
Broken/ missing teeth
Vitality tests

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13
Q

What would signs of Diplopia mean?

A

Possible orbital fracture

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14
Q

What aspects would you record as part of teeth assessment during trauma ?

A 
Colour
Fracture
Mobility
TTP
Cold
EPT
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15
Q

When would you consider a DPT in TDI?

A

Suspected condylar or mandibular fracture

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16
Q

What are the traumatic dental injuries that exist ?

A 
Enamel infraction
Crown fracture
Crown root fracture 
Root fracture 
Luxation
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17
Q

What are the types of luxation injuries?

A 
Concussion
Subluxation
Lateral luxation
Extrusive luxation
Intrusive luxation 
Avulsion
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18
Q

Why do luxation injuries more commonly occur in primary teeth ?

A

Cancellous bone is more spongey

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19
Q

What are the soft tissue injuries

A

Contusion
Abrasion
Laceration

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20
Q

What are the alveolar injuries

A

Fracture of socket wall or process

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21
Q

What are the features of enamel infraction ?

A

Crack in enamel with no loss of structure
No treatment needed
Normal pulp tests

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22
Q

What are the features of complicated crown fracture ?

A

Pulp exposed

Exposed pulp sensitive to stimuli eg cold/probing

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23
Q

What are the management principles of complicated crown fracture ?

A

Immature root -Cvek pulpotomy

Adult root : VPT or RCT

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24
Q

Management for crown root fractures ?

A

Remove broken fragment
Immature teeth try to preserve pulp
Consider extrusion at later stage
RCT as required

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25
Q

In root fractures pulp tests are usually?

A

Negative initially indicative of transient or permanent damage

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26
Q

What direction do root fractures tend to occur?

A

Transverse or oblique

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27
Q

If on the X-ray following root fracture you see a radiolucent line what may this indicate with regards to pulp vitality ?

A

The coronal portion may necrose

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28
Q

Where do you RCT in root fractures ?

A

To fracture line

Can place CaOH barrier

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29
Q

How long do you splint for in root fracture cases?

A

4 weeks to 4 months

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30
Q

What may indicate the presence of alveolar fracture ?

A

Occlusal disturbance

Misalignment of fracture portion

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31
Q

Teeth in the fracture alveolar bone are like to respond how to pulp tests ?

A

Negative

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32
Q

How long to splint in alveolar fractures ?

A

4 weeks

33
Q

In concussion injuries which tissues are damaged ?

A

Neurovascular bundle
PDL is unaffected

34
Q

How would you manage a subluxation injury ?

A

Splint if required

Review and monitor pulp

35
Q

How would you manage a lateral luxation injury ?

A

Reposition and splint 4 weeks

36
Q

What are the risks of lateral luxation?

A

Resorption

37
Q

What other injury is often associated with lateral luxation?-

A

Alveolar fracture

38
Q

What junction exposure is indicative of extrusive luxation ?

A

CDJ visible

39
Q

What sound would TTP be in an intrusive luxation?

A

Metallic

40
Q

How would you define subluxation

A

Damage resulting in loosening but not displacements

41
Q

How would you define concussion

A

TDI with no loosening or displacement but TTP

42
Q

How long would you splint an extruded tooth for?

A

2 weeks

43
Q

How would you manage an intruded tooth?

A

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

44
Q

At what timeframe would you carry out RCT in intruded cases?

A

2 weeks

45
Q

What is transient apical breakdown?

A

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

46
Q

How long for transient apical breakdown to resolve ?

A

12 months

47
Q

In extrusion what happens to PDL?

A

Severing

48
Q

In subluxation what happens to PDL?

A

Stretched

49
Q

In lateral luxation what happens to PDL?

A

Crushing causing death

50
Q

The management and success of avulsed tooth heavily dependant upon?

A

Extra oral dry time (EOT)

Ideally less than 60 mins

51
Q

If EOT is greater than 60 mins how do you manage this?

A

Soak in 2% sodium fluoride for 20 mins

52
Q

How long do you splint an avulsed tooth?

A

EOT <60 mins 2 weeks
EOT >60 mins 4 weeks

53
Q

In what circumstances do you carry out RCT in avulsed cases?

A

Closed apex
Open apex with EOT > 60 mins

54
Q

When should you start RCT by in avulsion?

A

7-10 days

55
Q

What are the main types of resorption likely to develop following avulsuon?

A

Replacement
Inflammatory

56
Q

Following avulsion patients also require what medication?

A

Antibiotics

57
Q

What types of splint exist ?

A

Rigid

Physiological

58
Q

What are the functions of splints ?

A

Allow for physiological tooth movement preventing anyklosis

Immobilises tooth into the correct position

59
Q

What are some examples of splints?

A

TTS
Wire
Composite resin

60
Q

What is the benefit with the TTS?

A

Allows for movement in vertical and horizontal plane

61
Q

How far should splint extend?

A

One tooth either side of trauma

62
Q

In which TDI cases are you more likely to see replacement resorption?

A

Excessive damage causing clastic cells to dominate

63
Q

In which TDI cases are you more likely to see inflam resorption?

A

Damaged PDL + infection

64
Q

Which two healing options exist following root fracture?

A

Regeneration of orginal tissue
Repair of tissue with fibrous

65
Q

What has occurred for regeneration during healing to be preferred over repair ?

A

Less trauma
Ability to stimulated stem cells been greater

66
Q

With regards to the apex what indicates the best outcome for TDI’s?

A

Open apex due to presence of thicker neurovascular bundle

67
Q

Which injuries have worst outcomes?

A

Intrusion

68
Q

What are the potential outcomes for pulp and apical tissues following trauma ?

A

Vital
Obliteration
Transient apical breakdown
Necrosis

69
Q

How will the occlusion be affected in intruded teeth?

A

Infraocclusion

70
Q

When carrying out Cvek pulpotomy what should you avoid using?

A

Adrenaline in LA

71
Q

What is the benefit of using MTA/Biodentine in complicated crown fractures ?

A

Odontoblast like cells are not innervated

72
Q

In trauma cases what is the benefit of placing a MTA or putty if apically?

A

If surgery needed later easier to perform

73
Q

How long does it take for odontblasts to lay down dentine bridge?

A

2-3 weeks

74
Q

What are the management strategies for open apex RCT?

A

Apexification
Regeneration by placing cocktail of AB and promotion stem cells
Apexogenesis

75
Q

What is another name for pulp canal obliteration?

McCabe and Dummer 2011

A

Calcific metamorphosis

76
Q

Which traumatic events most commonly lead to obliteration?

McCabe and Dummer 2011

A

Concussion
Subluxation

77
Q

Why does obliteration occur ?

McCabe and Dummer 2011

A

Damage to neurovascular bundle

78
Q

What colour do crowns of teeth go following obliteration?

McCabe and Dummer 2011

A

Yellowish hue due to calcification of pulp

79
Q

Obliteration can be partial or total? T/F

McCabe and Dummer 2011

A

T

ENDO (22 decks)

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