Dentoalveolar trauma 3 (Tissue Responses to Injury) Flashcards
What are the potential consequences of trauma?
Can range from nil to needing various treatments (including RCF, cast post/core, full crown, review) to extraction
What are the pulp responses to injury?
Favourable responses:
Recovery and return to normal state
Pulp fibrosis
Pulp canal calcification (can be partial or complete)
Unfavourable responses:
Pulp necrosis
Infection of the pulp space (Can usually diagnose within 3 months after luxation and root fractures)
Internal resorption (Surface, inflammatory, replacement)
There can also be a combination of these responses either simultaneously or sequentially over time.
How quickly does pulp canal calcificaition take typically?
Can be diagnosed within 12 months
What are the potential per-radicular responses to trauma?
Favourable:
Recovery and return to normal state
Fibrous healing
Transient apical breakdown
Unfavourable:
Cessation of root development
Disturbance to root development
Bone resorption (marginal, apical, lateral)
External resorption (surface, inflammatory, replacement, and invasive)
Ankylosis
Sometimes combination of various responses can occur either simultaneously or sequentially over time.
What is transient apical breakdown?
Following trauma, occassionally there is a PA radiolucency that eventually heals which is
How can we distinguish between chronic apical periodontitis and transient apical breakdown?
Tooth will still respond to pulp testing
How does soft tissue respond to trauma?
Favourable:
Recovery and return to normal state
Fibrous healing
Unfavourable:
Loss of attachment
Gingival recession
True or False: Tissue response to trauma can affect dental pulp, periradicular tissue AND soft tissue.
True
What distinguishes short term, medium term, and long term responses?
Short term = up to 3 months
Medium term = 3 months to 1 year
Long term = more than 1 year
What kind of effects can be seen in the short term typically following traumatic injury?
Pulp necrosis
Infection of pulp space
Cessation of root dvlpmt
Disturbance of root dvlpmt
Bone resorption
Gingival recession
External root resorption
All the positive outcomes would be seen in the short term except pulp canal calcification.
What kind of effects can be seen in the medium term typically following traumatic injury?
Pulp necrosis
Infection of pulp space
Cessation of root dvlpmt
Disturbance of root dvlpmt
Bone resorption
Gingival recession
External root resorption
ANKYLOSIS
Pulp canal calcification can start to be seen at this time.
What kind of effects can be seen in the long term typically following traumatic injury?
Pulp canal calcification
Pulp necrosis
Infection of pulp space
Internal resorption
Cessation of root dvlpmt
Disturbance of root dvlpmt
Bone resorption
Gingival recession
External root resorption
Ankylosis
What factors affect healing?
Mechanical factors:
Direct or indirect trauma
Energy of impact
Resiliency, shape and direction of impacting object
Biological factors:
Stage of root development (wider apical foramen = more pulp healing. Longer pulp = less pulp healing)
Extent of pulp involvement
Degree of displacement of the tooth
Concurrent injuries to the same tooth
Must all be assessed after trauma via clinical examination.
How does stage of development of tooth affect pulp healing and revascularization?
Wider apical foramen = more pulp healing. Longer pulp = less pulp healing
How should incompletely developed teeth be treated following injury?
Always wait for pulp to revascularize. It allows for further root development and improves long-term prognosis
Reposition and stabilise
Reassess regularly with pulp sensibility tests and radiographs
IF definite signs of pulp necrosis and infection then RCT. (signs are inflammatory root resorption, PA radiolucency, Draining sinus, Swelling, and pain)
What should you look for on a radiograph of an injured incompletely developed tooth?
Further root development
Pulp canal calcification
How can an incompletely developed tooth with a wide apical foramen be treated endodontically?
Apexification needed (Ca(OH)2 until apex closes up again) preferred measure to take
Apical plug
Repair
Which injuries heal best following trauma?
In order from best prognosis to worst:
Concussion
Subluxation
Extrusion
Lateral luxation
Intrusion
Avulsion
Can pulp survive an avulsion in immature teeth?
In immature teeth 34% of pulps survived in Andreason 1995 study but 0% in mature teeth
How does the PDL heal following avulsions?
Prognosis gets worse the longer time passes while the tooth is dry.
How likely is pulp necrosis following injury?
Depends on the type of injury:
In luxations, avulsions or root fractures the blood supply can be severed and this can result in inability to revascularize leading to pulp necrosis. If extruded more than a couple of mm chances are it will be severed.
Subluxation, concussion, and crown fractures: Apical blood supply wont be affected, bacterial invasion is the only issue.
Can bacteria get into the pulp following a traumatic injury?
Infractions if they reach dentin
Uncomplicated crown fractures and complicated crown fractures can involve dentin and pulp respectively
Bacterial entry would depend on the ability of pulp to resist the bacterial infection.
How does crown fracture affect the prognosis of dental injuries that cause damage to structures around the tooth?
They make the prognosis much worse
