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)
