Dentoalveolar Trauma & Management Flashcards
% of all bodily injuries?
oral regions is 1% of the body but 5% of all bodily injuries
most common facial injuries?
dental
implication of the vascular supply to teeth
redundant nature of the vascular supply allows most dento-alveolar bony injuries to heal well despite mucosal lacerations and extensive communication
ages 6-50 years old how much dental traums
1 in 4 had evidence of dental trauma
incidence of trauma
children with primary - 11-30%
children with permanent 5-20%
boys 2x girls
peak incidence of trauma
at 2-4 years
second peak incidence of trauma
at 8-12 years
most commonly involved teeth
maxillary central incisors
maxillary lateral incisors
mandibular anterior teeth
what includes the physical examination THEN?
- soft tissue
- jaw and alveoalar bone
- occlusion
- teeth
- infection
- fracture
- displacment
- mobility
- pulp testing
- percussion
then go to RADIOGRAPHIC
- examine the presence of any patholgy (root fracture/ extent/ peri-apical pathoses/ size of pulp/ jaw fractures/ tooth fragments)
classification of dento-alveolar injury
ellis and davey classification
ellis and davey classification
classification of dento-alveolar injury
ellis and davey classification I –> IV
I - fracture within enamel
II- fracture of enamel- dentin
III- fracture involving the pulp
IV - fracture involving the roots
peri-apical radiographs help with
intrusion or extrusion injuries
- influences the tx!!
- impotrant to recognoize
retain or extract has a lot to do with?
extent of root development!
size of pulp chamber and root canal implication?
larger pulp - increase in infection area - can be bigger?
radiographic examination can show laceration?
yes – may be able to see a tooth piece in the lip
radiographic examination can include
periapical occlusal pano -- ghost images appear CBCT-- medical CT
last two are best ones to look at for trauam
pano implication
if trauam in the midline – may be ghost image - not as accurate
medical CT use?
wide spread damage to other cranial bones
enamel crown fracture tx and follow up
smooth and relieve occlusion
follow up 6 weeks to 1 year and soft diet
enamel and dentin crown fracture tx and follow up
RESTORE then smooth and relieve occlusion
follow up 6 weeks to 1 year and soft diet
enamel / dentin / pulp crown fracture tx and follow up
IMMATURE teeth
calcium hydroxide and pulp cap or pulpotomy
6 weeks to 1 year
enamel / dentin / pulp crown fracture tx and follow up
mature teeth
endodontic tx
6 weeks to 1 year
important to follow up for like presence of cysts
pulp capping when?
exposure is SMALL
patient is seen shortly after the injury
patient has no root fracture
tooth is not displaced
no large or deep restorations exist that might indicate chronic inflammation of the pulp
crown root fracture with pulp involvment tx and follow up
expose fracture site – gingivectomy
- ortho extrusion
- endodontic tx
6 wweeks to 1 year and suggest soft diet
crown root fracture with NO pulp involvment tx and follow up
explore the fracture site by gingovectomy
orthodontic extruion
6 weeks to 1 year and soft diets
Difference here is no endo tx needed
vertical root fracture treatment
advise extraction
horizontal apical or middle root fracture tx and follow up
reposition and stabalize
4 and 8 weeks
then 6 monthts to a year for every five years
horizontal apical third root fracture
extract
main pulpal responses to trauma
- hyperemia - acute inflammation
- pulpal hemorrhage
- pulpal necrosis
- calcific metamorphosis
- internal resorption – considered a FAILURE
- vs anklylosis- he said considered a success if that results?
reaction of teth to trauma
surface resorption
inflammatory resorption
replacement resorption
tx to concussion
no – just observation only
as there is NO evidence of mobility
- no displacement
- no fracture
may be tenderness to percussion
subluxation is? tx?
loosening the force is absorbed by the tooth without apparent loss of tooth structure
may need occlusal adjustment , observation with vitality testing
like take out of occlusion
intrusive luxation is? tx? for immature
displacement of the tooth into its alveolus
immature apex – incomplete root development –> allow the tooth to re-erupt - 6-12 months
- monitor for necrosis
- if pulpal necorissi - endo treatment with calcium hydroxide
mature root development - has mature apex / complete root development
- so reposition ro original position and splint
- ortho extrusion if needed
- look at other card with more info
intrusive luxation is? tx? for mature
reposition to original position and splint
ortho exxtrusion (96% incidence of pulpal necrosis)
calcium hydroxide endo treatemtn within 8-12 months likley
52% of incidence of inflammatory replacement resorption
hanks balanced salt solution?
can maintian PDL osmolarity , pH and cell metabolite
natural pH of 7.2, osmolality of 32 mosm
ot is a collective group of salts rich in bicarbonate ions, formulated by microbiologists
- used as a buffer system in cell culture media and aid in maintaining the optimum physiologic pH - roughly 7-7.4 for cellular growth
extrusive luxation
tooth is displaced coronally
tooth should be repositioned and splinted for 2 weeks
64% incidence of pulpal necrosis
7% incidence of external resorption
lateral luxation
can occur in a buccal, lingual, mesial or distal direction
results in fracture of the alveolar bone
the tooth should be manually repositioned and non-rigidly splinted for 4-8 weeks
lateral luxation follow up
monitor the need for endo tx.
if tooth is displaced more than 5mm endodontic treatemtnis indicated
most common for alvulsed teeth
ages 7-10 years
maxillary central incisor is most common
most important factor for long term prognosis – amount of vital periodontal fibers remaining of the tooth surface prior to replantation
most important factor for long term prognosis for alvusion
amount of vital periodontal fibers remaining of the tooth surface prior to replantation
factors to consider before replanting avulsed teeth
per Andreason and hjortig hansen
- tooth should be free of advanced periodontal disease
- alveolar socket shuold be reasonably intact
- no orthodotnic contraindication
- extra alveolar period should be considered
- stage of root development
details of periodontla ligament cells
healing takes 3-4 weeks
pdl cells are necrotic in teeth that have been extra-oral for 120 minutes or more
hank’s balanced solutoin can maintain pdl osmolarity and pH and cell metabolite
whole milk?
can be used for transport medium if needed
- short term storage use up to 6 hours
- better than saliva (not as good as hanks)
- avulsed needs to be placed in it within 15 minutes - but DOES NOT PREVENT CELL DEATH
TX FOR ALVUSION within 2 hours with open apex
within 2 hours
- replant as soon as possible
- do NOT remove PDL
transport in Hanks solution or whole milk
place in 1mg / 20ml doxycycline solution for five minutes – higher rate of pulpal revascularization
do NOT remove blood clot from socket
monitor for endo tx
semi rigid splint for 10-14days
take tooth OUT of occlusion
importance of history for dealing with dental trauma
unaccounted for AVULSED TEETH or tooth fragments – SUSPICION OF ASPIRATION
need to aucultation of the chest to rule out wheezing or labored breathing
Andreasen classification?
also accepted for classification of dentoalveolar injury
accepted like the ellis and davey classification of dento-alveolar injuries
infraction
no fracture of enamel - like doesnt completely break the enamel
general under problems and consequences
- malocclusion
- loss of space
- altered etehtics
- dysfunctino
treatment of alvusion
within 2 HOURS / open apex
semi rigid splint for 10-14 days
take tooth out of occlusion
pdl cells are necrotic when?
in teeth that have been extra-oral for 120 minutes or more
doxycycline solution used?
In tx for AVULSION
place in 1mg / 20ml doxycycline solution for five minutes – higher rate of pulpal revascularization
prophylaxis for alvusion?
tetanus prophylaxis could be considered
post op for avulsion
antibiotic coverage for 7-10 days
soft diet
chlorohexidine mouth rinse 2x day
oral hygeine instructions
tx of alvusion if it has been MORE than 2 hours
open apex or closed
- necrotic pdl should be removed
- scraped off
- soaked in sodium hypochlorite for 30 minutes
endo tx – cleaning and shaping (extra orally - in hand)
risks associated with avulsion
ankylosis increases with prolonged splinting
external resorption increases with rigid splints
implication of rigid splints and prolonged splinting
prolonged – ankylosis can develop
rigid – external resorption can occur
stabalization period using splint for mobile teeth
7-10 days
stabalization period using splint for tooth displacement
2-3 weeksk
stabalization period using splint for root fracture
2-4 months
stabalization period using splint for avulsed (mature)
7-10 days
stabalization period using splint for avulsed (immature)
3-4 weeks
dentoalveolar fracture
fracture of the alvolar bone involving one or more teeth
tx of dentoalveolar fracture
reduction ofo the alveolar segment (closed or open)
stabalization with splint (4-6 weeks)
closure of mucosal laceration
check occlusion
post op tx for detoalveolar fracture
antibiotics for 7-10 days
chlorohexidine 2 times day / one week
soft diet
follow up
luxation in primary?
reposition or remove
extrusion in primary?
reposition or remove
intrusion in primary?
remove if contacting permanent tooth or re -eruption has not started in 408 weeks
remove if infection is also present
allow to erupt if not contacting permanent tooth
root fracture in primary if apical third?
middle or cervical third?
apical third – observation
middle or cervical third - removal without damaging permanent
long term follow up?
YES – required – since some complications can occur months or years later
