Emergency/Trauma/Regendo

Question 1

____% of dental emergencies are a result of pulpal or periapical disease and ___% of pop experienced a toothache in the last 6 months

Answer 1

85

12

Question 2

What pulpal emergency has intense prolonged pain to temperature and is treated by pulpectomy/pulpotomy and relieving occlusion?

Answer 2

Irreversible pulpitis (normal periapex)

Question 3

What pulpal emergency is extremely sensitive to percussion and is treated by complete pulpectomy or cleaning and shaping?

Answer 3

Irreversible Pulpitis (SAP)

*also relieve occlusion

Question 4

What pulpal emergency is extremely percussion sensitive and is treated by completely pulpectomy, drainage, CaOH medicament and antibiotics?

Answer 4

Necrotic Pulp (SAP w/o swelling)

Question 5

What is the difference in treatment between a necrotic pulp with swelling vs. without swelling?

Answer 5

With swelling-apical penetration when cleaning canal

Question 6

What is different about treating a necrotic pulp with fluctuant swelling and no drainage?

Answer 6

Mucosal Incision and Drainage

*also apical penetration

Question 7

How is a necrotic pulp with diffuse swelling and drainage treated? (Basic steps of most pulpal injury)

Answer 7

• Complete pulpectomy/clean and shape
• Copious irrigation
• CaOH after drying
• Cotton Cavit
• Antibiotics/pain management

Question 8

What is different about treating necrotic pulp with diffuse swelling but no drainage?

Answer 8

Establish Extra oral/intra oral drainage

Question 9

What are 4 kinds of drains?

Answer 9

1-I
2-T
3-Christmas Tree
4-Penrose

*want drainage for about 48 hours

Question 10

What kind of trauma has no pulpal treatment and is chipping of the outer layer of tooth only?

Answer 10

Enamel Fractures

*1-2% pulpal necrosis

Question 11

What fractures involve enamel and dentin and are treated by placing CaOH cement or other liner before restoring?

Answer 11

Crown Fractures without pulp exposure

*1-7% pulpal necrosis

Question 12

Which fractures will go to necrosis if left untreated and can be pulp capped (1st 30 hours), partial/full pulpotomy or pulpectomy?

Answer 12

Crown fracture with pulp exposure

*13% of all dental injuries. Immature roots need pulp to develop

Question 13

What is the most predictable successful treatment for an exposed pulp in a mature tooth?

Answer 13

Pulpectomy

Question 14

What should be attempted if the exposed pulp is in an immature tooth?

Answer 14

Vital Pulp Therapy

Question 15

What is the most important thing after pulpal therapy?

Answer 15

Bacteria-Tight seal

Question 16

Shallow removal (2mm) of pulp on the day of injury with an 80% success rate is referred to as?

Answer 16

Cvek pulpotomy

Question 17

What high pH, bacteria tight seal material acts as a base for permanent restorations?

Answer 17

MTA

Question 18

What tooth trauma is usually oblique and becomes a periodontal rather than endodontic challenge?

Answer 18

Crown-Root Fracture

Question 19

How are root fractures treated when they involved the cervical or middle third?

Answer 19

Splint

*apical third usually not treated

Question 20

Which luxation injury has no displacement or mobility, percussion sensitivity and does not need treatment?

Answer 20

Concussion

Question 21

Which luxation has no displacement but is mobile and percussion sensitive with possible sulcular bleeding?

Answer 21

Subluxation

no treatment

Question 22

Which luxation injury is displaced coronally, mobile, and non-vital?

Answer 22

Extrusive

*reposition and splint 2-4 weeks

Question 23

Which luxation injury is displaced mdbl?

Answer 23

Lateral

*reposition and splint 2-4 weeks

Question 24

Which lunation injury is displaced apically, no mobility and may re-erupt spontaneously if immature?

Answer 24

Intrussive

*ankylosis risk high

Question 25

Complete displacement from the socket is called?

Answer 25

Avulsion luxation

Question 26

What are 3 key factors of avulsion luxation treatment success?

Answer 26

1-Duration
2-Storage medium
3-Apical maturity

Question 27

What should you do with a closed apex tooth out of the mouth less than 60 minutes?

Answer 27

• Keep in saline, milk, saliva

- Irrigate socket and reimplant with splint. Antibiotics

Question 28

What should you do with an open apex tooth out of the mouth less than 60 minutes

Answer 28

• Clean w/ saline
• reimplant with splint, antibiotics

*follow for vitality

Question 29

What should you do with a closed apex out longer than 60 minutes?

Answer 29

1-Soak in 2% NaF 5-20 minutes
2-RCT in NaF soaked gauze hand
3-Reimplant and splint 4 weeks (ankylosis likely)

Question 30

What should you do with an open apex out longer than 60 minutes?

Answer 30

May not reimplant due to very high incidence of ankylosis

Question 31

If pulp vitality is not attainable what process involves a calcific barrier across the open apex with pulpal necrosis and no lesion?

Answer 31

Apexification

Question 32

What 3 things do you need for Regendo?

Answer 32

1-Stem Cells (pulpal mesenchymal from cell rich zone of hohl)
2-Growth Factors
3-Scaffold

Question 33

What are 4 criteria for Regendo case selection?

Answer 33

1-Pulp necrosis
2-Immature root apex
3-Pulp space not to be used for restorative purpose
4-Coronal Seal

Question 34

What is the Regendo process?

Answer 34

1-Access and debride necrotic pulp (WL, irrigate)
2-Medicate w/ triple antibiotic
3-Once infection resolved, use non-vasoconstrictor anesthesia and a #10 or 15 file to stimulate bleeding.
4-Place collagen matrix
5-MTA seal and permanent restoration

Question 35

What three antibiotics are in triple antibiotic paste?

Answer 35

1-Ciprofloxacin
2-Metronidazole
3-Minocycline