Emergency/Trauma/Regendo Flashcards
____% of dental emergencies are a result of pulpal or periapical disease and ___% of pop experienced a toothache in the last 6 months
85
12
What pulpal emergency has intense prolonged pain to temperature and is treated by pulpectomy/pulpotomy and relieving occlusion?
Irreversible pulpitis (normal periapex)
What pulpal emergency is extremely sensitive to percussion and is treated by complete pulpectomy or cleaning and shaping?
Irreversible Pulpitis (SAP)
*also relieve occlusion
What pulpal emergency is extremely percussion sensitive and is treated by completely pulpectomy, drainage, CaOH medicament and antibiotics?
Necrotic Pulp (SAP w/o swelling)
What is the difference in treatment between a necrotic pulp with swelling vs. without swelling?
With swelling-apical penetration when cleaning canal
What is different about treating a necrotic pulp with fluctuant swelling and no drainage?
Mucosal Incision and Drainage
*also apical penetration
How is a necrotic pulp with diffuse swelling and drainage treated? (Basic steps of most pulpal injury)
- Complete pulpectomy/clean and shape
- Copious irrigation
- CaOH after drying
- Cotton Cavit
- Antibiotics/pain management
What is different about treating necrotic pulp with diffuse swelling but no drainage?
Establish Extra oral/intra oral drainage
What are 4 kinds of drains?
1-I
2-T
3-Christmas Tree
4-Penrose
*want drainage for about 48 hours
What kind of trauma has no pulpal treatment and is chipping of the outer layer of tooth only?
Enamel Fractures
*1-2% pulpal necrosis
What fractures involve enamel and dentin and are treated by placing CaOH cement or other liner before restoring?
Crown Fractures without pulp exposure
*1-7% pulpal necrosis
Which fractures will go to necrosis if left untreated and can be pulp capped (1st 30 hours), partial/full pulpotomy or pulpectomy?
Crown fracture with pulp exposure
*13% of all dental injuries. Immature roots need pulp to develop
What is the most predictable successful treatment for an exposed pulp in a mature tooth?
Pulpectomy
What should be attempted if the exposed pulp is in an immature tooth?
Vital Pulp Therapy
What is the most important thing after pulpal therapy?
Bacteria-Tight seal
Shallow removal (2mm) of pulp on the day of injury with an 80% success rate is referred to as?
Cvek pulpotomy
What high pH, bacteria tight seal material acts as a base for permanent restorations?
MTA
What tooth trauma is usually oblique and becomes a periodontal rather than endodontic challenge?
Crown-Root Fracture
How are root fractures treated when they involved the cervical or middle third?
Splint
*apical third usually not treated
Which luxation injury has no displacement or mobility, percussion sensitivity and does not need treatment?
Concussion
Which luxation has no displacement but is mobile and percussion sensitive with possible sulcular bleeding?
Subluxation
no treatment
Which luxation injury is displaced coronally, mobile, and non-vital?
Extrusive
*reposition and splint 2-4 weeks
Which luxation injury is displaced mdbl?
Lateral
*reposition and splint 2-4 weeks
Which lunation injury is displaced apically, no mobility and may re-erupt spontaneously if immature?
Intrussive
*ankylosis risk high
Complete displacement from the socket is called?
Avulsion luxation
What are 3 key factors of avulsion luxation treatment success?
1-Duration
2-Storage medium
3-Apical maturity
What should you do with a closed apex tooth out of the mouth less than 60 minutes?
- Keep in saline, milk, saliva
- Irrigate socket and reimplant with splint. Antibiotics
What should you do with an open apex tooth out of the mouth less than 60 minutes
- Clean w/ saline
- reimplant with splint, antibiotics
*follow for vitality
What should you do with a closed apex out longer than 60 minutes?
1-Soak in 2% NaF 5-20 minutes
2-RCT in NaF soaked gauze hand
3-Reimplant and splint 4 weeks (ankylosis likely)
What should you do with an open apex out longer than 60 minutes?
May not reimplant due to very high incidence of ankylosis
If pulp vitality is not attainable what process involves a calcific barrier across the open apex with pulpal necrosis and no lesion?
Apexification
What 3 things do you need for Regendo?
1-Stem Cells (pulpal mesenchymal from cell rich zone of hohl)
2-Growth Factors
3-Scaffold
What are 4 criteria for Regendo case selection?
1-Pulp necrosis
2-Immature root apex
3-Pulp space not to be used for restorative purpose
4-Coronal Seal
What is the Regendo process?
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
What three antibiotics are in triple antibiotic paste?
1-Ciprofloxacin
2-Metronidazole
3-Minocycline
