ENDO Traumatic Injuries Flashcards
apical injuries may result in ___ and ___
swelling and bleeding that involves the PDL
T or F:
teeth with apical injuries are not sensitive to percussion
false
apical displacement with injury to vessels entering the apical foramen may lead to ___
pulpal necrosis
T or F:
during vitality testing after traumatic injuries, it is only necessary to test the injured teeth
false, you want to test the vitality of all the teeth in the area
after a traumatic injury, what might happen if you test vitality immediately after the injury?
- frequently yields a false negative response
- these data serve as a baseline for future reference, so the test results may be unreliable for 6-12 months
- tests should be repeated at 3 weeks, 3 months, 6 months, and 12 months, and yearly intervals after that
what is the purpose of continual vitality tests on teeth with traumatic injuries?
to establish a trend as to the physiologic status of the pulps
describe false negative pulp vitality test results from teeth involved in traumatic injuries
- all current pulp testing methods detect only the responsiveness and not the vitality of the pulp (vitality is determined by integrity of its blood supply)
- sensitivity tests for nerve function do not indicate the presence or absence of blood circulation within the pulp
- in traumatic injury, the neural response from the pulpal sensory nerves may be disrupted, but the vascular supply may be intact
___ is an incomplete crack of enamel without the loss of tooth structure
infraction
which classification of uncomplicated fracture involves enamel only (enamel chipping and incomplete fractures or cracks)?
ellis class I enamel fracture
what is the treatment for an ellis class I enamel fracture?
grinding and smoothing the rough edges or restoring lost structure
what is the prognosis for an ellis class I enamel fracture?
good
which classification of uncomplicated fracture is considered a fracture involving enamel and dentin only?
ellis class II crown fracture without pulp involvement
what is the treatment for an ellis class II fracture?
restoration with a bonded resin technique
what is the prognosis for an ellis class II fracture?
good unless accompanied by a luxation injury
which classification of complicated fracture involves enamel, dentin, and exposure of the pulp?
ellis class III crown fracture with pulp involvement
what distinguishes an uncomplicated fracture from a complicated fracture?
whether there is pulp involvement or not
in the treatment for an ellis class III fracture, what determines whether vital pulp therapy or RCT is appropriate?
- stage of development of the tooth (vital pulp therapy for immature tooth due to advantages of maintaining vital pulp)
- time between accident and treatment (<24 hours, initial reaction of pulp is proliferative with <2mm pulp inflammation; >24 hours, chances of direct bacterial contamination increase)
- periodontal injury compromises nutrient supply of the pulp
- restorative treatment plan (more complex plan may require RCT)
which type of root fracture may show bleeding from the sulcus?
horizontal
what are the 2 biologic consequences of a horizontal root fracture?
- when a root fractures horizontally, the coronal segment is displaced, but generally the apical segment is not. pulp necrosis of the coronal segment (25%) may result from displacement
- because the apical pulp circulation is not disrupted, pulpal necrosis in the apical segment is rare
why should you avoid only taking one radiograph when diagnosis horizontal root fractures?
- root fractures are usually oblique (facial to palatal), so one radiograph may miss it
- one occlusal film and three PA films (one at 0 degrees, then one at +15 degrees, and one at -15 degrees from the vertical axis of the tooth)
what are the healing patterns of horizontal root fractures described by andreasen and hjorting-hansen?
- healing with calcified tissue (ideal healing is calcific healing, where a calcific callus is formed at the fracture site on the root surface and inside the canal wall)
- healing with interproximal connective tissue
- healing with bone and connective tissue
- interproximal inflammatory tissue without healing (considered unsuccessful, typical when the coronal segment loses its vitality)
with horizontal root fractures that have maintained the vitality of the pulp, the main goal of treatment is ___. what is the treatment and prognosis?
- to enhance the healing process
- prognosis improves with quick treatment, close reduction of the root segments, and splinting
- splint as soon as possible, depending on location of the fracture and mobility
what is the prognosis of a horizontal coronal root fracture?
- poor
- if the fracture occurs at the level of or coronal to the crest of the alveolar bone, the prognosis is extremely poor
what is the treatment for a horizontal coronal root fracture?
- stabilize the coronal fragment with rigid splint for 6-12 weeks
- if reattachment of the fractured fragment is impossible, extraction of the coronal segment is indicated; the apical segment may be carried out by orthodontic forced eruption or by periodontal surgery
what is the treatment for a horizontal midroot fracture?
- stabilize for 3 weeks
- apexification may be indicated if pulpal necrosis occurs and the pulp lumen is wide at the apical extent of the coronal segment
- in rare cases when both coronal and apical pulps are necrotic, endodontic tx through the fracture is difficult, and necrotic apical segments can be removed surgically
in horizontal midroot fractures, pulp necrosis occurs in ___% of root fractures
25% (mostly limited to coronal segment)
what is the prognosis of a horiztonal apical root fracture?
- have the best prognosis in the apical third
- pulp is mostly vital and the tooth has little or no mobility
what characteristics of root fractures determine prognosis?
- improves as fracture approaches apex (more apical, better prognosis)
- horizontal is better than vertical
- nondisplaced is better than displaced
- oblique is better than transverse
___ is the dislocation of a tooth from its alveolus resulting from acute trauma
luxation (ellis class V)
in concussion of a tooth, is there displacement? mobility? sensitivity to percussion? response to pulp testing? does pulp blood supply recover?
- no displacement
- normal mobility
- sensitive to percussion
- generally responds to pulp testing
- pulp blood supply is likely to recover