IADT Guidelines Flashcards
What guidelines are to be used for dental trauma?
IADT 2012
(International association of dental traumatology)
What is prevalence of dental trauma?
25% of children
33% of adults
What is the most common traumatic injury to the primary dentition?
Luxation injuries.
What is the most common traumatic injury to the permanent dentition?
Crown fractures.
What are some consequences of primary trauma on developing permanent dentition?
Tooth malformation (dilaceration)
Impacted teeth
Eruption disturbances
What general advice can be given to a patient after they sustain a TDI?
Care for optimal healing
Avoid contact sports
Good OH
Rinsing with antibacterial agent (CHX)
Describe this TDI.
Infraction of an incisor.
Incomplete fracture of the enamel, without loss of tooth structure. Likely to be asymptomatic unless a luxation injury is involved.
What is the management for this TDI?
Infraction of an incisor.
In cases of marked infractions, etching and sealing with resin to prevent discoloration.
No review necessary.
Describe this TDI.
Note: No dentine has been exposed.
Enamel fracture of the 12.
What symptoms/features would you expect from this TDI?
Note: Dentine not exposed. No associated luxation injury.
No TTP
Normal mobility
Positive response to pulp tesing
What would your managment be for this TDI?
Note: Dentine not exposed, no sign of luxation injury.
Locate tooth fragment
Radiograph to rule out root fracture
If fragment available bond to tooth.
Conventional restoraiton if not present.
Review 6-8wks, 1yr.
Describe this TDI.
Note: Dentine exposed, but pulp sound.
Enamel-dentine fracture.
Fracture confined to enamel and dentine, pulp not exposed.
What is TDIs typically reslt in TTP?
Luxation, concusson, and root fracture.
What would you rmanagment be for this enamel dentine fracture?
Locate tooth fragment
Bond fragment to tooth if available
Cover exposed dentine with GI or composite
If dentine is pink, then place CaOH liner (indicates its within 0.5mm of pulp.
Review 6-8wks, 1yr
Describe this TDI.
Enamel-dentine-pulp fracture (complicated)
Clear exposure of pulp, which will be sensitive to stimuli.
What would your managment of this TDI be?
Note: Tooth is not TTP.
Complicated EDP fracture.
Generally advantagous to preserve pulp in young patient.
Pulp cap, or partial pulpotomy if open apex.
Conventional RCT if mature apex.
Conventional restorative treatment or bond fragment.
Review: 6-8wks, 1yr
Describe this TDI.
Note: Coronal fragment is mobile but there is no pulpal exposure?
Uncomplicated root-crown fracture.
Fracture involving enamel, dentine, and cementum.
Would be TTP
Sensibility test positive for apical fragment.
Confirm with radiograph.
What would your managment be for this TDI?
Note: Coronal piece mobile, no pulpal exposure.
Uncomplicated crown root fracture.
Tooth can be stabilised to adjacent teeth, if in an emergency situaton and treatment plan uncertain. Tx options:
- Fragment removal and gingivectomy
- Orthodontic extrusion for crown placement
- Surgical extrusion for crown placement
- Extraction followed by prosthesis
Note: All fractures with severe apical extensions will require extraction. Vertical fractures almost always do.
Review: 6-8wks, 1yr
What radiographs can be used to investigate potential root fractures?
Periapical
Occlusal variatons
What would your managment of this TDI be?
Note: Radiographic evidence of pulpal exposure, coronal fragment mobile.
Complicated crown-root fracture.
Tooth can be stabilised to adjacent teeth, if in an emergency situaton and treatment plan uncertain. Tx options:
- Appropriate pulp therapy for tooth development
- Fragment removal and gingivectomy
- Orthodontic extrusion for crown placement
- Surgical extrusion for crown placement
- Extraction followed by prosthesis
Note: All fractures with severe apical extensions will require extraction. Vertical fractures almost always do.
Review: 6-8wks, 1yr
Why is pulpotomy prefered for developing teeth?
Preserve vitality, to enable apexification
This creates a more durable root and an apex that is easier to seel during obturation.
What are the clinical signs of root fracture?
Coronal segment may be mobile
Tooth may be TPP
May bleed from gingival sulcus
Negative sensitivity testing
Transient crown discolouration may occur
What are the radiographic signs of root fracture?
Fracture involving root of tooth in horizontal/oblique plane.
Can use differing oblique views to visualise horizontal fractures.
Apical third more commonly oblique.
Mid-coronal third more commonly horizontal.
What is the management for root fracture?
Reposition if displaced
Check position radiographically
Stabilise with flexible splint
Monitor healing up to a year
If pulp necrosis develops, carry out RCT of coronal fragment
What are the reveiew appointments for a root fracture?
4ks (remove splint)
6-8wks
16wks
6mths
1yr
Yearly for 5 yrs
How long should a root fracture be splinted for?
4 weeks
Consider longer if root fracture near cervical area (up to 4 months)
Describe this TDI.
Note: Labial segment 11-12 is mobile, but the teeth move together.
Alveolar fracture of cortical plates of 11 + 12
Fracture of the alveolar process, but teeth often undammaged.
What radiographs can you use to help investigate an alveolar fracture?
Different angulations of PAs
Occlusal views
OPT
What are the treatment options for this TDI?
Alveolar fracture
Reposition displaced segment, and check radiograph for alignment.
Stabilise the segment for 4 weeks.
Suture gingival laceration if present.
What are the follow up appointments for alveolar fracture?
4 wks (splint removal)
6-8wks
16wks
6mths
1yr
Yearly for 5 yrs
What are the symptoms of concssion?
Tooth is TTP
Has not been displaced
Has no mobility
Positive sensibility testing
What treatment should be done for a tooth concussion?
No treatment indicated.
Review: 4wks, 6-8wks, 1yr
What are the clinical findings of a subluxation?
Tooth is TPP
Increased mobility
Tooth has no tbeen displaced
May bleed from gingival crevice
Likely to respond negative to sensibility testing
(^indicates transient pulpal damage)
What treatment is indicated for subluxation?
Usually none, however flexible splint for 2 weeks for patient comfort may be indicated.
Review:
- 2wks
- 4wks
- 6-8wks
- 6mths
- 1yr
The 11 below has sustained a dental trauma due to a traumatic injury. What type of TDI is this?
Note: There is no evidence of fracture, the tooth is mobile. TTP, and only displaced coronally. There is increased apical PDL width.
Extrusive luxation
Tooth appears elongated
Will likely have negative sensibility test
Outline the management for extrusive luxation?
Reposition the tooth by gently re-inserting it
Stablise with flexible splint for 2 weeks
+/- endo treatment if indicated
Outline the review appointments for extrusive luxation?
2wks (remove splint)
4wks
6-8wks
6mths
1yr
Yearly for 5 yrs
The 31 and 41 below have sustained a dental trauma due to a traumatic injury. What type of TDI is this?
Note: The teeth are immobile, and give ankylotic pitch There is increased PDL space.
Lateral luxation
Tooth is displaced lingual/labial direction
Fracture of the alveolar process is present
Sensibility tests will likely be negative
Outline the management options for a lateral luxation.
Reposition tooth with fingers or forceps
Stabilise tooth for 4 weeks using flexible splint
Monitor pulpal condition
If pulp becomes necrotic - RCT is indicated to prevent RR
Outline the review appointments for a lateral luxation TDI?
4wks (remove splint)
4wks
6-8wks
6mths
1yr
Yearly for 5 yrs
The 11 below has sustained a dental trauma due to a traumatic injury. What type of TDI is this?
Note: There is no evidence of lateral displacement, no mobility, and gives a high percussive note.
Intrusive luxation
CEJ is located more apically on a radiograph
Tooth is displaced axially into the bone
Sensiblity tests will likely be negative
What factors determine long term prognosis of avulsed teeth, if re-implanted?
Maturity of root (open or closed apex)
Viability of PDL cells
What patient information would you give to a parent of a child with an avulsed tooth over the phone?
Keep patient calm
Handle tooth by crown
Clean for 10 sec under cold water
Try to implant the tooth and bite on tea-towel
If not transport in sealed container of saliva or milk
Bring to dentist within 60 minutes
What steps should you take for a re-implanted avulsed tooth, with a closed apex? The tooth was replanted immediately.
Leave the tooth in place
Clean area with water
Suture gingival lacerations
Verify position of tooth
Apply flexible splint
Administer systemic anti-biotics
When should a patient be considered for a tetanus booster after replanting an avulsed tooth?
If the tooth has contacted soil, or if tetanus coverage is uncertain.
What steps should you take for a avulsed tooth, with a closed apex? The dry time was less than 60 minutes.
Clean tooth with saline
Administer LA
Re-insert tooth with gentle pressure
Suture gingival lacerations
Verify position of tooth
Apply flexible splint
Administer systemic anti-biotics
What steps should you take for a avulsed tooth, with a closed apex? The dry time was less longer than 60 minutes.
Clean tooth with saline
Administer LA
Root canal treatment to the tooth can be carried out prior to replantation
Re-insert tooth with gentle pressure
Suture gingival lacerations
Verify position of tooth
Apply flexible splint for four weeks
Administer systemic anti-biotics
What information should be given to the patient after treating an avulsed tooth?
Avoid participation in contact sports.
Soft diet for up to 2 weeks. Thereafter normal function as soon as possible
Brush teeth with a soft toothbrush after each meal
Use a chlorhexidine (0.1%) mouth rinse twice a day for 1 week
What are the most two common complications for a re-implanted avulsed tooth?
Ankylosis and infraposition.
What are the implications of replanting a tooth with an open apex?
Requires re-vascularisation of the pulp space
Rapid rate of infection related root resorption
Requirement for endo if re-vascularisation does not occur
What would a favourable outcome for a replanted tooth with an open apex be?
Asymptomatic
Normal mobility
Normal percussion sound
Radiographic evidence of
arrested or continued root formation and eruption.
Pulp canal obliteration is to be expected.
What would a favourable outcome for a replanted tooth with an closed apex be?
Asymptomatic
Normal mobility
Normal percussion sound
No radiographic evidence of resorption or periradicular osteitis: the lamina dura should appear normal.
How long can a false negative pulp testing persist on a traumatised tooth?
Up to three months.
What are the general unfavourable outcomes for a traumatised tooth?
Symptomatic
Negative sensibility testing
External root resorption
Arrested root development
Periapical pathology
Ankylosis
What is the treatment for a primary tooth enamel fracture
Smooth sharp edges
What is the treatment for a primary enamel dentine fracture?
Seal tooth with GI to prevent microleakage. Review 3-4 weeks.
What is the treatment for a enamel-dentine-pulp chamber in a primary tooth?
Preserve pulp vitality with partial pulpotomy.
Dress with CaOh, then restore with GI/composite.
Review:
- 1wk
- 6-8wks
- 1yr
What is the treatment for a crown-root fracture in a primary tooth?
If the fracture involves a small part of the root, and is suitable for restoration then remove fragment only.
In all other instances extract the tooth.
What is the treatment for a root fracture in a primary tooth?
If the coronal fragment is not displaced, no treatment is required.
If coronal fragment is displaced, then extract. Apical fragment should be left to be resorbed.
What treatment should be done for an alveolar fracture in a primary tooth?
Reposition the displaced segment, then place splint for four weeks.
Review:
- 1wk
- 3-4wks
- 6-8wks
- 1 yr
- Every year until exfoliation
What treatment should be done for concussion in a primary tooth?
No treatment indicated, but review 1 week and 6-8 weeks.
What treatment should be done for subluxation of a primary tooth?
No treatment indicated, but review 1 week and 6-8 weeks.
Monitor to see if dark discoloured crown develops - if so could be a sign of infection.
What treatment should be done for extrusive luxation of a primary tooth?
If less than 3mm, attempt to replace the tooth carefully or leave for spontaneous realignment.
Extraction if severe extrusion.
What treatment should be done for lateral luxation of a primary tooth?
If no occlusal interference, allow for spontaneous repositioning.
If occlusal interference present, then tooth can be gently repositioned, with combined labial and palatal pressure.
For severe labial displacement, extraction is indicated.
What treatment is indicated for intrusive luxation of a primary tooth?
If apex is displaced through bone plate, allow for spontaneous repositioning.
If tooth germ compromised, then extract.
What treatment should be done for avulsion of a primary tooth?
Do not replant, however review 1 week, 6 months, 1 year.
