IADT (permanent teeth) Flashcards
What is enamel infarction?
Incomplete fracture (crack or crazing) of the enamel
- no loss of tooth structure
What are the clinical findings of enamel infarction?
- crack or crazing seen
- not TTP (if ttp check for luxation/root fracture)
- normal mobility
- positive pulp sensibility tests
What investigations should be done for enamel infarction injuries?
PA radiograph
- no radiographic abnormalities should be present
What is the treatment for enamel infarction?
No Tx usually required
Severe cases:
- etch and seal with resin to prevent discolouration/bacterial contamination
Follow up for enamel infarction?
No follow up required
What are the clinical findings of an enamel fracture (uncomplicated)?
- loss of enamel
- no visible signs of exposed dentine
- normal mobility
- positive to pulp sensibility testing
(if TTP, assess tooth for luxation or root fracture)
What investigations should be done for an enamel fracture (uncomplicated)?
- account for missing fragments
- PA radiograph
What treatment should be done for an enamel fracture?
Tooth fragment available = bond back onto tooth
Otherwise smooth edges and place composite resin restoration
What is the follow up for an enamel fracture?
Clinical & Radiographs:
- 6/8 weeks
- 1 year
What would be considered unfavourable outcomes of an enamel fracture?
- symptomatic
- pulp necrosis and infection
- apical periodontitis
- loss of restoration
- breakdown of the restoration
- lack of further root development
What are the clinical findings of an enamel-dentine fracture (uncomplicated)?
- fracture that extends into dentine (no pulp)
- normal mobility
- positive pulp sensibility tests
- not TTP
What investigations should be done for an enamel-dentine fracture?
- account for missing fragment
- PA radiograph
What is the treatment for an enamel dentine fracture?
Tooth fragment available = soak fragment in saline to rehydrate it, rebond back onto tooth
Otherwise restore with GIC or composite resin (if within 0.5mm of pulp place a CaOH and GIC lining)
What are the follow up dates after an enamel-dentine fracture?
Clinical and Radiographs:
- 6/8 weeks
- 1 year
What would be considered unfavourable outcomes of an enamel-dentine fracture?
- symptomatic
- pulp necrosis and infection
- apical periodontitis
- lack of further root development
- loss of restoration
- breakdown of restoration
What are the clinical findings of a complicated crown fracture?
Fracture of enamel and dentine with pulp exposure
- normal mobility
- not TTP
- exposed pulp is sensitive to stimuli [air, cold, sweets]
What investigations should be done on a pt who presents with a complicated crown fracture?
- account for missing fragments
- PA radiograph
What is the treatment for a tooth that has experienced complicated crown fracture?
Open apices =
- Partial pulpotomy or pulp capping
Closed apices =
- Partial pulpotomy preferred option
- Root canal treatment
After pulp treated then either rebond tooth fragment OR restore with GIC and composite resin
What are the follow-up dates for a complicated crown fracture?
Clinical and Radiographs
- 6/8 weeks
- 3 months
- 6 months
- 1 year
What is an uncomplicated crown-root fracture?
A fracture involving enamel, dentine and cementum WITHOUT pulp exposure
What are the clinical findings of an uncomplicated crown-root fracture?
- positive pulp sensibility testing
- TTP
- coronal fragment mobile
- fracture extends sub alveolar
What investigations should be done for an uncomplicated crown root fracture?
- account for any missing fragments
- PA radiograph + 2 additional radiographs used with parallax
- CBCT can be considered
What is the initial treatment of a tooth that has experienced uncomplicated crown-root fracture?
- stabilisation of loose fragment to adjacent tooth OR to non-mobile fragment should be attempted
- or remove mobile fragment and restore tooth with GIC or composite resin
What is the finalised treatment of a tooth that has experienced uncomplicated crown-root fracture?
Options available:
- orthodontic extrusion of non-mobile fragment + restoration
- surgical extrusion
- RCT and restoration if pulp become necrotic
- root submergence
- extraction
- autotransplantation
What is the follow up schedule for a tooth that has experienced an uncomplicated crown-root fracture?
Clinical and Radiograph evaluations:
- 1 week
- 6/8 weeks
- 3 months
- 6 months
- 1 year
- yearly for at least 5 years
What would be considered unfavourable outcomes of a tooth that has experienced an uncomplicated crown-root fracture?
- symptomatic
- discolouration
- pulp necrosis and infection
- apical periodontitis
- lack of further root development in immature teeth
- loss/breakdown of restoration
- marginal bone loss & periodontal inflammation
What is a complicated crown-root fracture?
a fracture involving enamel, dentine and cementum WITH pulpal exposure
What are the clinical findings of a complicated crown-root fracture?
- positive pulp sensibility tests
- TTP
- coronal fragment mobile
What investigations should be done on a tooth with a complicated crown root fracture?
- account for missing fragment
- on PA radiograph + additional radiograph for parallax [can be occlusal]
- CBCT can be considered
What initial treatment should be done for a tooth with a complicated crown-root fracture while Tx plan is being formulated?
Stabilise loose fragment to adjacent teeth or to non-mobile fragment
What is the finalised treatment for a tooth that has experienced a complicated crown-root fracture?
Incomplete root formation/open apices = partial pulpotomy indicated with non-setting CaOH + restore
Mature teeth/closed apices = RCT + restore with composite/GIC
Restorative options:
- composite restoration
- orthodontic extrusion & restoration
- surgical extrusion & restoration
- root submergence
- extraction
- autotransplantation
What is the follow up schedule for a tooth that has experienced a complicated crown-root fracture?
Clinical and Radiographic =
- 1 week
- 6/8 weeks
- 3 months
- 6 months
- 1 year
- annually for 5 years
What are the clinical findings of a root fracture?
Fracture of root involving dentine, cementum and pulp:
- coronal segment may or may not be mobile/displaced
- potential TTP
- potential bleeding from gingival sulcus
- initial negative pulp sensibility results
What investigations should be done for a suspected root fracture?
- PA / occlusal radiographs + parallax
- CBCT if required
What is the treatment for a tooth that has experienced root fracture?
If displaced =
- coronal fragment repositioned & checked radiographically
- stabilise mobile coronal segment with passive/flexible splint 4 weeks
- if fracture is located cervically splint may be required for up to 4 months
- monitor pulp status
- if pulp becomes necrotic perform RCT of coronal segment
In mature teeth where cervucal fracture line is located above the alveolar crest + coronal fragment is very mobile =
- remove coronal fragment, RCT tooth and restore with a post-retained restoration
What is the follow-up schedule of a tooth that has experienced a root fracture ? [mid-third or apical fracture]
Clinical and Radiographic Evaluations:
- 4 weeks [splint removal]
- 6/8 weeks
- 6 months
- 1 year
- annually for 5 years
What is the follow-up schedule of a tooth that has experienced a root fracture ? [cervical third fracture]
Clinical and Radiographic Evaluations:
- 6/8 weeks
- 4 months [splint removal]
- 6 months
- 1 year
- annually for 5 years
What would be considered unfavourable outcomes for a tooth that has experienced root fracture?
- symptomatic
- extrusion and/or excessive mobility of coronal segment
- radiolucency at fracture line
- pulp necrosis and infection
What are the clinical findings of an alveolar fracture?
- segment mobility & displacement with several teeth moving
- occlusal disturbances and misalignment
- no response of teeth to pulp sensibility testing at area of fracture
What is the treatment for an alveolar fracture?
- reposition displaced segment
- stabilise segment by splinting teeth with a passive + flexible splint for 4 weeks
- suture any gingival lacerations
- monitor pulp condition of all teeth involved to determine if RCT is necessary
What is the follow up schedule after an alveolar fracture?
- 4 weeks [splint removal]
- 6/8 weeks
- 4 months
- 6 months
- 1 year
- yearly for 5 years
What would be considered unfavourable outcomes after an alveolar fracture?
- symptomatic
- pulp necrosis and infection
- apical periodontitis
- inadequate soft tissue healing
- non-healing of bone fracture
- external inflammatory resorption
What are the clinical findings after a concussion injury?
- normal mobility
- tooth is TTP
- tooth responds to pulp sensibility testing
What investigations should you do on a tooth that has experienced concussion?
PA radiograph [no abnormalities should be seen]
What treatment is required for a tooth that has experienced concussion?
No Tx
- monitor pulp condition for 1 year at least
What is the follow up schedule for a tooth that experienced concussion?
Clinical and Radiographic Evaluation:
- 4 wks
- 1 year
What would be considered unfavourable outcomes after a concussion injury?
- symptomatic
- necrosis and infection
- apical periodontitis
- no further root development in immature teeth
What is a subluxation injury?
Injury to the tooth supporting structures with abnormal loosening, but without displacement of tooth
What are the clinical findings of a subluxation injury?
- TTP
- increased mobility but NOT displaced
- bleeding from gingival crevice may be seen
- tooth may/may not respond to pulp sensibility testing
What investigations are done on teeth that have experienced subluxation?
PA/occlusal radiograph + another view for parallax (radiograph should appear normal)
What is the treatment required after a subluxation injury?
No Tx needed
If excessive mobility = passive + flexible splint for 2 weeks
What is the follow up regime for a tooth that has experienced subluxation?
Clinical and radiographic evaluations:
- 2 weeks [only if splint placed, this is for removal]
- 12 weeks
- 6 months
- 1 year
What would be considered unfavourable outcomes after subluxation of a tooth?
- symptomatic
- pulp necrosis and infection
- apical periodontitis
- no further root development in immature teeth
- external inflammatory resorption
What should be done if external inflammatory (infection-related) root resorption occurs after a subluxation injury ?
RCT initiated immediately
- use CaOH as intracanal medicament
- or Ledermix followed by CaOH
What is extrusion of a tooth?
Displacement of the tooth out of its socket in an incisal/axial direction
What are the clinical findings of an extrusion injury?
- tooth appears elongated
- tooth has increased mobility
- likely no response to pulp sensibility testing
What investigations should be done to a tooth that has experienced extrusion? What will be seen radiographically?
PA/Occlusal radiograph + another view for parallax
- increased PDL space
- tooth not seated in socket
What is the treatment for extrusion of a tooth?
- reposition tooth by gently pushing it back into the socket
- stabilise tooth using a passive + flexible splint [2 weeks]
- monitor pulp condition
- if pulp becomes necrotic then perform RCT based on appropriate stage of root development
What is the follow-up schedule for a tooth that has experienced extrusion?
Clinical and Radiographic evaluations:
- 2 weeks [splint removal]
- 4 weeks
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for 5 years
What would be considered favourable outcomes after extrusion of a tooth?
- asymptomatic
- signs of normal/healed PDL
- no marginal bone loss
- continued root development in immature teeth
What would be considered unfavourable outcomes after extrusion of a tooth?
- symptomatic
- pulp necrosis and infection
- apical periodontitis
- breakdown of marginal bone
- external inflammatory (infection-related) root resorption
What is lateral luxation?
Displacement of the tooth in any lateral direction
What are the clinical findings of a lateral luxation injury?
- tooth displaced in a lateral direction [lingual/palatal/labial]
- usually associated fracture of alveolar bone
- tooth frequently immobile
- percussion high metallic sound
- likely no response to pulp sensibility testing
What investigations should be done for a tooth that has experienced lateral luxation? What is seen radiographically?
PA/occlusal radiograph + another view for parallax
[widened PDL space]
How should a lateral luxation injury be treated?
- Reposition tooth under LA
- Stabilise tooth for 4 weeks using passive + flexible splint
- monitor pulp condition & make endodontic evaluation at around 2 weeks
INCOMPLETE ROOT FORMATION:
- spontaneous revascularisation may occur
- if root becomes necrotic RCT
COMPLETE ROOT FORMATION
- pulp will likely become necrotic
- RCT should be started using CaOH or Ledermix as an intracanal medicament
What is the follow up schedule for a tooth that has experienced lateral luxation?
Clinical and Radiographic Evaluation:
- 2 weeks
- 4 weeks [splint removal]
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for 5 years
What would be considered favourable outcomes after lateral luxation?
- asymptomatic
- healed PDL
- positive response to pulp sensibility testing
- marginal bone height corresponds repositioned tooth
- continued root development in immature teeth
What would be considered unfavourable outcomes of lateral luxation?
- symptomatic
- breakdown of marginal bone
- pulp necrosis & infection
- apical periodontitis
- ankylosis
- external replacement resorption
- external inflammatory resorption
What is intrusive luxation?
Displacement of tooth in an apical direction into the alveolar bone
What are the clinical findings of an instrusion injury?
- tooth displaced axially into alveolar bone
- immobile
- high metallic percussion sound
- likely no response to pulp sensibility tests
What investigations should be done for a tooth that has experienced luxation? What would be seen radiographically?
PA/occlusal radiograph + another view to use parallax technique
[PDL space may not be visible and CEJ is located more apically]
What is the treatment for an immature tooth that has experienced intrusion?
- allow re-eruption without intervention [spontaneous repositioning]
- if no eruption within 4 weeks initiate orthodontic repositioning
- monitor pulp condition
- if required perform RCT
What is the treatment for a mature tooth that has experienced intrusion?
- if less than 3mm intrusion, allow spontaneous repositioning
- if no re-eruption within 8 weeks resposition surgically & splint for 4 weeks with passive + flexible splint
- if tooth intruded 3-7mm, reposition surgically or orthodontically
- RCT started at 2 weeks
What is the follow up regime after a lateral luxation injury?
Clinical and Radiograph Evaluation:
- 2 weeks
- 4 weeks [splint removal]
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- annually for 5 years
What would be considered favourable outcomes after a lateral luxation injury?
- asymptomatic
- tooth in place or is re-erupting
- intact lamina dura
- positive response to pulp sensibility testing
- no root resorption
- continued root development in immature teeth
What would be considered unfavourable outcomes after a lateral luxation injury?
- symptomatic
- tooth locked in place/ankylotic tone to percussion
- pulp necrosis and infection
- apical periodontitis
- ankylosis
- external replacement resorption
- external inflammatory resorption
A pt phones and states that their child has knocked their tooth out playing sports, what advice do you give over the phone?
- keep pt calm and reassure
- find tooth and pick up by crown/white part (NOT ROOT)
- if tooth is dirty rinse gently in milk, saline or pts saliva
- replant tooth as soon as possible if possible
- once replanted pt should bite on gauze/tissue to hold in place
- if replantation not possible place tooth in storage medium (milk>HBSS>saliva)
- see dentine ASAP
Why is EADT important to know in avulsed teeth?
If <15 mins the PDL cells are most likely viable
If <60 mins the PDL cells may be viable but compromised
If >60 mins the PDL cells are likely non-vital
What is the treatment for an avulsed permanent tooth (with a CLOSED apex) that has been replanted at site of injury?
- Clean injured area (water/saline/chlorhexidine)
- Verify correct position of replanted tooth (clinically and radiographically) move tooth if necessary
- Stabilise the tooth for 2 weeks with a passive flexible splint (diameter 0.4mm)
- suture gingival lacerations if present
- initial RCT within 2 weeks
- administer systemic antibiotics & assess tetanus status
What is the treatment for an avulsed permanent tooth (with a CLOSED apex) that has an extra oral dry time of <60 mins?
- Remove visible contamination (saline)
- Take history & examine pt clinically/radiographically
- Irrigate socket & examine, reposition any socket fractures
- Replant tooth slowly (avoid excessive pressure)
- Verify correct position clinically/radiographically
- Stabilise with 0.4mm passive flexible splint for 2 weeks (associated alveolar fracture requires 4 weeks)
- Suture gingival lacerations if present
- Initiate RCT within 2 weeks
- Administer systemic antibiotics & check tetanus status
What is the treatment for an avulsed permanent tooth (with a CLOSED apex) that has an extra oral dry time of >60 mins?
- Remove visible contamination (saline)
- Take history & examine pt clinically/radiographically
- Irrigate socket & examine, reposition any socket fractures
- Replant tooth slowly (avoid excessive pressure)
- Verify correct position clinically/radiographically
- Stabilise with 0.4mm passive flexible splint for 2 weeks (associated alveolar fracture requires 4 weeks)
- Suture gingival lacerations if present
- Initiate RCT within 2 weeks
- Administer systemic antibiotics/check tetanus status
What is the treatment for an avulsed permanent tooth (with an OPEN apex) that has been replanted at site of injury?
- Clean area (saline/chlorhexidine)
- Verify correct position of tooth (clinically/radiographically)
- Leave tooth in place (move to correct position if necessary)
- Stabilise for 2 weeks using passive flexible splint 0.4mm wire
- Suture gingival lacerations if necessary
- Monitor pulp, if signs of pulp necrosis within 2 weeks initiate endodontic tx
- administer systemic antibiotics & check tetanus status
What is the treatment for an avulsed permanent tooth (with a CLOSED apex) that has an extra-alveolar dry time of <60mins?
- Remove visible contamination (saline)
- Take history & examine pt clinically/radiographically
- Irrigate socket & examine, reposition any socket fractures
- Replant tooth slowly (avoid excessive pressure)
- Verify correct position clinically/radiographically
- Stabilise with 0.4mm passive flexible splint for 2 weeks (associated alveolar fracture requires 4 weeks)
- Suture gingival lacerations if present
- Monitor pulp, begin endo treatment if pulp necrosis becomes apparent
- Administer systemic antibiotics/check tetanus status
