Lecture 6 Flashcards
most dental trauma occurs between what age range? where do most injuries occur?
- 7-10 years old
- anterior incisor region
should avulsed primary teeth every be replanted?
no
avulsed permanent teeth require follow-up evaluations for a minimum of ___ years to determine the outcome of therapy. what are some possible complications of replanted avulsed teeth?
- 2-3 years
- periapical abscess, internal root resorption, ankylosis and tooth submergence
if possible, should an avulsed tooth be replanted immediately? what if it is contaminated?
- yes
- if it is contaminated, it should be rinsed with water before replanting
- sometimes immediate replantation is not possible, so the tooth should be placed in the best transport medium possible
what are the best options for transport media for an avulsed tooth?
- hank’s balanced salt solution
- milk
- saline
- saliva (buccal vestibule or have pt spit into a cup)
- if none of these are available, use water
if extraoral dry time is less than ___ with or without storage in a physiological media, it should be replanted immediately
1 hour
how should the root surface of an avulsed tooth (<1 hour) be managed?
- keep tooth moist at all times
- do not handle the root surface - hold the tooth by the crown
- do not scrape or brush the root surface or remove the tip of the root
- if the root appears clean, replant as is after rinsing with saline
- if the root surface is contaminated, rinse with hanks or saline; if debris remains, use cotton or a wet sponge to gently remove whatever debris is left
if extraoral dry time is greater than 1 hour, how should you manage an avulsed tooth?
- soak in accepted dental fluoride solution for 20 minutes
- rinse with saline
- replant
the american academy of pediatric dentists recommends that an avulsed tooth (>1 hour) be placed in what type of solution and for how long before replantation?
1/23% sodium fluoride solution for 5-20 minutes
according to recent research, how can ankylosis of a replanted avulsed tooth (>1 hour) be prevented?
- apply to the root surface a medium that favors the regeneration of injured parts of the PDL
- examples are fluorides, steroids, sodium alendronate, enamel matrix derivatives, and basic fibroblast growth factor
how should the socket of an avulsed tooth be managed?
- gently aspirate without entering the socket (if a clot is present, use light irrigation with saline)
- if the alveolar bone is collapsed and prevents reimplantation, carefully insert a blunt instrument into the socket to reposition the bone to its original position
- after reimplantation, manually compress (if alveolar bone is spread apart) facial and lingual bony plates
what are some things that should be avoided in managing the socket of an avulsed tooth?
- do not curette the socket
- do not vent the socket
- do not make a surgical flap unless bony fragments prevent reimplantation
how should soft tissues be managed in the area of an avulsed tooth?
tightly suture any soft tissue lacerations, particularly in the cervical region
what are some splinting options in the treatment of avulsed teeth?
- use acid etch/resin alone
- use acid etch/resin with a soft arch wire
- use orthodontic brackets with a passive arch wire
- examples: .0195 braided stainless steel bond with composite, .017x.025 stainless steel wire bond with composite, 018 round stainless steel wire bond with composite, or monofilament nylon (20-30lb test) with composite
when constructing a split for the treatment of an avulsed tooth, the splint should not interfere with the patient’s capability to perform ___ and should allow ___; it should be rigid enough to ___, while allowing for ___
- correct hygiene
- physiological movement of the tooth
- hold the teeth in their proper positions
- minor tooth movement to occur during normal function to stimulate normal PDL healing
___ wire splints are contraindicated in the treatment of avulsed teeth
circumferential
a splint should remain in place for how long? what are the exceptions?
- 7-10 days
- the splint should be replaced if the tooth demonstrates excessive mobility (should be within acceptable limits of <1mm)
- bony fractures resulting in mobility usually require longer splinting periods (2-8 weeks)
home care during the splinting period should encompass what 3 things?
- no biting on splinted teeth
- soft diet
- maintenance of good oral hygiene
why should rigid composite splints be avoided when possible?
- difficult to maintain patients oral hygiene
- difficult to remove
- is extremely rigid, and doesn’t allow for minor tooth movement to stimulate normal PDL development
what are the steps for making a splint for an avulsed tooth that has been lingually displaced with a fracture of the alveolar bone?
- bend wire to touch passively on non-involved teeth, while approximating the anterior arc of the wire to position the avulsed teeth in their prior positions
- prepare all teeth for bonding
- bond the wire to the non-involved teeth using composite
- place composite on the labial surface of the involved teeth and press/pull the teeth forward until they are in their proper position and the composite has surrounded the arch wire
- cure composite
- squeeze alveolar bone together bucally and lingually
- place any necessary sutures
splints should extend distally to at least how many non-involved teeth?
2
what are some adjunct drug therapy considerations for the treatment of dental trauma?
- systemic antibiotics
- referral to physician for tetanus consultation within 48 hours
- chlorhexidine rinses
- analgesics
___ is a load applied to an object that will tend to move it to a different position in space
force
___ is a point at which resistance to movement can be concentrated for mathematical analysis
center of resistance
for an object in free space, the center of resistance is the same as the center of ___
mass
if an object is partially restrained as is the case for a tooth embedded in bone, the center of resistance is located where?
approximately halfway (3/5) between the root apex and the crest of the alveolar bone
___ is a measure of the tendency of a force to rotate an object around some point
moment
how is a moment generated?
by a force acting at a distance to the center of resistance
quantitatively, a moment is the product of the ___ times the ___
force times the perpendicular distance from the point of force application to the center of resistance