long term follow up Flashcards
what are the complications of trauma to primary teeth (x4)
- pulpal necrosis
- pulpal obliteration
- root resorption
- damage to successors
what do you look for in pulpal necrosis? (x4)
- persistent grey colour to tooth that does not fade
- no reduction in size of pulp cavity
- radiographic signs of periapical inflammation
- clinical signs of infection
what are the clinical signs of infection? x4
- tenderness
- sinus
- swelling
- suppuration
action to be taken in the case of pulpal necrosis
extraction of tooth
clinical appearance of pulpal obliteration
tooth may become a yellow/opaque colour
radiographical appearance of pulpal obliteration
pulp chamber will shrink
action to be taken in the case of pulpal obliteration
nothing if asymptomatic; if there are radiographic signs &/or clinical signs of infection –> extraction
what to look out for root resorption
radiographic signs of root resorption; possible clinical mobility
action to be taken in the case of root resorption
extract if there are signs of infection
what damages could trauma cause to the successor teeth? x2
- crown damage
- root damage
what damages could trauma cause to the root of the successor teeth? x3
- root duplication
- root dilaceration
- arrest of root formation
why does an injury sustained before 3 y/o cause the most damage?
tooth germ is still in a developmental stage
which type of injury carry the most risk to successor teeth?
intrusive luxation
what does root dilaceration refer to?
the deviation of root shape from the normal long axis formation
what do you look for if suspecting root dilaceration?
delayed eruption / failure of eruption of successors
radiographic signs of root dilaceratioin
root malformation / changes in angulation
how do you treat a case of root dilaceration?
depends on the severity of dilaceration; may involve orthodontics and oral surgery input
complications of trauma to permanent teeth x6
- loss of vitality (pulp necrosis)
- resorption
- ankylosis
- external / internal resorption
- discolouration
signs of pulpal necrosis x5
- no response to sensibility testing (beware false neg)
- greyish discolouration
- pt symptoms + history
- radiographical/clinical signs of periradicular inflammation
- no further radiographic evidence of root development in an immature teeth
which is the gold standard material for apexification?
MTA
what is pulp canal obliteration?
progressive hard tissue formation within the pulp cavity, resulting in gradual narrowing of the pulp chamber and root canal and partial or total obliteration
how does the pulp canal become obliterated?
when hard tissue formation (reactionary dentine) occurs in the root canal and pulp chamber, causing the pulp space to narrow
what are the 2 types of root resorption?
inflammatory and replacement
what are the 2 types of inflammatory root resorption?
- external inflammatory root resorption
- internal inflammatory root resorption
which type of teeth are associated with external inflammatory root resorption?
teeth with necrotic pulps and associated infection
what is external inflammatory root resorption initiated by?
periodontal ligament damage
what is external inflammatory root resorption propagated by?
propagated by infected necrotic pulpal products diffusing down the dentinal tubules into the PDL
what is external inflammatory root resorption initiated by and propagated by?
initiated by periodontal ligament damage and propagated by infected necrotic pulpal products diffusing down the dentinal tubules into the PDL
radiographical diagnosis of external inflammatory root resorption
change in external contour of root which is often surrounded by a bony lucency
clinical diagnosis of external inflammatory root resorption
if excessive resorption, tooth may have mobility
how is external inflammatory root resorption differentiated from internal inflammatory root resorption radiographically?
asymmetrical shape; superimposed contour of the intact root canal walls, and the fact that it moves in relation to the root canal on periapical films of different horizontal angle
treatment of external inflammatory root resorption
If restorable, commence RCT and monitor - pulp extirpation, debridement and filling with non-setting calcium hydroxide until infection is controlled, then permanent root filling
what type of resorption is cervical resorption?
external inflammatory root resorption
what is cervical resorption initiated by?
damage to root surface in the cervical region
what is cervical resorption propagated by?
either infected root canal contents or periodontal microflora
how is cervical resorption diagnosed?
radiographically - characteristically site radiolucency (as resorption commences from a small entry point below the gingival crevice and often spreads widely within the crown before the root canal is invaded)
tx of cervical resorption
for necrotic pulp/non-vital tooth: start RCT; for both necrotic and vital teeth, treatment may involve curettage of apical region and resorption defect
what is internal inflammatory root resorption caused by?
chronic pulpal inflammation
radiographical appearance of internal inflammatory root resorption
presents as a round, symmetrical radiolucency which is usually centred on the canal
how does replacement resorption differ from inflammatory resorption?
in replacement resorption, there is no new infection and no inflammatIon
what happens in replacement resorption
ankylosis
when does replacement resorption usually occur?
after large luxation or avulsion injuries (usually if an avulsed tooth is replanted too late, or an intruded tooth where the PDL of both socket and root surface is crushed)
what is pulpal vitality determined by?
the presence of blood supply (not intact nerve supply)
what are the 9 tests commonly used to test for tooth vitality?
- colour
- EPT
- thermal test
- transillumination
- TTP
- mobility
- sinus/alveolar tenderness
- history
- radiographic examination
