Luxation Flashcards
With regards to luxation, what is the most commonly injured tooth and what is the relative frequency for each gender?
Centrals
Boys > girls, 3:1
What are 5 types of luxation injuries?
- Concussion
- Subluxation
- Lateral luxation
- Intrusion
- Extrusion
What can predispose teeth to more dental injuries?
- Malocclusions
- Severe Overjet
- Open Bite
What are 4 things to ask in all luxation injuries?
- Was the tooth displaced?
- What happened to Neurovascular bundle?
- What happened to PDL and cementum?
- Is apex open or closed?
(5. Do I have access to dental trauma.org?)
For the initial endo therapy thought process, very generally, what is the likely treatment for a displaced tooth?
Flexible splint
If the luxated tooth has a neurovascular bundle torn, what is the likely outcome and treatment for the tooth?
Likely will devitalize and require NSRCT
If the luxated tooth had a PDL and cementum are
torn in the luxation, what is the complication the tooth is predisposed to?
Predisposed to complication of root resorption
What is indicated to avoid the root resporption risk associated with PDL and cementum damage in a luxation injury?
Ca(OH)2
In a concussion-type luxation injury, what is the only thing injured on the tooth?
The PDL only is injured
What will occur in the PDL in a concussion luxation?
Hemorrage and edema in the PDL
What is the only presenting feature in a concussion luxation injury?
Pain to percussion
What is the radiographic appearance of a tooth that has had a concussion luxation?
Normal radiograph
Will there be mobility or bleeding from the sulcus in a concussion luxation injury?
No mobility
No bleeding
Will there be tooth displacement in a subluxation luxation injury?
No
What will be the clinical presentation of a subluxation luxation injury?
No tooth displacement, damage with loosening and/or bleeding from sulcus
Will there be pulp damage in a subluxation luxation injury?
Partial rupture of neurovascular bundle supply to the tooth
What baselines should be gathered for both the concussion and subluxation luxation injuries?
Sensitivity tests
What diet is indicated for concussion and subluxation injuries?
Soft diet for weeks
What is a dental treatment that may be indicated for concussion and subluxation luxation injuries?
Adjust occlusion to relieve symptoms
What is indicated at follow up or recall appointments for concussion and subluxation injuries?
PA and vitality tests
Is pulpal devitalization common in concussion and subluxation injuries?
No
Is the likelihood for complications, such as resorption, common in concussion and subluxation luxation injuries?
No
What is a luxation injury where the tooth is displaced laterally?
Lateral luxation
In a lateral luxation, the crown will normally go in which direction: lingual, mesial, distal, labial?
Lingual
In a lateral luxation with the crown displaced lingually, what can happen to the apex?
The apex can displace through cortical plate and be “locked in”
What will occur in the PDL and cementum in alateral luxation?
Both the PDL and cementum are injured
What will occur in the bone in a lateral luxation?
Injury
What is the most common injury to the neurovascularbundle in a lateral luxation injury?
The neurovascular bundle is torn
What is the minimum number of PA’s indicated for a lateral luxation injury?
4
What is a luxation injury where a force displaces the tooth out of the socket?
Extrusive luxation
What is the only thing preventing the tooth from avulsion in an extrusive luxation?
Only gingival fibers
What happens to the PDL fibers and the pulp tissue in extrusive luxation?
Both are stretched and severed
How many PA’s are indicated for extrusive luxation?
4 PA’s
What will a PA show for extrusive luxation?
Extrusion and widening of PDL space
What is an injury where the tooth appears pushed into socket (the clinical crown appears shortened visually and on x-ray)?
Intrusive luxation
Will a tooth with an intrusive luxation injury be mobile?
No. It may be locked into bone.
How many radiographs are indicated for an intrusive luxation?
4 PA’s
Due to extensive damage to the socket, what is the intruded tooth at risk for?
Replacement resorption
What treatment should be expected for an intrusive luxation with a crushed neurovascular bundle?
NSRCT
If the PDL is ripped on intrusive luxation, what should be placed to decrease the likelihood of replacement resorption?
Ca(OH)2
What are 2 ways to reposition an intrusive luxation?
Surgically or orthodontically
What apex has a better survival rate after an intrusive luxation?
Open
What are 4 post-traumatic complications?
- Discoloration
- Pulpal necrosis
- Calcific metamorphosis
- Root resorption
What are 3 types of root resorption?
- Healing with surface resorption (repair related)
- Ankylosis replacement resorption
- Inflammatory (infection related resorption)
What percentage of teeth do not respond to EPT immediately after luxation?
50%
What are 4 instances where EPT is unreliable?
- Children
- Immediately after trauma
- Erupting permanent teeth
- Teeth with open apices
Which vitality test is better to perform in children?
Cold
Will vital teeth with open apices always respond to cold test?
No
Pulps of traumatized teeth should be considered vital for up to how long if there is the absence of what 3 things?
Vital for up to one year if there are NO radiolucencies, NO sinus tracts, NO abscesses
Will a necrotic tooth following luxation be symptomatic?
No. They are normally asymptomatic.
What are 3 indicators of pulp necrosis in an asymptomatic, previously luxated tooth?
- Decreased translucency
- Color change
- Persistent negative vitality test
Where is the color change particularly evident on an asymptomatic necrotic previously luxated tooth?
Particularly lingual surface color change
What causes discoloration in a luxated tooth?
Pulpal hemorrhage, leading to extravasated blood cells that undergo hemolysis releasing the hemosiderin (Iron[FeS])
Discoloration responds well to what?
Internal bleaching
What is the term for extensive formation of tertiary (irregular secondary) dentin in the pulp chamber or on pulp walls. Usually follows an impact injury that DID NOT result in pulp necrosis?
Calcific metomorphosis
Calcific metamorphosis is more common in teeth with what apex: open or closed?
Open
What percentage of teeth that have calcific metamorphosis become necrotic?
Less than 10%
If calcific metamorphosis is noted, should prophylactic endo be completed?
No
Repair-related resorption is synonymous with what type of resorption and is it transient or permanent?
Surface resorption and it is transient
After a luxation injury, what resorption appears as a lacunae of resorption in cementum of replanted teeth?
Surface resorption
Is surface tension usually evident on radiographs?
No
If surface resorption does not continue, the lacunae is repaired how?
Deposition of new cementum
What resorption occurs as a response to the presence of infected necrotic pulp tissue in conjunction with injury to the periodontal ligament?
Inflammatory (infection-related) resorption
What are 2 characteristics of inflammatory (infection-related) resorption?
- Loss of tooth structure
2. Loss of adjacent alveolar bone
When will inflammatory (infection-related) resorption cease?
After removal of necrotic, infected pulp
What is the indicated treatment for reimplanted teeth with closed apices to prevent the occurrence of inflammatory resorption?
Root canal treatment
Resorption in which the tooth structure is resorbed and replaced by bone resulting in ankylosis?
Replacement (Ankylosis-related) resorption
What are the characteristics of ankylosis?
- Lack of physiologic mobility
- Failure of tooth to erupt along with adjacent teeth
- Solid “metallic” sound when percussed
In teeth that have had long extraalveolar dry periods, the resorptive process can be slowed, but not halted by doing what?
Immersing tooth in fluoride before reimplantation
What is the recall schedule for luxation?
2 weeks 4 weeks 6-8 weeks 6 months 1 year 5 years
