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D3 Endo > Luxation > Flashcards

Luxation Flashcards

1
Q

what are the different types of luxation injuries?

A
  • concussion
  • subluxation
  • lateral luxation
  • intrustion
  • extrustion
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2
Q

luxation: etiology and incidence

A
  • permantent dentition: ages 9-10
  • boys 3X more than girls
  • most common for central incisors
  • malocclusions perdispose teeth to more dental injuries, (severe over jet and open bite)
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3
Q

what are the three questions you should ask yourself with each injury?

A
  • Was the tooth displaced?
  • what happened to the neurovascular bundle?
  • what happened to PDL and cementum?
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4
Q

if the tooth is diplaced, what is the likely treatment?

A

usually splint the teeth (flexible splint)

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5
Q

if the neurovascular bundle is torn….

A

-it will probably become necrotic, thus will need NSRCT

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6
Q

if the PDL and cementum are torn…

A

the tooth will be predisposed to complication of resorption

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7
Q

what is Concussion?

A
  • PDL injury only
  • hemorrhage and edema in PDL
  • pain to percussion is only present feature
  • normal radiograph
  • no mobility and no bleeding from sulcus
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8
Q
  • PDL injury only
  • hemorrhage and edema in PDL
  • pain to percussion is only present feature
  • normal radiograph
  • no mobility and no bleeding from sulcus
A

concussion

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9
Q
  • No tooth displacement
  • PDL: damage with loosening and/or bleeding from sulcus
  • Pulp: minor rupture of neurovascular supply to the tooth
A

subluxation

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10
Q

subluxation

A
  • No tooth displacement
  • PDL: damage with loosening and/or bleeding from sulcus
  • Pulp: minor rupture of neurovascular supply to the tooth
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11
Q

if patient has concussion/subluxation how do you assess and treat?

A
  • Assessment: always canine to canine (periapicals, occlusal, “endo testing”)
  • treatment: reassurance, prevention (ortho for malocc, or mouthguard), soft diet for two weeks
  • complications are rare
  • recall: 4, 6-8 weeks, and one year
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12
Q

root resorption

A
  • surface heals with “wavey” lamina dura
  • dentin and cementum replaced with bone
  • cannot be reversed
  • often results in ankylosis
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13
Q

what is ankylosis?

A

root dentin and cementum replaced with bone

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14
Q

immediately after luxation, what % of teeth respond to EPT?

A

more than 50% of teeth do NOT respond, cold testing more reliable

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15
Q

when is EPT unreliable?

A
  • in children
  • erupting permanent teeth
  • teeth with open apicies
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16
Q

if there are discrepancies in cold and EPT testing….

A

pulps of traumatized teeth should be considered vital for up to a year if there are no RLs on PA, no sinus tracts, no discoloration and tooth remains asymptomatic

17
Q
  • Tooth is displaced laterally (usually with crown to lingual)
  • Apex may protrude through buccal cortical plate and be “locked in”
  • PDL&Cementum: injured
  • Bone: fractured
  • Pulp: neurovascular bundle often torn
A

lateral luxation

18
Q
  • Forces displace tooth out of socket (extruded)
  • Only gingival fibers prevent tooth from avulsion
  • PDL fibers and cementum torn
  • Neurovascular bundle stretched or severed
A

extrusive luxation

19
Q
  • Tooth appears pushed into socket; clinical crown appears shortened visually and on x-ray
  • May be locked into bone
A

intrusive luxation

20
Q

intrusive luxation

A
  • Extensive damage to bone and socket
  • PDL and cementum remain intact
  • Neurovascular bundle crushed
  • Repositioning a challenge and will depend upon mm of intrusion
21
Q

luxation general standards of treatment

A

-At least 4 PAs initially
-Sensitivity Testing and PAs at each recall visit
-If need to splint
– 2 weeks to 4 weeks depending upon whether alveolar fracture
– Physiologic splint always
-If require NSRCT place Ca(OH)2 as interim
medicament and leave in 2-4 weeks
-Refer to Endodontists always a good idea

22
Q

splinting, how and how long?

A
  • splint if mobile using at least one tooth mesial and distal to injured tooth
  • usually two weeks
  • if splinted more than two weeks may cause ankylosis
23
Q

if the NV bundle is crushed, severed, or stretched…

A

– Monitor with sensibility test for necrosis
– May need NSRCT
– Do only if tooth repeatedly tests necrotic
– Do ASAP when necrosis occurs

24
Q

**Luxation recall schedule

A
  • 2 wks
  • 4 wks
  • 6-8 wks
  • 6 months
  • 1 year
  • 5 years
  • ADA code 0140 problem focused exam
  • ADA code 0220 for PAs
25
Q

what is the website for trauma?

A

www.dentaltraumaguide.org

26
Q

recall schedule

A

2, 4, 6-8, 6, 1, 5

27
Q

Calcific Metamorphosis

A

-Pulpal inflammation due to trauma that results in laying down of dentin to obliterate the pulp canal space.
– More common with open apex
-Less than 10% of teeth with calcific metamorphosis become necrotic
– Confirm vital with Cold and/or EPT
– Treat only if Pulp Necrosis & Symptomatic
-Prophylactic endodontic treatments not indicated

28
Q

Luxation Standards of Treatment

A

At least 4 PAs initially
 Sensitivity Testing and PAs at each recall visit
 If need to splint
– 2 weeks to 4 weeks depending upon whether alveolar fracture
– Physiologic splint always
 If require NSRCT place Ca(OH)2 as interim
medicament and leave in 2-4 weeks
 Referral to Endodontists always a good idea

29
Q

rules for repositioning an internally luxated tooth

A 
Open apex
-up to 7 mm: spontaneous
-more than 7 mm: ortho and surgical 
Closed apex:
-up to 3 mm: spontaneous
-3-7 mm: ortho and surgical
-more than 7 mm: surgical

D3 Endo (2 decks)

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