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Paeds > Management of dentine and enamel fractures > Flashcards

Management of dentine and enamel fractures Flashcards

1
Q

Enamel infraction what is it

A

Incomplete fracture of enamel without loss of tooth structure

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2
Q

Treatment of enamel infraction?

A

 Monitor
 Occasionally etch and seal if sensitive

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3
Q

What is an enamel fracture

A

 Minimal fracture
 Loss of tooth substance confined to enamel

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4
Q

Treatment of enamel fracture

A

 Leave (smooth if necessary)
 Composite restoration
 Splint if any mobility
 Periodic review
 Radiographic
 Sensibility

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5
Q

Treatment of primary teeth enamel fractures?

A

 Monitor
 Usually sufficient to smooth if possible to prevent soft tissue
damage

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6
Q

What is enamel dentine fracture uncomplicated?

A

Loss of tooth substance confined to enamel and dentine
and not involving the pulp

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7
Q

Treatment of enamel dentine fractures uncomplicated?

A

Loss of tooth substance confined to enamel and dentine
and not involving the pulp

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8
Q

Emergency treatment of enamel dentine fractures uncomplicated? option1

A

 Dress exposed dentine with glass ionomer
 Composite bandage / composite crown build up

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9
Q

Emergency treatment of enamel dentine fractures option 2? uncomp

A

Reattachment of fragment
 Immediately reattach fragment if possible
 If fracture close to pulp –indirect pulp cap
 Dress exposed dentine with glass ionomer
 Thin lining / cement over dentine, aim to maintain vitality
 Delay placement of fragment and store in milk / saline

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10
Q

Technique of reattachment of fragments? first …. uncomp

A

Check vitality of tooth
 Check fit of fragment
 Keep fragment hydrated

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11
Q

step by step technique of enamel dentine fractures? uncomp

A

Isolate tooth - rubber dam
Attach fragment to gutta percha for handling
Etch enamel on both fracture sites & 2mm margins
Wash, dry, apply primer
Bonding agent
Note - Do NOT dessicate fragments

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12
Q

Once the fragment is rebonded? uncomp

A

 Place composite –remove excess
 Finish

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13
Q

Follow up once the fragment is rebonded? for uncomp

A

Monitor vitality
 Monitor colour changes

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14
Q

Consequence after rebond for uncpmplicated fracture?

A

Space loss

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15
Q

Treatment of primary teeth enamel dentine fractures

A

 Glass ionomer dressing to protect dentine and decrease
sensitivity if sufficient cooperation
 Smooth if possible to prevent soft tissue trauma

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16
Q

Complicated fractures- whats the idea?

A

the pulp is involved !

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17
Q

what factors to consider with enamel dentine and pulp fractures? complicated f

A

*Time from pulp exposure
*Size of pulp exposure
*Stage of root development
*Age of child –cooperation

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18
Q

What are your options for enamel dentine and pulp fracture treatment? complicated f

A

*Pulp cap
*Pulpotomy
*Pulpectomy

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19
Q

When to pulp cap? (presentation?) complicated fractures

A

Short time, pin point exposure, poor co
- operation
Prognosis better if seen < 24 hrs

20
Q

Treatment - pulp cap (comp)

A

Layer of Ca OH2 placed directly over
exposed pulp
Bandage of GI or composite

21
Q

Aim of pulp capping- comp fractures

A

Preserve vital pulp, bridge of reparative
dentine

22
Q

Monitering vitality/ radiographs? post pupl capping treatment -complicated f

A

Exclude resorption /necrosis

23
Q

When to pulpotomy for complicated fractures? (presentation)

A

Incomplete apex / complete apex
Small exposure
Vital pulp, not infected
Patient co-operative

24
Q

Treatment pulpotomy for complicated fractures is done when

A

asap

25
Q

Aim of pulpotomy for complicated fractures?

A

Allow continued root growth –apexogenesis
Avoid need for open apex RCT –apexification

26
Q

Success rate of pulpotomy for complicated fractures

A

80-96 percent
96 percent (Cvek 1978)

27
Q

Clinical procedure of vital pulpotomy - Cvek - complicated fractures

A

Local anaesthetic
Isolation
Remove non vital tissue (2-3mm)
Non setting Calcium Hydroxide
No pressure
Glass ionomer dressing
Other materials used –MTA or biodentine

28
Q

Follow up for pulpotomy

A

Review
 Radiographs at 1 month, then 3-6 month
 Check hard tissue barrier formation
 Check continued root growth

29
Q

When to pulpectomy for complicated fractures> - presentation

A

Gross exposure / extrusion of pulp
Complex crown / root fracture
Necrotic pulp in open apex

30
Q

What is treatment ie. pulpectomy for complicated fractures ?

A

Closed apex –standard RCT
Open apex –apexification

31
Q

Aim for pulpectomy after complicated fracture

A

Maintain tooth
Weak tooth as no further development

32
Q

Note … for pulpectomy - after complicated fracture

A

Endodontic management of immature
non vital tooth covered in a later
lecture

33
Q

Treatment of primary teeth for enamel/ dentine fracture with pulp exposure

A

Generally extraction due to limited cooperation for
pulp treatment

34
Q

Classification of root fractures?

A

 Dentine, cementum and pulp
-Apical
- Middle
- Coronal third
 Displaced
 Undisplaced

35
Q

Treatment of root fractures?

A

 Immediate repositioning
 Splint 4 weeks or until stable
 Soft diet and Chlorhexidine mouthwash
 Review vitality of coronal fragment
 Treat complications

36
Q

Diagnosis for root fractures

A

May require 2 views radiographically to position + displacement

37
Q

Treatment of root fractures at coronal 1/3 of root?

A

 Poorer prognosis
 May require extraction of tooth
 May require extraction of coronal fragment + extrusion of root
 May require endodontic treatment to fracture line

38
Q

Repositioning after root fracture?

A

Reposition as early as possible
 May require local anaesthetic
 Digital manipulation
 Forceps
 Orthodontics

39
Q

Aim for splinting after root fracture?

A

to immobilise tooth in correct anatomical position
preventing further trauma and allowing healing

40
Q

The type of splint depends on? (root fracture)

A
  • Injury
  • Age of child / teeth present
  • Facilities
41
Q

What is a functional splint (root fracture)

A

 one that includes tooth either side of the traumatised tooth

42
Q

For a root fracture what splint treatment

A

 4 weeks of functional splint
 Previously recommended rigid fixation (2 teeth either side
of traumatised tooth)

43
Q

Assessing the position of the root fracture for treatment

A

 If coronal fragment is stable then it can be monitored
 If coronal fragment is displaced / mobile then
extraction may be required

44
Q

Displacement injuries

A

Luxation (see other lecture)

45
Q

Realistically the prognosis for traumatised teeth depends on accurate diagnosis and appropriate immediate management

A

Paeds (11 decks)

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