Management of dentine and enamel fractures Flashcards
Enamel infraction what is it
Incomplete fracture of enamel without loss of tooth structure
Treatment of enamel infraction?
Monitor
Occasionally etch and seal if sensitive
What is an enamel fracture
Minimal fracture
Loss of tooth substance confined to enamel
Treatment of enamel fracture
Leave (smooth if necessary)
Composite restoration
Splint if any mobility
Periodic review
Radiographic
Sensibility
Treatment of primary teeth enamel fractures?
Monitor
Usually sufficient to smooth if possible to prevent soft tissue
damage
What is enamel dentine fracture uncomplicated?
Loss of tooth substance confined to enamel and dentine
and not involving the pulp
Treatment of enamel dentine fractures uncomplicated?
Loss of tooth substance confined to enamel and dentine
and not involving the pulp
Emergency treatment of enamel dentine fractures uncomplicated? option1
Dress exposed dentine with glass ionomer
Composite bandage / composite crown build up
Emergency treatment of enamel dentine fractures option 2? uncomp
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
Technique of reattachment of fragments? first …. uncomp
Check vitality of tooth
Check fit of fragment
Keep fragment hydrated
step by step technique of enamel dentine fractures? uncomp
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
Once the fragment is rebonded? uncomp
Place composite –remove excess
Finish
Follow up once the fragment is rebonded? for uncomp
Monitor vitality
Monitor colour changes
Consequence after rebond for uncpmplicated fracture?
Space loss
Treatment of primary teeth enamel dentine fractures
Glass ionomer dressing to protect dentine and decrease
sensitivity if sufficient cooperation
Smooth if possible to prevent soft tissue trauma
Complicated fractures- whats the idea?
the pulp is involved !
what factors to consider with enamel dentine and pulp fractures? complicated f
*Time from pulp exposure
*Size of pulp exposure
*Stage of root development
*Age of child –cooperation
What are your options for enamel dentine and pulp fracture treatment? complicated f
*Pulp cap
*Pulpotomy
*Pulpectomy
When to pulp cap? (presentation?) complicated fractures
Short time, pin point exposure, poor co
- operation
Prognosis better if seen < 24 hrs
Treatment - pulp cap (comp)
Layer of Ca OH2 placed directly over
exposed pulp
Bandage of GI or composite
Aim of pulp capping- comp fractures
Preserve vital pulp, bridge of reparative
dentine
Monitering vitality/ radiographs? post pupl capping treatment -complicated f
Exclude resorption /necrosis
When to pulpotomy for complicated fractures? (presentation)
Incomplete apex / complete apex
Small exposure
Vital pulp, not infected
Patient co-operative
Treatment pulpotomy for complicated fractures is done when
asap
Aim of pulpotomy for complicated fractures?
Allow continued root growth –apexogenesis
Avoid need for open apex RCT –apexification
Success rate of pulpotomy for complicated fractures
80-96 percent
96 percent (Cvek 1978)
Clinical procedure of vital pulpotomy - Cvek - complicated fractures
Local anaesthetic
Isolation
Remove non vital tissue (2-3mm)
Non setting Calcium Hydroxide
No pressure
Glass ionomer dressing
Other materials used –MTA or biodentine
Follow up for pulpotomy
Review
Radiographs at 1 month, then 3-6 month
Check hard tissue barrier formation
Check continued root growth
When to pulpectomy for complicated fractures> - presentation
Gross exposure / extrusion of pulp
Complex crown / root fracture
Necrotic pulp in open apex
What is treatment ie. pulpectomy for complicated fractures ?
Closed apex –standard RCT
Open apex –apexification
Aim for pulpectomy after complicated fracture
Maintain tooth
Weak tooth as no further development
Note … for pulpectomy - after complicated fracture
Endodontic management of immature
non vital tooth covered in a later
lecture
Treatment of primary teeth for enamel/ dentine fracture with pulp exposure
Generally extraction due to limited cooperation for
pulp treatment
Classification of root fractures?
Dentine, cementum and pulp
-Apical
- Middle
- Coronal third
Displaced
Undisplaced
Treatment of root fractures?
Immediate repositioning
Splint 4 weeks or until stable
Soft diet and Chlorhexidine mouthwash
Review vitality of coronal fragment
Treat complications
Diagnosis for root fractures
May require 2 views radiographically to position + displacement
Treatment of root fractures at coronal 1/3 of root?
Poorer prognosis
May require extraction of tooth
May require extraction of coronal fragment + extrusion of root
May require endodontic treatment to fracture line
Repositioning after root fracture?
Reposition as early as possible
May require local anaesthetic
Digital manipulation
Forceps
Orthodontics
Aim for splinting after root fracture?
to immobilise tooth in correct anatomical position
preventing further trauma and allowing healing
The type of splint depends on? (root fracture)
- Injury
- Age of child / teeth present
- Facilities
What is a functional splint (root fracture)
one that includes tooth either side of the traumatised tooth
For a root fracture what splint treatment
4 weeks of functional splint
Previously recommended rigid fixation (2 teeth either side
of traumatised tooth)
Assessing the position of the root fracture for treatment
If coronal fragment is stable then it can be monitored
If coronal fragment is displaced / mobile then
extraction may be required
Displacement injuries
Luxation (see other lecture)
Realistically the prognosis for traumatised teeth depends on accurate diagnosis and appropriate immediate management
