Management of fractures (permanent teeth) Flashcards
What are the clinical signs of an enamel-dentine fracture?
Fracture confined to enamel and dentine with loss of tooth structure but not involving the pulp.
Sennsibility tests normally positive but may be negative indicating transient pulpal damage (which indicates an increased risk of later pulp necrosis)
How should an enamel fracture be managed?
If fragment availible, can be bonded to the tooth
Smooth sharp edges if necessary
Rule out luxation injuries and root fractures radiographically
Restore with CR
How should an enamel-dentine fracture be managed?
If fragment availible, can be bonded to the tooth.
Disinfect area with water spray, saline or CHX.
As emergency treatment, GIC can be applied as temporary coverage.
REstore with CR.
What are the clinical presentations of an enamel-dentin-pulp fracture?
Exposed pulp tissue on visible examination.
No ttp, normal mobility, sensibility tests normally positive. A negative test at the initial examination indicates an inccreased risk of future pulp necrosis.
How should an enamel-dentin-pulp fracture be managed?
Pulp capping with MTA or CaOH
Partial pulpotomy (recommended):
LA, RD, clean area with water spray, disinfect with Miltons, pulpotomy to depth of 2mm with roudn diamond bur and water spray, saline cotton pellet agaisnt pulup wound until bleeding has ceased, apply pulpotomy material, seal exposed dentine with GIC orr CR and restore with CR.
Follow up 2months and 1 year.
What are the clinical signs of a crown-root fracture without pulpal involvement?
Crown fracture extending below gingival margins.
Tender to percussion an coronal fragment mobile.
Sensibility test normally positive for apical segment.
How should a crown-root fracture withoout pulpal involvement be managed using fragement removal?
Fragment removal:
Fragment removal with forceps
Clean area with water spray
Suture gingival lacerations if present
Allow gingiva to reattach to exposed dentine
Apply GIC to exposed dentine abovve gingival level same day or after a couple of days
Restore with CR
What are the six treatment scenarios that can be considered in the event of a crown-root fracture without pulpal involvement?
1) Fragment removal only
2) Fragment removal and gingivectomy
3) Orthodontic extrusion of the apical fragment (for post retained crown following RCT of the apical segment)
4) Surgical extrusion
5) Decoronation (root submergence) - for later implant
6) Extraction
What are the clinical signs of a crown-root fracture with pulpal involvement?
Crown fracture extending below the gingival margin
Ttp with coronal fragment mobile.
Sensibility tests normally positive for coronal fragment
How should a crown-root fracture with pulpal involvement be managed?
Initially can temporarily bond the coronal portion to cervical portion of tooth with composite. Final treatment as follows:
1) Fragment removal, gingivectomy and pulpotomy
2) Orthodontic extrusion of apical fragment
3) Surgical extrusion of apical fragment
4) Decoronation - can be used when root ccannnot support a post-retained crown
5) Extraction
What are the clinical presentations of a root fracture?
A fracture to the root involving cementum, dentine and pulp.
Coronal segment may be mobile and sometimes displaced. Transient crown discolouration may occur. Bleeding from gingival sulcus may be noted.
Tooth may be TTP.
Sensibility testing may result negative initially, inndicating transient orr permanent neural damage.
Radiographically, the root fracture line is usually visible and normally in a horizontal or diagonal plane.
How should a root fracture be managed?
Rinse the exposed tooth surface with saline before repositioning. If displaced, reposition coronal segment asap.
Verify correct position clincally and radiographically.
Stabilise tooth with flexible splint for 4 weeks. If root fracture near the cervical area can increase the length of splinting (up to 4 months)
Monitor healing for at least one year. If pulpal necrosis develops then RCT to the fracture line is indicated.
What are the clincial signs of an alveolar fracture?
Several teeth typically move as a unit when mobility checked. Occclusal interference normally present.
Normally TTP. Sensibility tests normally negative.
Radiogaphically, vertical line of fracture may run along PDL or septum.
How should an alveolar fracture be managed?
LA
Manual repositioning using finger pressure labially and lingually
Clean area with H20 spray, saline, or CHX
Suture gingival lacerations if present.
Apply splint for stabilisation of segment for 4 weeks.
Monitor at 1 mmonth, 2 months, 4 months, 6 months, 1 year and yearly for 5 years.
