Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endodontics > Management of the Avulsed Tooth > Flashcards

Management of the Avulsed Tooth Flashcards

1
Q
  • What is the incidence and main etiologic factors of tooth avulsion?
A

Incidence: 0.5% to 16% of traumatic injuries

Main etiologic factors:

  • Fights
  • Sports Injuries
  • Automobile Accidents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common avulsed tooth?

A

Maxillary Central Incisor

  • Most commonly avulsed tooth
  • Mandibular teeth - seldom affected
  • Most frequently involves a single tooth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common age to avulse teeth?

A

Most common age: 7 - 11

  • Permanent Incisors Erupting
  • Lossely Structured PDL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some common associated injuries of avulsed permanent teeth?

A
  • Fracture of alveolar socket wall
  • Injuries to the lips and gingiva
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the ultimate goal of managing an avulsed tooth?

A

Manage the PDL!

  • PDL healing without root resorption
  • MOST CRITICAL FACTOR: Maintaing an intact and viable PDL on the root surface
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What 3 ways can the PDL respond to tooth avulsion?

A
  1. Surface Resorption
  2. Replacement Resorption (Ankylosis)
  3. Inflammatory Resorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What treatment considerations are there when dealing with a hockey player who stopped the final goal by stopping the puck with his teeth and happen to avulse his tooth?

A
  1. Extraoral time
  2. Extraoral environment
  3. Root surface manipulation
  4. Managment of the socket
  5. Stabilization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How time extraoral time affect resoprtion?

A

Shorter time = Better prognosis

< 30 min → 10% resorption

> 90 min → 90% resorption

*depending on storage medium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What liquids yield poor results as storage mediums and which offer good protection for 2 hours?

A

Poor Results…

  1. Tap Water
  2. Dry

Good protection for 2 hours

  1. Saliva
  2. Saline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some characteristics of milk as a storage medium?

A
  • Physiologic osmolality
  • Markedly fewer bacteria than saliva
  • Readily available
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is Milk compare to Saliva as a storage media?

A
  • Storage for 2 hours - Periodontal healing almost as good as immediate replantation
  • Storage for 6 hrs - Saliva → extensive replacement resorption
  • Milk → healing almost as good as immediate replantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some characteristics of Hank’s Balanced Salt Solution?

A
  • Proper pH and osmolaity
  • Reconstitutes depleted cellular metabolites
  • Washes toxic breakdown products from the root surface
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some characteristics of Viaspan (Organ Transplant Storage Media)?

A
  • Dramatically prolongs the storage of human organs
  • Expensive
  • Not readily available
  • Complete healing after 6 and 12 hours
  • Good for extended storage periods (72 and 96 hours)
  • Hank’s balanced solution → healing results similar to Viaspan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are 5 recommended Storage Media?

A
  1. Socket (immediate replantation)
  2. Cell culture medium
  3. Milk
  4. Physiologic saline
  5. Saliva
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What things do you NOT do when trying to retain PDL cell viability?

A
  • Do not curette root surface
  • Avoid caustic chemicals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long is milk, saliva, and tap water acceptable to place a tooth in for extra oral handling?

A
  • Milk - 6 hours
  • Saliva - 2 hours
  • Tap Water - Unacceptable Media
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 3 handling recomendations for a tooth with extra oral dry time < 1 hour?

A

PDL healing is still possible

  1. Keep root moist
  2. Dnot handle root surface
  3. Gentle Debridement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What happens to a tooth with an extra oral dry time of > 1 hour?

A
  • Loss of PDL cell viability
  • Treatment recomendations: → Remove tissue tags, Soak in accepted dental fluoride solution for 20 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is an acceptable topical fluoride solution for an avulsed tooth?

A
  • 1.0 - 2.4% fluoride solution
  • Sodium Fluoride (Andreasen)
  • Stannous Fluoride (Krasner)
  • 20 minute soak
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you manage the socket of an avulsed tooth?

A
  1. Remove contaminated coagulum in socket → Irrigate with sterile saline
  2. Examine socket → IF FRACTURE IS EVIDENT → Reposition fractured bone with a blunt instrument
  3. Replant the tooth using digital pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define Splint…

A

A RIGID or FLEXIBLE device used to support, protect, or immoblize teeth, preventing further injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 2 types of splints?

A
  1. Acid Etch Composite
  2. Cross-Suture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some different acid etch composite splints?

A
  1. Interproximal Composite
  2. Composite with arch wire
  3. Composite with monofilament nylon
24
Q

Are acid etch composite splints considered fuctional splints?

A

Yes!

  • 20-30 lb monofilment nylon
  • Bonded with composite
  • Allows phsiologic movement
25
Q

What are the indications for a cross-suture splint?

A
  1. No adjacent teeth to splint to
  2. Unmangeable traumatized children
26
Q

What is the recommended amount of days one should splint teeth?

A

7-10 Days

27
Q

What is the recommended splinting time for closed apex? Open apex with dry time < 60 minutes? Open apex with a dry time > 60 minutes?

A
  • Closed Apex → 7 - 14 days
  • Open Apex with dry time < 60 minutes → 7 - 14 days
  • Open Apex with dry time > 60 minutes → 4 weeks
28
Q

What is the chance of revascularization for mature roots (< 1.0mm) and immature roots (> 1.00)?

A
  • Mature Roots → 0% Revascularization
  • Immature Roots → 18-34% Revascularization
29
Q

What is the sequence of revascularization after a tooth is reimplanted?

A
  1. Loss of blood supply to pulp
  2. Coronal Pulp (Day 4) - Extensive ischemic injury
  3. Apical Pulp (Day 4) - Initial Revascularization
  4. In 4 weeks you will have: Revasculrization, Reinnervation, New odontoblastic layer
30
Q

What is the typical sequela of revascularization?

A

Pulp canal obliteration

31
Q

As dry storage time increases…pulp survival increases or decreases?

A

Pulp Surival DECREASES

32
Q

What chance of pulp revascularization do you have with nonphysiologic storage media?

A

Minimal chance of pulp revascularization

33
Q

What chance of revascularization do you have if the tooth is placed in physiologic storage like HBSS, milk, saline, or saliva?

A

Improved chance of pulp revascularization

34
Q

Does systemic antibiotics increase the chance of pulp revascularization?

A

No!

35
Q

Does applying topical Doxycycline affect the pulpal prognosis?

A

YES!

  • Decreased microorganisms in pulpal lumen
  • Increased pulp revascularization
36
Q

What is the recomended topical antibiotic?

A

Topical Doxycyline or Minocycline

1 mg in 20 ml physiologic saline, 5 minute soak

37
Q

What is the endodontic raitonale for applying topical antibiotics?

A

In a mature root at 4 weeks…

Very limited revascularization

Ischmemic coronal pulp with GREAT RISK OF INFECTION!!!

38
Q

For a mture root, what is the endodontic rationale for using Calcium Hydroxide?

A
  • Antibacterial
  • Increaeses pH in dentin
  • Favors mineralization over resorption
39
Q

How long would you apply Calcium Hydroxide for a mature root?

A

4 Weeks

40
Q

When do you have wiggle room for EXTRAORAL dry time for a closed apex or open apex?

A
  • Closed apex → One hour or less
  • Open apex → More than one hour
41
Q

For a mture root, when do you do a pulpectomy?

A
  • Immediately after reimplantation or…
  • 7-10 days
42
Q

If the extraoral dry time is < 1 hour, how would you treat a Closed Apex? How would you treat an Open Apex?

A
  • Closed Apex → Pulpectomy immediately after replantation or 7-10 days
  • Open Apex → Observe
43
Q

How would you treat a tooth with an extra oral dry time of > 1 hour for an Open Apex? How about a Closed Apex?

A
  • For Open or Closed → Pulpectomy immediately prior to/aftet replantation or wait until 7-10 days
44
Q

If extra oral dryt time is > 60 minutes, how do you remove necrotic tissue attached to the root?

A

Gauze

45
Q

What is the sequence of event if the extra oral dry time is > 60 minutes for an OPEN APEX?

A
  1. Carefully remove necrotic tissue attached to the root using gauze
  2. Administer local anesthesia
  3. Irrigate the socket with saline
  4. Examine the socket for possible fracture and reposition if necessary
  5. Preferably, root canal treatment should be carries out priot to replantation
  6. Replant the tooth slowly with slight digital pressure
  7. Suture gingival laceration, especially in the cervical area
  8. Verify normal position of the replanted tooth radiogrpahically
  9. Apply a flexible splint for 4 weeks (up to 0.016” or 0.4mm).
46
Q

What steps should you use in emergency treatment for replantation?

A
  1. Local anesthetic, if necessary
  2. Radiograph to verify position
  3. Check occlusion
  4. Physiologic Splint
47
Q

What are some additional considerations in emergency treatment to consider as post operative care?

A
  1. Analgesics (Motrin & Tylenol)
  2. Chlorhexidine
  3. Tetanus → Refer to physician for tetanus prophylaxis prn
48
Q

What are the sigs for Antibiotics after dental trauma/reimplantation?

A
  • Doxycyline - 50 mg bid for 7 days (appropriate dose per pt age and weight)
  • Amoxicillin - 500 mg qid for 7 days (appropriate dose per pt age and weight)
49
Q

How does tetracycline stack up versus amoxicillin in a repalcement resorption model?

A

Tetracycline had BETTER anti-resorptive properties

50
Q

How does tetracycline stack up vs amoxicillin in an inflammatory root resorption model?

A

Tytracycline had BETTER anti-bacterial properties

51
Q

What is the bottom line recomendation for tetraycline?

A

“Tetracycline could be considered as an alternative to amoxicillin after avulsion injuries”

52
Q

Would you worry about tetracycline stating after prescribing to a child?

A
  • Not a problem since avulsed maxillary anteriors have already erupted and are not susceptible to staining
  • At worst, posterior teeth might be stained → Remote possibility with 7-10 day prescription
53
Q

What is the treatment algorhythm for < 1 hour of extra oral dry time for a Closed Apex and Open Apex?

A
  • Closed Apex → Pulpectomy, immediate 7-10 days Ca(OH)2 tx
  • Splint removal: 2 weeks
  • Open Apex → Observe
  • Splint removal: 2 weeks
54
Q

What is the treatment algorhythm for > 1 hour of extraoral dry time for both a Closed Apex and Open Apex?

A
  • Closed Apex → Pulpectomy immediate 7-10 days Ca(OH) 2 tx
  • Splint Removal: 2 weeks
  • Open Apex → Pulpectomy immediate 7-10 days Ca (OH)2 tx
  • Splint removal: 4-6 weeks
55
Q

In summary, there are 4 factors to remember when treating an avulsed tooth…

A
  1. Be prepared - DENTAL TRAUMA KIT
  2. Immerse tooth in a physiologic storage medium to “buy time”
  3. Determine extraoral DRY time
  4. Follow AAE Guidelines
56
Q
A

Endodontics (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions