Mixed Dentition Trauma Flashcards
what are the principles of luxation injury management
- Reposition (take repositioning x ray to verify position before splinting, tooth should be in socket)
- Fixation (splint)
- Endo monitoring – pulpal and perio status
what are the objectives of splinting a tooth following luxation injury
Stabilise the tooth to optimise healing outcomes for pulp and PDL esp during function
Improve function, provide comfort
if there is breakdown of marginal bone or alveolar socket wall, splint for __ (duration)
additional 4 weeks
Lateral luxation of permanent tooth clinical presentation of young permanent tooth
often immobile, apex is locked in by bone fracture
highly metallic (ankylotic) sound when you percuss
no response to pulp sensibility testing
When do you make endodontic evaluation following luxation injury of young permanent tooth
2 weeks post evaluation
compare the outcomes following lateral luxation of tooth with incomplete root formation and complete root formation
Spontaneous revascularisation may occur in tooth with incomplete root formation, while there is increased risk of pulp necrosis due to pulp strangulation or luxation in tooth with complete root formation
After lateral luxation of young permanent tooth, negative response to pulp sensibility testing. no other signs and symptoms of loss of vitality. when do you start RCT?
False negative may be possible for several months. should not start endodontic treatment solely based on no response to pulp sensibility testing
unfavourable outcome of lateral luxation of young permanent tooth
Pulp necrosis and infection Ankylosis External inflammatory infection related resorption External replacement resorption Apical periodontitis Break down of marginal bone Symptomatic
what can you to help prevent inflammatory type root resorption in young permanent teeth
calcium hydroxide or corticosteroid antibiotic intracanal medicament, initiation of root canal treatment
with root injuries, you are worried about
inflammatory resorption and replacement resorption
what is replacement resorption
osteoclastic action eats up the tooth. loss of pdl space as bone replaces root
what is the short term, medium term, long term management following trauma of young permanent teeth
short term:
pulp extirpation 2 weeks post trauma, initiate rct 4 weeks post trauma with splint kept on
medium term:
restore aesthetics, prevent mesial drift, monitor for healing after splint removal
long term:
monitor for root resorption
possible sequelae of incisal trauma young permanent teeth
loss of vitality
ankylosis/replacement resorption
internal and external root resorption
pulpal calcification and obliteration
Rank injuries in terms of risk of pulp necrosis to young permanent teeth
in decreasing order
- Avulsion
- Intrusion
- Luxation, extrusion
- Concussion, subluxation
concomitant injury eg luxation with concomitant crown fracture –> higher risk of pulp necrosis
how does inflammation resorption occur after trauma
during trauma, protective layer ie pre cementum is damaged. pulp or pdl cell necrosis sustain inflammation around the root, inflammatory response result in root resorption
why does focal/surface resorption occur
mild injury eg subluxation, mild extrusion –> PDL cells still viable. hence cemental healing can occur, end up with focal surface resorption
post trauma pulp canal obliteration tends to occur in what kind of teeth (age)
immature permanent teeth with wide open apex
consequences of pulp canal obliteration
may cause pulp strangulation and hence loss of vitality
endodontic treatment difficult as cannot visualise the space
orthodontic movement of tooth with pulp canal obliteration increases risk of tooth becoming non vital due to slender neurovascular bundle
how to describe root fractures
number level eg mid root, apical third direction eg horizontal, oblique mobility/point of rotation degree of separation
how does degree of separation related to pulpal death
mm. greater degree, higher risk of pulp death
Cervical fracture of young permanent tooth. Coronal fragment not mobile. What should you do at the emergency visit?
Do not remove coronal fragment as cervical fracture has potential to heal. Stabilisation may require longer period of time, up to 4 months
when to initiate rct for tooth with root fracture
Monitor healing of fracture for at least one year, monitor pulp status. Do not initiate at emergency visit. Pulp necrosis usually only occurs at coronal segment hence endo coronal segment up to fracture line
4 types of root fracture healing outcomes
hard tissue union (best, most favourable outcome) interposition of connective tissue interposition of bone and connective tissue granulation tissue (20-44% chance of pulp necrosis)
What is cvek pulpotomy, and how does it compare to vital pulpotomy for primary teeth
Cvek pulpotomy is performed on injured immature permanent teeth with pulp exposure. Open apices. Cvek pulpotomy helps to preserve pulpal function for continued root development
Amputate coronal pulp with high speed with irrigation, vs slow speed round bur or big spoon excavator in pulpotomy for deciduous teeth
Reach vital pulp where there is fresh bleeding. Hemostasis with cotton pellet soaked in saline. Pulp cap. Coronal seal
Materials that can be used for pulp cap in cvek pulpotomy
Non setting caoh2
MTA
tricalcium silicate materials eg biodentine
what is transient apical breakdown
temporary discolouration and changes to sensibility
usually after moderate injury in mature teeth with closed/closing apex
tooth trying to heal itself, resorbs apical foramen to allow more blood supply to enter pulpal space, resulting in surface resorption and/or obliteration of pulp canal.
grey discolouration and loss of sensibility otherwise no other symptoms. return to normal with normalisation of radiographic condition
treatment for intrusion of young permanent tooth with complete root formation
intruded less than 3mm: allow for re eruption without intervention. if does not re erupt in 8 weeks, reposition surgically or orthodontically
intruded 3-7mm reposition surgically or orthodontically
intruded more than 7mm reposition surgically
complete root formation –> pulp almost always becomes necrotic, start RCT asap
treatment for intrusion of young permanent tooth with incomplete root formation
allow for eruption without intervention. if no movement within a few weeks, reposition orthodonticallly
intruded more than 7mm, reposition surgically
