Operative Techniques for Dental Trauma Flashcards
What is the replantation procedure of an avulsed tooth
- Do not hold the root
- Rinse with saline if dirty
- Rinse out old blood clot
- Manipulate bone if required
- Consider apex development and time out of the socket
- LA may be required
1) Replant tooth slowly with slight digital pressure
2) Sututre gingival lacerations
3) Verify positioning clinically and radiographically
4) Flexible splint for up to 2 weeks
5) Administer systemic antibiotics
6) Check tetanus protection
7) Give patient instructions
Generic post op advice for avulsed teeth
- Avoid contact sports for 2 weeks
- Pain relief, analgesic advice
- Eat soft foods for 2 weeks
- Chlorhexidine 0.1% twice a day for 1 week
- Careful OH with soft brush
Definition of a splint
-Rigid or flexible device or compound used to support, protect or immobilise teeth that have been loosened, replanted, fractured or subjected to certain Endodontics surgical procedures
Name some ideal properties of a splint
- Easy to clean
- Easy to place
- Adequate fixation for whole stabilisation period
- Easy to remove
- Allows physiological tooth mobility
- No interference with occlusion
- Aesthetically acceptable
- No damage to soft tissues
- Endo treatment and sensibility testing should still be possible
Types of immobilisation (rigid/flexibke) and what it entails
- Functional-physiologic flexible splint (one abutment either side of the injured tooth)
- Physiological mobility of teeth to promote healing of the PDL
- Discourages replacement resorption
- Rigid splint involves two abutment teeth either side of the injured tooth
- Only used in cervical root fractures and dentoalveolar fractures
Types of materials for splints
- Composite wire
- Protemp acrylic
- Soft mouth guard
- Brackets-orthodontic wire
- TTS (titanium trauma splint)
Why do we splint
-Trauma may loosen the tooth due to damage to PDL and/or fracture of the root
By splinting, we are stabilising the tooth until healing of the PDL occurs or repairs of root fracture occurs
Splinting times for all DTIs
Avulsion (EADT>60 mins), intrusion and apical-mid 1/3rd root fracture and lateral luxation= 4 weeks
Avulsion (EADT<60 minutes) and extrusion is 2 weeks
Coronal 1/3rd root fracture needs to be splinted for 4 months with a rigid splint
How would u treat an enamel fracture
‘Selective grinding’ -Maya Sandhu 01/02/2022 @ 18.04 in NHH Library Floor 2
‘Shaving down the matching tooth on the other side’ as seen in her oral surgery consultant clinic session
Google:
-Occlusal surfaces of the teeth are precisely altered to improve the contact pattern
How would u treat an enamel-dentine fracture
-Reattach crown fragment and restore
Emergency treatment can include covering over the exposed dentine using a composer or composite bandage
Definitive tx would be acid etch composite tip
How would u treat an edp fracture
- Pulpotomy
- Pulpectomy
Aim when treating pulpal exposure
-Maintain pulp vitality so that the immature teeth continue root development and maturation
What does survival of the pulp depend on
- Associated PDL injury
- Extent of exposed dentine
- Age of patient (open v closed apex)
- Time elapsed since injury
-IF there is no displacement (lunation), the prognosis is better
Bacterial ingress causes pulp death
What is a cvek pulpotomy
-Access through exposure and only remove superficial diseased pulp
Technique of cvek pulpotomy
- Rubber dam and clamp
- Remove pulpal tissue 2-3mm using high speed diamond/TC bur
- Arrest haemorrhage using cotton wool pellet
- Dress pulp using non setting caoh
- Restore with dressing/restoration
