Paediatric Trauma IV - Trauma to permanent dentition (hard tissue injuries) Flashcards
Classification of fractures?
Enamel Enamel-dentine - complication or uncomp Crown-root - comp or uncomp Root Alveolar fracture
What radiographs to take to aid diagnosis?
Periapical - Central beam through the injured tooth - M or D to the injured tooth Occlusal Soft tissue view if lacerations
Enamel infarctions?
Disruption of enamel prisms
Extends from surface to ADJ
Usually seen when light is parallel to long axis of tooth
Enamel fractures?
Loss of enamel only
Generally requires only smoothing or sealing
Uncomplicated enamel-dentine fractures?
Not involving pulp
Most common injury (of permanent incisors)
Crown fracture sequelae - prevalence of pulp necrosis after extensive proximal fracture with no tx or dentine coverage?
Prevalence of pulp necrosis after extensive proximal fracture
No tx: 54%
Dentine coverage 8%
Emergency tx for trauma (enamel fracture)?
Ideally composite - flowable easy and quick
If excessive bleeding RMGI may be used as emergency option
Prognosis of appropriately treated uncomplicated crown fractures?
Almost 100% maintain vitality
Resorption rare
Complicated enamel-dentine fracture? What do the tx options depend on?
Involve pulp
Tx depends on:
Extent
Time of exposure
Developmental stage
Tx options for complicated fractures and when to do each one?
Pulp cap
- pin point exposures
- Minimal exposure time (<24hrs)
Pulpotomy (partial removal of coronal pulp)
- Usually where there is an incomplete apex
Pulpectomy (complete removal of coronal and radicular pulp)
- non-vital tooth or symptoms if irreversible pulpitis
- Prolonged exposure time, complete apical dev, large exposure
What is a Cvek pulptotomy?
Partial pulpotomy Amputate pulp to gingival level Arrest haemorrhage with saline soaked pledget CaOH (powder/non-setting) onto pulp Setting caoh Restore with composite
What is the Cvek pulpotomy prone to?
Pulp canal obliteration
What is the success rate of Cvec pulpotomy?
79% 1-14yrs Gelbier et al 1988
Why do pulpectomys have problems in immature teeth?
Open apex, wide pulp canal which can lead to fracture
Will need to use procedures to artificially¥ create an apical barrier (biodentine, MTA, caoh)
What can crown root fractures be?
Complicated and uncomplicated
Apical 3rd, middle 3rd, cervical 3rd
Tx options for crown root fracture?
Fragment removal and restoration
Fragment removal and ortho extrusion
Fragment removal, root burial and removable denture
What radiographs to take?
Periapical with central beam through tooth
Occlusal helpful for diagonal fractures
Progosis of fractures depends on..?
Concomitant crown fracture
Maturity of tooth
Location of fracture
Degree of displacement
What does healing depend on?
Approximation of 2 fragments at time of injury, stabilisation, absence of infec
List the best to worst types of healing?
Hard tissue union Interposition of C.T Interposition of bone and C.T Granulation tissue BAD - coronal pulp necrosis - coronal segment pulp extirpation leading to healing
What usually occurs with root fractures?
Apical fragment usually remains vital (if not displaced)
What to do if loss of vitality of the coronal portion occurs after a root fracture?
Extirpate and root fill to fracture line
Possibly preceded by caoh dressings, the MTA or biodentine and thermoplastic GP
What does the IADT 2012 state to do with root fractures?
Do not splint non-displaced root fractures
Reposition, if displaced, the coronal segment of the tooth asap
Stabilise the tooth with a flexible splint for 4 weeks
Cervical 3rd fractures tx?
Stabilisation is beneficial for a longer period of time - up to 4 months
What are alveolar fractures?
Fracture of segment
Several teeth move as one block
Gingival lacerations
Tx of alveolar fractures?
Reposition
Can be difficult due to bony lock
Splint 4 weeks
Non-vital immature teeth features?
Root dev incomplete
- Open apex
- Thin dentine walls
- Short roots
- Prone to fracture
- Need to create barrier to obturate
What is apexification?
Chemically induced hard tissue barrier formation
Created by placement of non-setting caoh dressing to apex
Dressings replaced at 3 month intervals
Can take 12-18 months
How to carry out apexification?
Extirpation of pulp with/wo LA
rubber dam
extirpation of pulp
usually no mechanical prep required due to wide canal
irrigation with sodium hypochlorite or chlorhexidine
non setting caoh placed with syringe
small file size 25 placed to WL to ensure no air bubbles
cotton wool placed in access cavity and caoh compressed to be in contact with the apical tissues
dressed with irm
replace every 3 months
test for barrier with paper points
Disadvantages of caoh?
Multiple visits Dehydration of dentine Cervical fractures - apex open, <2/3 root length complete - 75% risk - Root length complete - 25% risk
Alternative to caoh?
Negative?
MTA
Can cause discolouration
Its alkalinity is similar to caoh
Biodentine features?
Bioactive dentine substitute Tricalcium silicate powder and ca chloride solution Sets in 12 mins Radiopaque: zirconium oxide Slightly less alkaline than MTA
Infraoccluded incisor management - best to worse?
Incisal edge build up Surgical luxation and orthodontic repositioning Distraction osteogenesis Extraction Decoronation (BAD)
What is decoronation?
Removal of crown
Indications for decoronation?
Infraocclusion
Ankylosis in growing pt
Why decoronate a tooth?
Defect in alveolar ridge
Tilting of adjacent
Aesthetics
Disadvantages of decoronation?
Potential for infec
Advantages of decoronation?
Helps maintain bone width
Promotes vertical bone growth over the root surface
When to do tooth autotransplantation?
Survival rate?
Traumatic loss of anterior screen
Premolar aplasia
Ectopic development of teeth
Replacement of misshapen teeth
74-100% at 5 yrs
Ideal transplant tooth?
Md 1st and 2nd premolars due to root anatomy
Mx 1st molar NOT optimal as a graft as divergent root anatomy
When to monitor transplanted teeth?
4w 3m 6m 1yr 2yr
