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acs > Paediatric Trauma IV - Trauma to permanent dentition (hard tissue injuries) > Flashcards

Paediatric Trauma IV - Trauma to permanent dentition (hard tissue injuries) Flashcards

1
Q

Classification of fractures?

A 
Enamel
Enamel-dentine - complication or uncomp
Crown-root - comp or uncomp
Root
Alveolar fracture
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2
Q

What radiographs to take to aid diagnosis?

A 
Periapical
- Central beam through the injured tooth
- M or D to the injured tooth
Occlusal
Soft tissue view if lacerations
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3
Q

Enamel infarctions?

A

Disruption of enamel prisms
Extends from surface to ADJ
Usually seen when light is parallel to long axis of tooth

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4
Q

Enamel fractures?

A

Loss of enamel only

Generally requires only smoothing or sealing

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5
Q

Uncomplicated enamel-dentine fractures?

A

Not involving pulp

Most common injury (of permanent incisors)

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6
Q

Crown fracture sequelae - prevalence of pulp necrosis after extensive proximal fracture with no tx or dentine coverage?

A

Prevalence of pulp necrosis after extensive proximal fracture
No tx: 54%
Dentine coverage 8%

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7
Q

Emergency tx for trauma (enamel fracture)?

A

Ideally composite - flowable easy and quick

If excessive bleeding RMGI may be used as emergency option

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8
Q

Prognosis of appropriately treated uncomplicated crown fractures?

A

Almost 100% maintain vitality

Resorption rare

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9
Q

Complicated enamel-dentine fracture? What do the tx options depend on?

A

Involve pulp

Tx depends on:
Extent
Time of exposure
Developmental stage

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10
Q

Tx options for complicated fractures and when to do each one?

A

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
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11
Q

What is a Cvek pulptotomy?

A 
Partial pulpotomy
Amputate pulp to gingival level
Arrest haemorrhage with saline soaked pledget
CaOH (powder/non-setting) onto pulp
Setting caoh
Restore with composite
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12
Q

What is the Cvek pulpotomy prone to?

A

Pulp canal obliteration

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13
Q

What is the success rate of Cvec pulpotomy?

A

79% 1-14yrs Gelbier et al 1988

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14
Q

Why do pulpectomys have problems in immature teeth?

A

Open apex, wide pulp canal which can lead to fracture

Will need to use procedures to artificially¥ create an apical barrier (biodentine, MTA, caoh)

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15
Q

What can crown root fractures be?

A

Complicated and uncomplicated

Apical 3rd, middle 3rd, cervical 3rd

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16
Q

Tx options for crown root fracture?

A

Fragment removal and restoration
Fragment removal and ortho extrusion
Fragment removal, root burial and removable denture

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17
Q

What radiographs to take?

A

Periapical with central beam through tooth

Occlusal helpful for diagonal fractures

18
Q

Progosis of fractures depends on..?

A

Concomitant crown fracture
Maturity of tooth
Location of fracture
Degree of displacement

19
Q

What does healing depend on?

A

Approximation of 2 fragments at time of injury, stabilisation, absence of infec

20
Q

List the best to worst types of healing?

A 
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
21
Q

What usually occurs with root fractures?

A

Apical fragment usually remains vital (if not displaced)

22
Q

What to do if loss of vitality of the coronal portion occurs after a root fracture?

A

Extirpate and root fill to fracture line

Possibly preceded by caoh dressings, the MTA or biodentine and thermoplastic GP

23
Q

What does the IADT 2012 state to do with root fractures?

A

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

24
Q

Cervical 3rd fractures tx?

A

Stabilisation is beneficial for a longer period of time - up to 4 months

25
Q

What are alveolar fractures?

A

Fracture of segment
Several teeth move as one block
Gingival lacerations

26
Q

Tx of alveolar fractures?

A

Reposition
Can be difficult due to bony lock
Splint 4 weeks

27
Q

Non-vital immature teeth features?

A

Root dev incomplete

  • Open apex
  • Thin dentine walls
  • Short roots
  • Prone to fracture
  • Need to create barrier to obturate
28
Q

What is apexification?

A

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

29
Q

How to carry out apexification?

A

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

30
Q

Disadvantages of caoh?

A 
Multiple visits
Dehydration of dentine
Cervical fractures
- apex open, <2/3 root length complete - 75% risk 
- Root length complete - 25% risk
31
Q

Alternative to caoh?

Negative?

A

MTA
Can cause discolouration
Its alkalinity is similar to caoh

32
Q

Biodentine features?

A 
Bioactive dentine substitute
Tricalcium silicate powder and ca chloride solution
Sets in 12 mins
Radiopaque: zirconium oxide
Slightly less alkaline than MTA
33
Q

Infraoccluded incisor management - best to worse?

A 
Incisal edge build up 
Surgical luxation and orthodontic repositioning
Distraction osteogenesis
Extraction
Decoronation (BAD)
34
Q

What is decoronation?

A

Removal of crown

35
Q

Indications for decoronation?

A

Infraocclusion

Ankylosis in growing pt

36
Q

Why decoronate a tooth?

A

Defect in alveolar ridge
Tilting of adjacent
Aesthetics

37
Q

Disadvantages of decoronation?

A

Potential for infec

38
Q

Advantages of decoronation?

A

Helps maintain bone width

Promotes vertical bone growth over the root surface

39
Q

When to do tooth autotransplantation?

Survival rate?

A

Traumatic loss of anterior screen
Premolar aplasia
Ectopic development of teeth
Replacement of misshapen teeth

74-100% at 5 yrs

40
Q

Ideal transplant tooth?

A

Md 1st and 2nd premolars due to root anatomy

Mx 1st molar NOT optimal as a graft as divergent root anatomy

41
Q

When to monitor transplanted teeth?

A 
4w
3m
6m
1yr
2yr

acs (23 decks)

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