PAEDS - trauma handbook Flashcards
how would you manage a traumatised permanent incisor where there is an enamel/ dentine fracture and a pulpal exposure?
pulpotomy
known as the Cvek technique or partial pulpotomy
what is the purpose of performing a pulpotomy on a tooth with exposed pulp?
remove infected and inflamed pulp tissue
maintain the tooth’s vitality and allow the root to continue development in the case of immature teeth
when treating a tooth with pulpal exposure, what is the remaining healthy pulpal tissue treated with?
healthy pulpal tissue surface treated with non-setting calcium hydroxide or non-staining calcium silicate
if the patient is in the mixed dentition phase, with spacing or teeth close to exfoliation, what may be difficult prior to pulpotomy? and how do you resolve this?
placing rubber dam or wedging material
split dam - interproximal dam between adjacent holes
can use caulking agent or alternative in con junction
what is used to amputate the pulp when performing a pulpotomy? and how much pulp would normally be removed?
round diamond bur in a high speed air rotor with water spray
1-2mm pulp removed
how do you know how much pulp to remove when performing a pulpotomy?
remove until you see bleeding healthy pulp
how is bleeding arrested when performing a pulptomy?
cotton wool pledget soaked in sterile water/ saline
alternative: adrenaline free LA
what is the exposed pulp dressed with during a pulptomy?
non-setting calcium hydroxide
or
white MTA
or
non-staining calcium silicate cement
how does calcium silicate and calcium hydroxide work?
promote calcific repair and milk antibacterial properties
what are examples of calcium silicates?
biodentine
white MTA
what is the calcium hydroxide covered with when performing a pulpotomy? what does this function as? where should it be placed?
RMGI cement
limited to dentine
acts as a lining in preparation to composite (larger bonding area)
what must you do to the RMGI cement during a pulpotomy?
light cure
what is a composite bandage?
temporary dressing placed on a tooth immediately after an enamel dentine fracture or an enamel dentine pulp fracture that has undergone a pulpotomy
what is the purpose of a dentine bandage?
seal over any exposed dentine tubules (and pulp cap if present) minimising the risk of microbial invasion and preventing see
what material is not suitable for composite bandage ?
GI - not robust enough
what are the 4 reasons for the use of a composite bandage being used in the short term?
pt may be distressed and in pain
difficult after trauma to achieve a dry field
operator may have limited time
restoring tooth short of occlusion is advantageous if there has been periodontal injury
why is it important when restoring the tooth definitively to preserve as much of the composite bandage as possible?
reduces further insult to the pulp increasing its prognosis
what should the composite bandage cover?
pulp cap and all exposed dentine
what are the 8 tests to assess pulp vitality?
colour
EPT
thermal test
transillumination
TTP
mobility
sinus/ alveolar tenderness
history
radiographic exam
what is pulp vitality determined by?
presence of an intact blood supply - NOT intact nerve supply
what signs should be present to indicate endodontics in a tooth?
2 signs of pulpal necrosis
what should be asked in a history when reviewing trauma?
pain?
swelling?
bad taste?
specific tooth?
what makes it sore?
sore to touch/ move?
darkening?
mobility?
why does decolouration not mean the pulp is irreversibly necrotic?
products of pulpal necrosis may permeate tubules and stain surrounding dentine.
initially pinkish which may turn brownish due to haemosiderin from oxidising haemoglobin
what is transillumination useful for?
detecting craze lines, enamel infraction and assessing colour of the tooth
what direction should the light be in when investigating a tooth with transillumination?
perpendicular to the long axis of the tooth
what does percussion examine?
percussion note and whether the tooth is tender
what has happened if there is increased mobility of a tooth weeks after trauma?
pathognomic of periapical infection
what is Millers classification?
mobility
class 1: <1mm (horizontal)
class 2: >1mm (horizontal)
class 3: >1mm (horizontal and vertical)
what does pulp testing with EPT or ethyl chloride test?
pulpal sensory nerve supply - NOT true pulp vitality
what type of teeth are not likely to respond to pulp testing?
vital teeth that have been traumatised
vital teeth with incomplete root development
what are radiographic signs that a traumatised tooth is non vital when reviewing?
the root development is lagging behind an undamaged contralateral tooth
