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Stage 4 CDH > Permanent dentition trauma 2 (ST) > Flashcards

Permanent dentition trauma 2 (ST) Flashcards

1
Q

define concussion

A

injury to the tooth supporting structures with abnormal loosening or displacement of the tooth (bruising)

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2
Q

1.Visual None
2. Mobility None
3.Percussion= Tender to touch
4. Sensibility
Testing’s=
Usually positive (negative may be transient)
5. Radiographic
Findings=
No abnormalities
whats the problem?

A

consussion

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3
Q

what treatment do you do for a concussion injury

A

follow up at 4 weeks and 1 year.

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4
Q

Define Subluxation

A

an injury to the tooth suppporting structures with abnormal loosening but without displacement of tooth

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5
Q 
Visual None
Mobility =increased mobility
Percussion= Tender to touch
Sensibility
Testing's= 
Usually positive (negative may be transient)
Radiographic
Findings
No abnormalities often noted
whats the problem?
A

subluxation injury

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6
Q

What is the tx and follow up intervals for a subluxation injury?

A

splint removal after 2 weeks

follow up= 2w, 12 w, 6m, 1yr

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7
Q

Define extrusion@

A

partial displacement of the tooth out of its socket

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8
Q 
Visual Appears elongated
Mobility Very mobile
Percussion Tender to touch
Sensibility
Testing's
Usually negative (mild displacement may
be positive)
Radiographi
c Findings
Increased PDL spacing, tooth displaced from socket
A

extrusion

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9
Q

tx for extrusion
b) follow-up
(what are you monitoring for?)

A

a) LA; Digital repositioning, flexible splint, splint removal after 2 weeks
b) 2w, 4w, 8w, 12w, 6m, 1yr, annualy for 5
years
Monitoring pulpal healing and associated
root resorption

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10
Q

Define lateral luxation

b) what is it accompanied by?

A

Displacement of tooth in a direction other than axially ( palatal better than buccal)
b) assompanied by communication or # of the alveolar socket

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11
Q 
Visual=  Displaced in a palatal, lingual or labial direction
Mobility =Very mobile or immobile (in a bony lock)
Percussion= Tender to touch
Sensibility
Testing's=
Usually negative (mild displacement may be
positive)
Radiographic
Findings= 
Widened PDL spacing; tooth may appear
shortened or elongated
what is the problem?
A

lateral luxation

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12
Q

Lateral luxation
treatment
follow up

A

1) LA
Reposition the tooth
Flexible Splint for 4 weeks
2)2w, 4w, 8w, 12w, 6m, 1yr, annualy for 5 years
Monitoring pulpal healing and associated root
resorption

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13
Q

Define intrusion
2) When it comes to tx of intrusion it varies :
a) open apices less the 7 mm if intrusion
b) open apices more than 7mm
c) closed apices les than 3mm
d) 3-7mm
e) more then 7mm
Keep in mind teeth will lose vitality and require extirpation

A

the tooth has been driven into the alveolar process, PDL damadged severly, osteoclasts nible tooth away with replacement resorption foten

2) a) spontanous eruption
b) orthodonic reposition or surgically reposition the tooth (numb and forceps to move tooth then flexible splint)
c) spontanous repostioning
d) orthodontic or surgical
e) surgical

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14
Q 
Visual= Displaced axially into the alveolar bone
Mobility= Usually immobile
Percussion =Tender to touch
Sensibility
Testing's=
Almost certainly negative
Radiographic Findings=
The periodontal ligament space may be
absent from all or part of the root. CEJ more apically positioned.

whats the problem?

A

intrusion

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15
Q

treatment of intrusion injuries

b) what is the objective of tx?

A 
Treatment will depend on degree of
intrusion*
Flexible Splint
Endodontic Treatment initiated within
10days if complete apex
Splint removal after 4 weeks
b) reposition and stabilise tooth for 4 weeks
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16
Q

follow up of intrusion injuries?

A

2w, 4w, 8w, 12w, 6m, 1yr, annualy for 5
years
Monitoring pulpal healing and associated
root resorption

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17
Q

define avulsion

A

complete displacement of the tooth out of its socket

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18
Q 
Visual The tooth is removed from its socket.
Mobility n/a
Percussion n/a
Sensibility
Testing's
n/a
Radiograph
ic Findings
n/a
whats the problem?
A

avulsion

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19
Q

you walk in a 111 call centre, pt phone tooth is removed from socket what do you advise?

A 
• Hold by crown
• Rinse under saline or milk
• Replant
• Bite on handkerchief and get
to a dentist
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20
Q

you walk in a 111 call centre, pt phone tooth is removed from socket what do you advise? it can’t be reimplanted

A 
If it can’t be replanted store
tooth in:
• Saliva
• Saline
• Milk
• Contact lens solution
• Tooth rescue box
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21
Q

What are the benefits of milk used to store a tooth?

A

• Nutrients maintain PDL cell viability, and with its
physiological pH of 6.5-7.2
• PDL cells can survive 2- 6 hours
easily availabel and a practical choice

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22
Q

disadvantages of milk used to store a tooht?

A

• The antigens present in milk could interfere with

the process of reattachment of PDL cells

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23
Q

can you use sour milk to store tooth?
is warm milk better?
is higher fat better?

A

Milk needs to be fresh and refrigerated
• Sour milk should not be used as it harmful to the
PDL cells
chilled milk and lower fat is best

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24
Q

what determines the success of replantation of an avulsed tooth?

A

Extra-alveolar dry time (EADT)
 Extra-alveolar time (EAT)
 Storage medium
 Medical history

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25
Q

when avulsion has occurred PDL cells are most likely viable if…

A

The tooth has been replanted immediately or within a very short time
(about 15 minutes)

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26
Q

when avulsion has occurred PDL cells may be viable but compromised if…

A

The tooth has been kept in a storage medium and the total extra‐oral
dry time has been <60 minutes).

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27
Q

when avulsion has occurred PDL cells are most likely non-viable if…

A

The total extra‐oral dry time has been more than 60 minutes,

regardless of the tooth having been stored in a medium or not.

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28
Q

if the PDL cells are most likely viable what is done following reimplantation?

a) apices closed
b) open apices

A 
Extirpate within 2 weeks post injury
 Dress with Ca(OH)2 for up to 4 weeks
 Obturate
Open apices
 Leave to revascularize, only extirpate if signs of loss of
vitality and resorption
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29
Q

if the PDL cells are may be viable but complomised what is done following reimplantation?

a) apices closed
b) open apices

A 
Extirpate within 2 weeks post injury
 Dress with Ca(OH)2 for up to 4 weeks
 Obturate
Open apices
 Leave to revascularize, only extirpate if signs of loss of
vitality and resorption
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30
Q

what is the treament aim if a tooth is avulsed and the PDL cells are likely non-viable?

A

Replacement resorption will occur. Aim of treatment is to maintain
tooth until future loss with the benefit of maintaining space and bone

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31
Q

what is the treatment if a tooth with closed apices is avulsed and the PDL cells are likely non-viable?
closed vs open apices

A

Extirpate within 2 week post injury
 Dress with Ca(OH)2 for up to 4 weeks
 Obturate
 Consider intracanal materials if root burial is to be considered
If open apices: consider the risk of inflammatory root resorption should be wieghed against the chances of obtaining pulp space revascularization. Leave to revascularize , only extirpate with signs of loose of vitality and resorption- very clsoe monitory needed.

32
Q

what is the treatment if a tooth with open apicesis avulsed and the PDL cells are likely non-viable?

A

Consider the risk of inflammatory root resorption should be weighed against
the chances of obtaining pulp space revascularization.
 Leave to revascularize, only extirpate if signs of loss of vitality and
resorption – very close monitoring is needed

33
Q

if teeth are replanted what is the follow-up, what does it involve?

A 
Replanted teeth should be monitored
clinically and radiographically at:
 2 weeks (when the splint is removed),
4 weeks,
 3 months,
 6 months,
 one year,
 Annualy thereafter for at least five years
34
Q

Post-op instructions for reimplanted teeth:

A

1.Avoid participation in contact sports.
2.Maintain a soft diet for up to 2 weeks,
according to the tolerance of the patient.65
3.Brush their teeth with a soft toothbrush after
each meal.
4.Use a chlorhexidine (0.12%) mouth rinse
twice a day for 2 weeks.

35
Q

what is the prognosis of concussion in
a) open
b) closed apices
of pulp survival at 5 years

A

a) 100% b)96%

36
Q

what is the prognosis of subluxation in
a) open
b) closed apices
of pulp survival at 5 years

A

a) 100

b) 85%

37
Q

what is the prognosis of extrusion in
a) open
b) closed apices
of pulp survival at 5 years

A

a) 95%

b) 45%

38
Q

what is the prognosis of lateral luxation in
a) open
b) closed apices
of pulp survival at 5 years

A

a) 95%

b) 25%

39
Q

what is the prognosis of intrusion in
a) open
b) closed apices
of pulp survival at 5 years

A

a) 40%

b) 0

40
Q

what is the prognosis of avulsion/replantation in
a) open
b) closed apices
of pulp survival at 5 years
there is also usually more resorption 100% closed apice that is replanted

A

a) 30%

b) 0%

41
Q

There are so many methods for splinting teeth name 5?

A 
 Lead Foil +sutures (this will overextend into gums and be help in place by suture)
 Acrylic and wire
 Composite and wire
 Composite mesh
 Gumshield
 Mouthguard +perforations and cement
 Arch bar
 Ortho brackets and wire
 Trauma Titanium Splint (looked like metal dna helix going over top of teeth)
42
Q

what is the issue with a “gumshield” splint

A

oral hygiene is often very poor

43
Q

what is the issue with an archbar splint?

A

too rigid

44
Q

when is an acryllic URA type splint usefu:

A

when there are few abutment teeth

45
Q

What is a foil temporary splint cemented with?

A

kalzinol

46
Q

true of false

Damage to PDL can cause resorption

A

true

47
Q

true of false

 Splints should be non-passive and rigid

A

false should be passive and flexible

48
Q

true of false
PDL injuries be monitored for
pulp necrosis and resorption

A

true

49
Q

true of false

 Patients should be informed of prognosis at
an later stage in avulsion injuries

A

false should be informed at early stages.

50
Q

 Root surfaces indistinct
 Tramlines of root canal intact
 Treatment: Pulp extirpation. Mechanical and chemical irrigation, NS
CaOH.

diagnosis?

A

external inflammatory root resoption

51
Q

treatment for external inflammatory root resorption?

A

Biomechanical preparation & N/S Ca(OH)2 until evidence of non
progression
 Obturate (if doesn’t progress)

52
Q

Resorption -External Inflammatory

1) initiated by?
2) progessive?

A

1) damadge to PL initialy
2) yes- Maintained and propagated by necrotic pulp tissue via dentinal
tubules

53
Q

Resorption -External surfaces

1) define?
2) progessive?

A

1) damadge to PL which subsequently heals

2) non-progressive

54
Q

Diagnosis:
 Tramlines of root canal indistinct
 Root surfaces intact

A

resorption - internal inflammatory

55
Q

treatment of resorption - internal inflammatory

A

Treatment: Extirpation
 Mechanical and chemical preparation
 Dress with NS Ca(OH)2
 Obturate if signs of non progression

56
Q

Resorption -internal inflammatory

1) initiated by?
2) progessive?

A

1) non-vital pulp

2) progressive yes

57
Q

Reorption - replacement “ankylosis

1) initiated by?
2) disease process?
3) progessive?

A

1) initiated by severe damadge to pL e.g. evulsion/ intrusive injuries
2) normal repair doesn’t occure, instead PDL is dead and osteoclasts access root surface producing bone that directly connects to dentine, the tooth is no part of bone remodelling so it gradually resorbed.

58
Q

Diagnosis:
 loss of PL and lamina dura
tone of percussion different , metallic sound

A

resoption - replacement ankylosis

59
Q

tx for resoption - replacement ankylosis

A

nil
puberty growth face- decoronation ( gingival fibres grown over top of tooth, pulling on transceptal firbes promoting bone to grow over the top of the tooth)= lots of bone
autotransplantation- taking a tooth from a another place, 2/3 of root development moved into gap
resin-retained bridge
removable p/p
othodontic space closure

60
Q

why can pulp canal obliteration be seen as a positive thing?

A

is a response for a vital pulp!

61
Q

what is the process of pulp canal obliteration

A

 Progressive hard tissue formation within pulp cavity
 Gradual narrowing of pulp chamber and pulp canal -total or
partial obliteration

62
Q

treatment for pulp canal obliteration?

A

conservatice (only 10% =PAP)

63
Q

what is the missing step?

  1. Rinse the root surface with a gentle stream of saline
  2. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  3. Administer local anaesthesia
  4. Irrigate the socket with sterile saline.
  5. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  6. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  7. Replant the tooth slowly with slight digital pressure.
  8. Verify the correct position of the replanted tooth both clinically and radiographically.
  9. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  10. Suture gingival lacerations, if present.
  11. Administer systemic antibiotics.
  12. Check tetanus status.
  13. Provide post‐operative instructions.
  14. Arrange follow up
A
  1. Do not touch the root
64
Q
  1. Do not touch the root
  2. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  3. Administer local anaesthesia
  4. Irrigate the socket with sterile saline.
  5. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  6. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  7. Replant the tooth slowly with slight digital pressure.
  8. Verify the correct position of the replanted tooth both clinically and radiographically.
  9. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  10. Suture gingival lacerations, if present.
  11. Administer systemic antibiotics.
  12. Check tetanus status.
  13. Provide post‐operative instructions.
  14. Arrange follow up
A
  1. Rinse the root surface with a gentle stream of saline
65
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. ?
  5. Irrigate the socket with sterile saline.
  6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  7. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  8. Replant the tooth slowly with slight digital pressure.
  9. Verify the correct position of the replanted tooth both clinically and radiographically.
  10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  11. Suture gingival lacerations, if present.
  12. Administer systemic antibiotics.
  13. Check tetanus status.
  14. Provide post‐operative instructions.
  15. Arrange follow up
A

administer LA

66
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. Administer local anaesthesia
    5.?
  5. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  6. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  7. Replant the tooth slowly with slight digital pressure.
  8. Verify the correct position of the replanted tooth both clinically and radiographically.
  9. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  10. Suture gingival lacerations, if present.
  11. Administer systemic antibiotics.
  12. Check tetanus status.
  13. Provide post‐operative instructions.
  14. Arrange follow up
A

irrigate socket with sterile saline

67
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. Administer local anaesthesia
  5. Irrigate the socket with sterile saline.
  6. ????
  7. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  8. Replant the tooth slowly with slight digital pressure.
  9. Verify the correct position of the replanted tooth both clinically and radiographically.
  10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  11. Suture gingival lacerations, if present.
  12. Administer systemic antibiotics.
  13. Check tetanus status.
  14. Provide post‐operative instructions.
  15. Arrange follow up
A

Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.

68
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. Administer local anaesthesia
  5. Irrigate the socket with sterile saline.
  6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  7. ???
  8. Replant the tooth slowly with slight digital pressure.
  9. Verify the correct position of the replanted tooth both clinically and radiographically.
  10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  11. Suture gingival lacerations, if present.
  12. Administer systemic antibiotics.
  13. Check tetanus status.
  14. Provide post‐operative instructions.
  15. Arrange follow up
A

Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.

69
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. Administer local anaesthesia
  5. Irrigate the socket with sterile saline.
  6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  7. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  8. ???
  9. Verify the correct position of the replanted tooth both clinically and radiographically.
  10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  11. Suture gingival lacerations, if present.
  12. Administer systemic antibiotics.
  13. Check tetanus status.
  14. Provide post‐operative instructions.
  15. Arrange follow up
A

Replant the tooth slowly with slight digital pressure.

70
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. Administer local anaesthesia
  5. Irrigate the socket with sterile saline.
  6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  7. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  8. Replant the tooth slowly with slight digital pressure.
  9. ????
  10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  11. Suture gingival lacerations, if present.
  12. Administer systemic antibiotics.
  13. Check tetanus status.
  14. Provide post‐operative instructions.
  15. Arrange follow up
A

Verify the correct position of the replanted tooth both clinically and radiographically.

71
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. Administer local anaesthesia
  5. Irrigate the socket with sterile saline.
  6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  7. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  8. Replant the tooth slowly with slight digital pressure.
  9. Verify the correct position of the replanted tooth both clinically and radiographically.
  10. ???
  11. Suture gingival lacerations, if present.
  12. Administer systemic antibiotics.
  13. Check tetanus status.
  14. Provide post‐operative instructions.
  15. Arrange follow up
A

Stabilize the tooth for 2 weeks using a passive, flexible wire splint

72
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. Administer local anaesthesia
  5. Irrigate the socket with sterile saline.
  6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  7. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  8. Replant the tooth slowly with slight digital pressure.
  9. Verify the correct position of the replanted tooth both clinically and radiographically.
  10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  11. ???
  12. Administer systemic antibiotics.
  13. Check tetanus status.
  14. Provide post‐operative instructions.
  15. Arrange follow up
A

Suture gingival lacerations, if present.

73
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. Administer local anaesthesia
  5. Irrigate the socket with sterile saline.
  6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  7. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  8. Replant the tooth slowly with slight digital pressure.
  9. Verify the correct position of the replanted tooth both clinically and radiographically.
  10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  11. Suture gingival lacerations, if present.
    12.????
  12. Check tetanus status.
  13. Provide post‐operative instructions.
  14. Arrange follow up
A

Administer systemic antibiotics.

74
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. Administer local anaesthesia
  5. Irrigate the socket with sterile saline.
  6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  7. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  8. Replant the tooth slowly with slight digital pressure.
  9. Verify the correct position of the replanted tooth both clinically and radiographically.
  10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  11. Suture gingival lacerations, if present.
  12. Administer systemic antibiotics.
  13. ???
  14. Provide post‐operative instructions.
  15. Arrange follow up
A

Check tetanus status.

75
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. Administer local anaesthesia
  5. Irrigate the socket with sterile saline.
  6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  7. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  8. Replant the tooth slowly with slight digital pressure.
  9. Verify the correct position of the replanted tooth both clinically and radiographically.
  10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  11. Suture gingival lacerations, if present.
  12. Administer systemic antibiotics.
  13. Check tetanus status.
  14. ???
  15. Arrange follow up
A

Provide post‐operative instructions.

76
Q
  1. Do not touch the root
  2. Rinse the root surface with a gentle stream of saline
  3. Put or leave the tooth in a storage medium while taking a history, examining the
    patient clinically
  4. Administer local anaesthesia
  5. Irrigate the socket with sterile saline.
  6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
    fractured fragment into its original position with a suitable instrument.
  7. Removal of the coagulum with a saline stream may allow better repositioning of the
    tooth.
  8. Replant the tooth slowly with slight digital pressure.
  9. Verify the correct position of the replanted tooth both clinically and radiographically.
  10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
  11. Suture gingival lacerations, if present.
  12. Administer systemic antibiotics.
  13. Check tetanus status.
  14. Provide post‐operative instructions.
  15. ?
A

Arrange follow up

77
Q

intrusion prognosis

A 
pulp necrosis
root resorption
arrest root development
loss of marginal bone support
ankylosis
pulp canal obliterations ( in more mild case)
ginigival recessions

Stage 4 CDH (2 decks)

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