Permanent Tooth Trauma Flashcards
Tx for concussion in permanent teeth?
Usually no need
Monitor pulpal condition for at least 1 year
- soft food and reinforce OH
Tx for subluxation of permanent tooth?
Clean area with saline
Consider flexible splint for 2 weeks
Soft diet and reinforcer OH
Tx of extrusion in permanent tooth?
Give LA
Clean exposed root surface with saline
Reposition tooth by gentle reinsertion into the socket
Stabilise for 2 weeks with a splint or 6 weeks if marginal bone fracture
Monitor pulpal condition for vitality and root resorption
If pulpal necrosis / infection, carry out appropriate endodontic tx for root maturity
Tx of lateral luxation in permanent tooth?
All teeth:
- apply LA
- rinse exposed root surface with saline
- gently reposition tooth
- stabilise with splint for 4 weeks or 8 weeks if marginal bone fracture
Immature root
- monitor for spontaneous revascularisation
- Root treat if necrosis
Mature root
- likely pulp necrosis so RCT to prevent infection or resorption
Tx of intrusion in permanent tooth with immature root?
- allow spontaneous repositioning
- if no eruption within 4 weeks, commence orthodontic repositioning
- monitor pulpal status
- spontaneous revascularisation may occur, if not then RCT tooth ASAP
Tx of intrusion in permanent tooth with mature apex?
Allow spontaneous repositioning if tooth intruded 3>mm
- if no re-eruption within 4 weeks, surgically reposition and splint for 2 weeks, or orthodontically reposition
If intrusion is 3-7mm, right to surgical or orthodontic repositioning
Beyond 7mm, reposition surgically
RCT within 2 weeks or as soon as position of tooth allows
Tx of avulsion in permanent tooth, with immature apex, when tooth replanted prior to appt?
Leave in place and apply LA
- clean area with saline
- verify normal tooth position
- splint for 2 weeks
- systemic antibiotics
- tetanus jab if not covered
- RCT if pulp does not revascularize
Tx of immature apex avulsed tooth with EOT <60 mins?
LA with no vasoconstrictor
- rinse tooth and apical foramen with saline
- examine socket and irrigate with saline
- replant tooth and verify normal position
- 2 week splint
- systemic antibiotics
- tetanus booster if uncovered
Tx of avulsed permanent tooth with open apex and EOT >60 mins?
- clean root surface and apical foramen with saline and place in storage medium while taking history
- give LA no vasoconstrictor
- examine socket for fracture and irrigate socket with saline
- replant tooth and confirm correct position
- flexible splint for 2 weeks
- systemic antibiotics
- tetanus jab if not covered
- treat root surface with 2% sodium fluoride solution for 20 mins
Why does delayed replantation have a poor prognosis?
What are the aims of tx in delayed replantation?
Likely outcome?
PDL will be necrotic and cannot be expected to heal
- goal to restore dentition for aesthetic, functional and psychological reasons
- to maintain alveolar contour
Ankylosis and resorption of root
Tx of avulsion of mature apex tooth that has been replanted prior to presenting?
Leave tooth in place
- clean area with saline
- LA no vasoconstrictor
- reposition tooth within 48 hours of trauma if placed wrong into socket
- confirm position radiographically
- 2 week splint
- systemic antibiotics
- tetanus booster if not covered
- RCT 2 weeks
Tx of avulsed mature apex permanent tooth where EOT <60 mins?
- clean root surface and apical foramen with saline
- LA no vasoconstrictor
- check socket for fracture and irrigate socket with saline
- replant tooth and confirm position
- splint for 2 weeks
- systemic antibiotics
- tetanus booster if not covered
- RCT 2 weeks
Tx of avulsed permanent tooth with mature apex where EOT >60 mins?
Clean root surface and apical foramen with saline
- place tooth in storage medium while taking history / exam
- LA no vaso
- examine socket for fracture, irrigate socket with saline
- replant tooth and verify correct position
- 2 week splint
- systemic antibiotics
- tetanus booster if not covered
- RCT 2 weeks
2% sodium fluoride solution for 20 mins - slow down osseous replacement
Tx of permanent tooth with infraction?
Etch and seal with resin to prevent discolouration and bacterial contamination
Tx of enamel fracture in permanent tooth?
Radiographic examination to rule out other injury
- 3 views
Smooth sharp edges
- etch and bond
- composite
Or re-bond lost tooth fragment
Tx of ED fracture in permanent tooth?
Clean area with saline
- disinfect dentine with chlorhexadine
- if fragment available, but is dry, rehydrate in saline for 20 mins before bonding back to tooth
No fragment?
- account for it - soft tissues / chest X-ray
- consider cap / lining if close to pulp
- cover exposed dentine with GIC
- definitive restoration
Tx of EDP fracture in permanent tooth?
Preserve vitality!
- pulp cap or partial pulpotomy advised in both mature and immature apex
- if fragment available, bond back to tooth
RCT if a post is to be placed or there is an associated luxation injury with displacement
Tx of crown root fracture without pulpal involvement in a permanent tooth
- localise fracture line
- stabilise loose fragment to adjacent teeth as emergency tx while definitive plan made
Options for definitive
Fragment removal only
- and restoration of exposed dentine
Fragment removal and gingivectomy
Ortho extrusion of apical fragment
Surgical extrusion of apical fragment more coronally
Coronectomy for later implant placement to retain bone levels
Extraction and delayed fixed pros
Tx of crown root fracture with pulpal involvement in permanent tooth
Emergency tx includes
- localise fracture line with radiographs
- stabilise loose fragments to adjacent teeth
In open apex
- pulp cap or partial pulpotomy
In closed apex
- extirpate pulp
Cover dentine with GIC and composite restoration
Refer for definitive tx
- same as CRF with no pulpal involvement
Tx of root fracture in permanent tooth?
Radiographic examination with 2 exposures
(See avulsion tx if coronal fragment has been avulsed out socket)
- rinse exposed root surface with saline
- reposition coronal segment and check position radiographically
- stabilise with splint for 4 weeks
- monitor healing for 1 year to determine pulpal status and commence RCT if indicated - up to fracture line
If fracture line is above alveolar crest
- remove coronal segment
- RCT and post and core
Tx of alveolar fracture in permanent tooth dentition?
LA
- manual repositioning
- clean area with chlorhexadine
- splint 4 weeks
- monitor pulp and commence RCT if indicated
