Permanent Tooth Trauma Sequelae Flashcards
What are the two main categories of dental trauma injuries?
what are the types in each?
Fracture injuries
Enamel fracture (uncomplicated crown fracture)
Enamel-dentine fracture (uncomplicated crown fracture)
Enamel-dentine fracture with pulp exposure (complicated crown fracture)
Crown-root fracture (+/- pulp exposure, complicated/uncomplicated)
Root fracture
Alveolar fracture
Displacement injuries
Concussion
Subluxation
Lateral luxation
Intrusion
Extrusion
Why is long-term monitoring of dental trauma required, and for how long should it be conducted?
Dental trauma requires at least 5 years of monitoring because complications can arise long after the initial injury.
Regular follow-ups help detect issues like loss of vitality, root resorption, and unfavourable tooth positions.
What clinical assessments should be performed at every trauma review?
Trauma stamp for affected teeth
Sinus presence (+/-)
Tooth colour (Normal, Grey, Yellow, Pink)
Mobility (Grade recorded)
Tenderness to percussion (TTP) (+/-)
Percussion note (Normal/Dull)
Ethyl chloride response (+/-)
Electric pulp testing (EPT) (Number recorded)
Radiographic examination
List the long-term complications of dental trauma.
- Discolouration
- Loss of vitality
- Root resorption (Internal and External)
- Unfavourable tooth positions
- Defects in hard and soft tissues
What are the types of root resorption?
Internal:
Internal infection-related inflammatory root resorption
External:
Surface
External infection-related inflammatory root resorption
Cervical
Ankylosis-related replacement root resorption
Describe the pathophysiology of internal infection-related inflammatory root resorption.
cause - diagnosis - pathology - management
Cause: Progressive pulp necrosis allowing infected material from the non-vital coronal pulp to propagate resorption.
Pathology: Osteoclastic destruction of hard tissue inside the root canal.
Diagnosis:
Variable pulp sensibility
Symmetrical “ballooning” of root canal walls
Indistinct root canal tramlines but intact external root surface
Management: Endodontic treatment
What are the characteristics of external surface root resorption?
Caused by localized trauma
Superficial resorption lacunae repaired with new cementum
Not progressive
Often not visible on radiographs
What is external infection-related inflammatory root resorption?
cause - diagnosis - pathology - management
Cause: Damage to the periodontal ligament (PDL)
Pathophysiology: Toxins from a non-vital tooth reach the external root surface, leading to destruction.
Diagnosis:
Non-vital pulp
Saucer-shaped irregularities with adjacent radiolucencies
Root canal tramlines remain intact
Management:
Immediate endodontic treatment
Non-setting calcium hydroxide (CaOH) for ~4 weeks
Obturate with gutta-percha
What is external cervical resorption, and how is it diagnosed?
Destruction of hard tissue in the cervical region by osteoclastic cells.
Aetiology:
Unknown, but occurs due to damage to PDL and subepithelial cementum layer.
Diagnosis:
Vital pulp
Pink crown appearance
Localized periodontal pocket extending into the resorptive defect
What is ankylosis-related replacement resorption, and what are its key features?
Cause: Severe trauma (luxation/avulsion) leading to direct contact between bone and root dentine.
Pathophysiology:
PDL and cementum fail to regenerate → bone cells replace root structure.
Root is gradually remodelled into bone.
Radiographic findings:
“Ragged” root outline
Loss of PDL space
Outcome:
Infraocclusion in growing patients due to alveolar bone development.
What are the final key points in managing permanent tooth trauma sequelae?
Thorough history and diagnosis are crucial.
Regular clinical and radiographic reviews as per IADT guidelines.
Multidisciplinary team (MDT) assessment for complex trauma in growing patients.
