Review of dental trauma and sequelae

Question 1

Sequelae of trauma to permanent dentition

Answer 1

loss of vitality
periapical inflammation
arrest of root development
root resorption
- inflammatory
- replacement
pulp canal obliteration

Question 2

periapical inflammation

Answer 2

> 4% of mature teeth following luxation injuries
mimics apical resorption
ambivalent clinical and radiographic signs - delay endo tx
monitor closely

Question 3

arrest root development

Answer 3

if necrosis affects root sheath before root development then no further growth
radiographically - majority show failure of root canal to mature and reduce in size will indicate loss of vitality

Question 4

inflammatory root resorption

Answer 4

external
internal
cervical

Question 5

External inflammatory root resorption

Answer 5

non-vital pulp
mainly seen with avulsion and intrusion injuries (e.g., lateral luxation, extrusion, subluxation)
initiated by PDL damage and propagated by necrotic pulp
Radiographically –> punched out areas of resorption, loss of root surface, loss of adjacent bone areas, pdl expansion, evident for 3 weeks
tx –> extirpation of necrotic pulp, debridement, non-setting CaOH

Question 6

Internal inflammatory root resorption

Answer 6

Chronic pulpal inflammation
ballooning of walls of root canal
extirpation
debridement to avoid perforation to PDL
non-setting CaOH dressing

Question 7

Cervical inflammatory root resorption

Answer 7

damage to the root surface in the cervical region. propagated by necrotic pulp or perio disease.
curette defect and restore rct

Question 8

Replacement resorption (ankylosis)

Answer 8

extensive damage to the PDL and cementum results in bony union between alveolar socket and root surface
radiographically –> loss of PDL space, bone in direct contact with root
high metallic note

Question 9

Pulp canal proliferation

Answer 9

Progressive hard tissue formation with pulp cavity - narrowing of root canal
Opaque crown
reduced response to vitality testing
tx –> root canal tx in cases of negative vitality
7-27% of teeth with pulp canal obliteration will develop pulp necrosis in their lifetime

Question 10

Uncomplicated crown fracture

Answer 10

pulp necrosis 54% if no dentinal coverage (dentinal tubules are wide in immature teeth, therefore, facilitating the ingress of bacteria)
Pulp necrosis 8% if dentine protected
The apexogenesis procedure has a success rate of 80-96%. Better prognosis than direct pulp cap for immature permanent teeth exposed >24hrs.

Question 11

Root fracture prognosis

Answer 11

Position of fracture line – the more apical the fracture line the better the prognosis
Degree of displacement of the coronal fragment – the prognosis is better the less displacement. Necrosis of pulp usually only coronal fragment and coronal to fracture line.

Question 12

Avulsion prognosis

Answer 12

E/O time is critical (tooth rei-mplanted within 10-15 mins is good)
Storage medium important. dry storage decreases prognosis due to desiccation of PDL. contamination decreases prognosis as it stimulates an inflammatory process
prolonged splint time
PDL survival is critical - resorption at 1 year best predictor of survival
pulp death is less important

Question 13

Pulpal necrosis

Answer 13

grey colour
failure of pulp cavity to reduce radiographically
tx – extraction/endodontic tx

Question 14

Pulp canal obliteration

Answer 14

yellow crown
pulp canal narrowing
tx – extraction

Question 15

Replacement resorption clinical exam and tx

Answer 15

infraocclusion
confirm presence of replacement resorption
extraction tx