Supporting Tissue Injuries

Question 1

What will supporting tissue injuries impact?

Answer 1

Surrounding bone
Neurovascular bundle
Root surface

Question 2

What are the 2 natures of supporting tissue injury?

Answer 2

Separation injury
Crushing injury

Question 3

What are the clinical findings, treatment and follow up for concussion?

Answer 3

There is pain on percussion
No treatment
Clinical and radiograph evaluation at 4 weeks and 1 year

Question 4

What are the clinical findings of subluxation?

Answer 4

Increased mobility
Tender to percussion
Bleeding from the gingival crevice may be present

Question 5

What is the treatment and follow up for subluxation?

Answer 5

Tx normally not required, splint if excessive mobility or tenderness when biting
Clinical and radiographic evaluation at 2 weeks (including splint removal), 12 weeks, 6 months and 1 year

Question 6

How can concussion and subluxation be monitored?

Answer 6

Trauma Stamp
Sensibility tests - thermal and electric
Radiographs to show root development, comparison with contralateral tooth and resorption

Question 7

What are the pulp survival rates after 5 years for concussion and subluxation?

Answer 7

100% if open apex
95% if closed apex for concussion
85% if closed apex for subluxation

Question 8

What is the 5 year root resorption rate for concussion and subluxation?

Answer 8

1% if open apex
3% if closed apex for concussion
7% if closed apex for subluxation

Question 9

What are the clinical findings of extrusion?

Answer 9

Tooth appears elongated
Usually displaced palatal
Tooth mobile
Bleeding from gingival sulcus

Question 10

What is the treatment and follow up for extrusion?

Answer 10

Reposition the tooth by gently pushing it back into the tooth socket under LA, then splint
Clinical and radiographic evaluation at 2 weeks (including splint removal), 4 weeks, 8 weeks, 12 weeks, 6 months and 1 year
Then annually for at least 5 years

Question 11

What are the 5 year pulp survival rates for extrusion?

Answer 11

95% if open apex
45% if closed apex

Question 12

What are the 5 year resorption rates for extrusion?

Answer 12

5% if open apex
7% if closed apex

Question 13

What are the clinical findings of lateral luxation?

Answer 13

Tooth appears displaced in socket
Tooth immobile
High ankylotic percussion tone
May be bleeding from gingival sulcus
Root apex may be palpable in sulcus

Question 14

What is the treatment for lateral luxation?

Answer 14

Reposition under LA
Splint
Monitor - endo evaluation about 2 weeks after injury

Question 15

What should happen after lateral luxation if there is incomplete root formation?

Answer 15

Spontaneous revascularisation may occur
If the pulp becomes necrotic and there are signs of IIR external resorption then commence endo treatment

Question 16

What should happen after lateral luxation if there is complete root formation?

Answer 16

Pulp will likely become necrotic
Commence endo treatment
Corticosteroid antibiotic or CaOH as intra-canal medicament to prevent the development of IIR external resorption

Question 17

What is the follow up for lateral luxation?

Answer 17

Clinical and radiographic evaluation at 2 weeks, 4 weeks (including splint removal), 8 weeks, 12 weeks, 6 months and 1 year
Then annually for at least 5 years

Question 18

What are the 5 year pulp survival rates for lateral luxation?

Answer 18

95% if open apex
25% if closed apex

Question 19

What are the 5 year resorption rates for lateral luxation?

Answer 19

3% if open apex
38% if closed apex

Question 20

What are the clinical findings of intrusion?

Answer 20

Crown appears shortened
Bleeding from gingivae
Ankylotic high, metallic percussion tone

Question 21

How is intrusion treated if there is immature root formation?

Answer 21

Spontaneous repositioning independent of the degree of intrusion
If no re-eruption within 4 weeks then orthodontic repositioning
Monitor the pulp condition
Spontaneous pulp revascularisation may occur
If pulp becomes necrotic and infected or signs of IIR external resorption then endo treat ASAP when the position of the tooth allows

Question 22

How is intrusion treated if there is mature root formation of <3mm?

Answer 22

Spontaneous repositioning
If no re-eruption within 8 weeks - reposition surgically and splint for 4 weeks or reposition orthodontically before ankylosis develops

Question 23

How is intrusion treated if there is mature root formation of 3 - 7mm?

Answer 23

Reposition surgically (preferably) or orthodontically

Question 24

How is intrusion treated if there is mature root formation of >7mm?

Answer 24

Reposition surgically

Question 25

Why is endo treatment needed in intrusion where there is mature root formation and when should this be carried out?

Answer 25

The pulp almost always becomes necrotic
Start tx at 2 weeks or as soon as tooth positioning allows
Aim to prevent the development of IIR external resorption

Question 26

How should intrusion be followed up?

Answer 26

Clinical and radiographic evaluation at 2 weeks, 4 weeks (including splint removal), 8 weeks, 12 weeks, 6 months and 1 year
Then annually for at least 5 years

Question 27

What are the 5 year pulp survival rates for intrusion?

Answer 27

40% if open apex
0% if closed apex

Question 28

What are the 5 year resorption rates for intrusion?

Answer 28

67% if open apex
100% if closed apex