Supporting Tissue Injuries Flashcards
What will supporting tissue injuries impact?
Surrounding bone
Neurovascular bundle
Root surface
What are the 2 natures of supporting tissue injury?
Separation injury
Crushing injury
What are the clinical findings, treatment and follow up for concussion?
There is pain on percussion
No treatment
Clinical and radiograph evaluation at 4 weeks and 1 year
What are the clinical findings of subluxation?
Increased mobility
Tender to percussion
Bleeding from the gingival crevice may be present
What is the treatment and follow up for subluxation?
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
How can concussion and subluxation be monitored?
Trauma Stamp
Sensibility tests - thermal and electric
Radiographs to show root development, comparison with contralateral tooth and resorption
What are the pulp survival rates after 5 years for concussion and subluxation?
100% if open apex
95% if closed apex for concussion
85% if closed apex for subluxation
What is the 5 year root resorption rate for concussion and subluxation?
1% if open apex
3% if closed apex for concussion
7% if closed apex for subluxation
What are the clinical findings of extrusion?
Tooth appears elongated
Usually displaced palatal
Tooth mobile
Bleeding from gingival sulcus
What is the treatment and follow up for extrusion?
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
What are the 5 year pulp survival rates for extrusion?
95% if open apex
45% if closed apex
What are the 5 year resorption rates for extrusion?
5% if open apex
7% if closed apex
What are the clinical findings of lateral luxation?
Tooth appears displaced in socket
Tooth immobile
High ankylotic percussion tone
May be bleeding from gingival sulcus
Root apex may be palpable in sulcus
What is the treatment for lateral luxation?
Reposition under LA
Splint
Monitor - endo evaluation about 2 weeks after injury
What should happen after lateral luxation if there is incomplete root formation?
Spontaneous revascularisation may occur
If the pulp becomes necrotic and there are signs of IIR external resorption then commence endo treatment
What should happen after lateral luxation if there is complete root formation?
Pulp will likely become necrotic
Commence endo treatment
Corticosteroid antibiotic or CaOH as intra-canal medicament to prevent the development of IIR external resorption
What is the follow up for lateral luxation?
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
What are the 5 year pulp survival rates for lateral luxation?
95% if open apex
25% if closed apex
What are the 5 year resorption rates for lateral luxation?
3% if open apex
38% if closed apex
What are the clinical findings of intrusion?
Crown appears shortened
Bleeding from gingivae
Ankylotic high, metallic percussion tone
How is intrusion treated if there is immature root formation?
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
How is intrusion treated if there is mature root formation of <3mm?
Spontaneous repositioning
If no re-eruption within 8 weeks - reposition surgically and splint for 4 weeks or reposition orthodontically before ankylosis develops
How is intrusion treated if there is mature root formation of 3 - 7mm?
Reposition surgically (preferably) or orthodontically
How is intrusion treated if there is mature root formation of >7mm?
Reposition surgically
Why is endo treatment needed in intrusion where there is mature root formation and when should this be carried out?
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
How should intrusion be followed up?
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
What are the 5 year pulp survival rates for intrusion?
40% if open apex
0% if closed apex
What are the 5 year resorption rates for intrusion?
67% if open apex
100% if closed apex
