Supporting Tissue Injuries Flashcards
What are the three structures of the tooth which can be affected during traumatic injury ?
Surrounding bone, neuromuscular bundle, root surface.
What is an example of a separation injury ?
Extrusive luxation.
What is an example of a crushing injury ?
Intrusive luxation.
Define a separation injury.
Cleavage of intercellular structures i.e. collagen, causing limited damage to cellular structures. Wound healing can occur from existing cellular structures.
Define crushing injury ?
Damage to cellular and inter-cellular systems, meaning damaged tissue must be removed by macrophages and/or osteoclasts before restoration causing delayed healing time.
Define concussion.
Injury to tooth supporting structures without abnormal loosening or displacement of tooth.
What are the clinical findings you would expect to see for concussion injury ?
Pain on percussion.
Normal mobility.
Retained in normal position in arch.
No abnormal radiographic radiolucency.
What follow up would be required for concussion injury ?
Clinical and radiographic review at 4 weeks and 1 year post-injury.
Define subluxation.
An injury to tooth supporting structures with abnormal loosening but without tooth displacement.
What clinical findings would you expect to see in a subluxation injury ?
Increased mobility.
Tender to percussion.
Bleeding from gingival crevice (may or may not be present).
No displacement of tooth.
Normal radiographic appearance.
What treatment would be required for subluxation injury ?
Normally nothing.
Passive or flexible splint for 2 weeks post-injury where excessive mobility or tenderness when biting.
What follow up would be required for subluxation injury ?
Clinical and radiographic review.
2 weeks - splint removal.
12 weeks.
6 months.
1 year.
What monitoring tools (special tests) can be used for concussion and subluxation injuries ?
Trauma stamp.
Sensibility test.
Radiographs - track root development, comparison with contra-lateral tooth, resorption.
What 8 assessments should be made in trauma stamp ?
TTP.
Sinus.
Colour.
Mobility.
Percussion.
Ethyl chloride.
EPT.
Radiograph.
Define extrusion.
Injury which tooth suffers axial displacement partially out of the socket.
What clinical finding would be expected following extrusion injury ?
Tooth appears elongated.
Usually displaced palatally.
Tooth mobile.
Bleeding from gingival sulcus.
Radiographically -
- Widened PDL apically and laterally.
- Crown elongated and tooth not fully seated within alveolar bone.
What treatment would be required for extrusion injury ?
Reposition tooth with LA.
Passive flexible splint for 2 weeks. If fracture to marginal supporting bone - additional 4 weeks.
What follow up would be required for extrusion injury ?
2 weeks - splint removal.
4 weeks.
8 weeks.
12 weeks.
6 months.
1 year.
Annually for 5 years.
Define lateral luxation.
Displacement of tooth in socket in direction other than axially. Accompanied by communication or fracture of alveolar bone plate or facial cortical bone.
What clinical findings would you expect following lateral luxation ?
Tooth appears displaced in socket.
Tooth immobile as tooth becomes locked in bone.
High ankylotic percussion tone (metallic tone).
May or may not - bleeding from gingival sulcus.
Root apex palpable in sulcus.
Radiograph - widened PDL space - may need 2x radiographs.
What treatment would be required for lateral luxation injury ?
Reposition with LA.
Passive flexible splint - 4 weeks.
Monitor with endodontic evaluation (2 weeks) - if necrotic, extirpate.
What is the prognosis and healing which can be expected following lateral laxation injury in a tooth with incomplete root formation (with immature apice) ?
Spontaneous revascularisation.
Necrotic pulp and signs of infection related inflammation external resorption - start RCT - specialist paediatric consultant treatment.
What is the prognosis and healing which can be expected following lateral laxation injury in a tooth with complete root formation (with mature apice) ?
Necrotic pulp - start RCT.
Corticosteroid and antibiotic or CaOH - intra oral medicament to prevent development of infection-related inflammation external resorption.
What follow up should be given post-lateral luxation injury ?
Clinical and radiographic assessment.
2 weeks - endo assessment.
4 weeks - splint removal.
8 weeks.
12 weeks.
6 months.
1 year.
Annually for 5 years.
Define intrusion.
Tooth forced into socket in axial direction and locked into bone.
What clinical findings should be expected for intrusion injury ?
Shortened crown.
Bleeding for gingivae.
Ankylotic percussion tone.
Immobile.
2x radiographs to visualise.
What treatment should follow intrusion of tooth with immature root formation ?
Spontaneous repositioning of tooth.
No-eruption after 4 weeks ? Ortho treatment.
Monitor pulp condition.
Spontaneous revascularisation can occur.
Necrotic and signs of infection-related inflammatory external resorption - start RCT ASAP.
What treatment should follow intrusion of <3mm of tooth with mature root formation ?
Spontaneous repositioning.
No eruption in 8 weeks ? Reposition surgically and splint for 4 weeks OR reposition ortho before ankylosis.
What treatment should follow intrusion of 3-7mm of tooth with mature root formation ?
Reposition surgically or orthodontically.
What treatment should follow intrusion of >7mm of tooth with mature root formation ?
Reposition surgically.
What is the most likely prognosis for a intruded mature tooth with complete root formation ?
Will almost always become necrotic.
Start end treatment at 2 weeks or as soon as tooth position allows.
What does RCT of traumatised tooth aim to prevent ?
Aims to prevent development of inflammatory (infection-related) external resorption and ankylosis.
What follow up should be given after intrusion injury ?
2 weeks.
4 weeks - splint removal.
8 weeks.
12 weeks.
6 weeks.
1 year.
Annually for 5 years.
