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DG2016 - CK 2 > Trauma > Flashcards

Trauma Flashcards

1
Q

What percentage of all schoolchildren experience dental trauma?

A

25%

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2
Q

What is the most common injury to permanent teeth?

A

uncomplicated crown fracture/enamel dentine fracture

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3
Q

What characteristic double the incidence of accidental trauma?

A

overjet >9mm

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4
Q

What history should be taken regarding the injury?

A
  • when, where, how
  • any other symptoms
  • lost teeth/fragments
  • investigate laceration for missing fragment
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5
Q

What medical history should be taken post injury?

A
  • congenital and acquired heart anomalies
  • immunosuppression
  • consult physician
  • vaccination status - tetanus
    these conditions are not contraindications to treatment but appropriate additional abx may need to be given
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6
Q

What extra oral examinations should be undertaken post injury?

A
  • lacerations
  • haematomas
  • haemorrhage
  • subconjunctival haemorrhage
  • bony step deformities
  • mouth opening
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7
Q

What intra oral examinations should be undertaken post injury?

A
  • soft tissue: penetrating wounds, foreign bodies
  • alveolar bone
  • occlusion: traumatic occlusion demands urgent treatment
  • teeth
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8
Q

What 3 things may tooth mobility indicate?

A
  • displacement
  • root fracture
  • bone fracture
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9
Q

What 3 things can transillumination show post injury?

A
  • fracture lines in teeth
  • pulpal degeneration
  • caries
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10
Q

What 3 things can tactile test with probe look for post injury?

A
  • horizontal fractures
  • vertical fractures
  • pulpal involvement
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11
Q

What special investigations can be carried out following injury?

A
  • sensibility tests: thermal & electrical
  • percussion
  • radiographs: additional vertical angle to see root fractures
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12
Q

What 8 things are documented on a trauma stamp/chart?

A
  • mobility
  • displacement
  • TTP
  • colour
  • sinus/tender in sulcus
  • thermal
  • electric (EPT)
  • radiograph
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13
Q

For how long after an injury should sensibility testing be done?

A

5 years
- temp loss of sensibility is a frequent finding during post-traumatic healing, especially post luxations

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14
Q

What are 6 indications of loss of vitality?

A
  • PDL widening
  • arrested root development (though not always)
  • TTP (slightly)
  • slight tenderness in buccal sulcus
  • poor response to sensibility testing
  • discolouration
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15
Q

What are 4 indications that show obvious loss of vitality?

A
  • periapical radiolucency
  • infection
  • pain
  • inflammatory resorption
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16
Q

The prognosis of crown and root fractures can depend on which 5 things?

A
  • age of child: mature/immature tooth
  • type of injury
  • combination of 2 different types of injuries in same tooth will be more detrimental - negative synergistic effect
  • time between injury and treatment
  • presence of infection
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17
Q

What are 4 aims of emergency management treatment?

A
  • try and retain vitality by protecting exposed dentine
  • treat exposed pulp tissue
  • reduction and immobilisation of displaced teeth
  • tetanus prophylaxis if indicated
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18
Q

What are 2 aims of intermediate management treatment?

A
  • +/- pulp treatment
  • restoration: minimally invasive
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19
Q

What are 4 aims of permanent management treatment?

A
  • apexification
  • root filling +/- root extrusion
  • gingival and alveolar collar modification if required
  • coronal restoration
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20
Q

What is the definition of infraction?

A

incomplete enamel fracture without tissue loss

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21
Q

What is the definition of enamel fracture?

A

a fracture confined to the enamel with loss of tooth structure

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22
Q

What is the definition of enamel-dentine fracture?

A

a fracture confined to enamel and dentine with loss of tooth structure, but not involving the pulp

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23
Q

What is the definition of uncomplicated fracture?

A

no pulpal involvement

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24
Q

What investigations should be done for crown fractures?

A
  • PA + soft tissue exam
  • evaluate size of pulp chamber and stage of root development
  • sensibility testing
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25
Q

What material should be used as a liner for fractures within 0.5mm of pulp?

A

calcium hydroxide

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26
Q

What are the 2 treatment options for crown fractures?

A
  • rebond fragment, rehydrate in water or saline for 20 mins prior to rebonding
  • composite dressing
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27
Q

How often should sensibility tests be carried out after trauma?

A

1 month, 3 months, 6 months, 1 year then yearly for 5 years

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28
Q

What clinical test should be carried out after trauma to monitor tooth?

A

trauma stamp

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29
Q

What should be examined on radiographs in order to monitor tooth after trauma?

A
  • root development - width of canal and length
  • comparison with other side
  • internal and external inflammatory resorption
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30
Q

What is the pulp survival rate for open and closed concussion?

A

open - 95%
closed - 85%

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31
Q

What is the pulp survival rate for open and closed subluxation?

A

open - 80%
closed - 50%

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32
Q

What is the pulp survival rate for open and closed extrusion?

A

open - 60%
closed - 20%

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33
Q

What is the pulp survival rate for open and closed lateral luxation?

A

open - 65%
closed - 15%

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34
Q

What is the pulp survival rate for open and closed intrusion?

A

open - 0%
closed - 0%

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35
Q

What is the definition of enamel-dentine-pulp fracture?

A

a fracture involving enamel and dentine with loss of tooth structure and exposure of the pulp

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36
Q

What is the definition of a complicated fracture?

A

involving the pulp

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37
Q

How should a enamel-dentine-pulp fracture be assessed?

A
  • PA
  • evaluate like uncomplicated crown fracture
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38
Q

What factors does treatment depend upon for a enamel-dentine-pulp fracture?

A
  • size of exposure
  • time since exposure

prognosis depends on: associated luxation injuries

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39
Q

What is the treatment for a tiny exposure and within 24 hours of trauma for enamel-dentine-pulp fracture?

A
  • direct pulp cap with calcium hydroxide
  • hermetic seal (composite)
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40
Q

What is the treatment for a large exposure or more than 24 hours since trauma for enamel-dentine-pulp fracture?

A
  • pulpotomy - partial (Cvek) or full coronal: with Biodentine, white MTA
  • hermetic seal (composite)
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41
Q

What is the treatment for a large exposure with no vital tissue remaining in the coronal portion after enamel-dentine-pulp fracture?

A
  • pulpectomy (open apex) - calcium hydroxide, then MTA/biodentine to produce apical stop and then obturate
  • pulpectomy and conventional root treatment in closed apex tooth
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42
Q

Which treatment is being described?
- LA and rubber dam
- pulp tissue (2-3mm) excised with diamond bur
- normal bleeding stops with moist cotton wool
- rinse gently with sterile saline
- apply biodentine/calcium hydroxide dressing to pulp
- hermetic seal with composite

A

partial pulpotomy

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43
Q

Which treatment is being described?
- after doing a partial pulpotomy, if no bleeding/uncontrollable bleeding proceed to this treatment
- excised all pulp in chamber with excavator/round bur
- normal bleeding stops with moist cotton roll
- rinse gently with sterile saline
- apply biodentine/calcium hydroxide dressing to pulp
- hermetic seal with composite
- rebonding a fragment can still be done after rehydration and after the pulp has been treated

A

full coronal pulpotomy

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44
Q

What is the success rate of a partial pulpotomy?

A

97%

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45
Q

What is the success rate of a full coronal pulpotomy?

A

75%

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46
Q

What are 6 advantages of MTA?

A
  • sets in a wet environment
  • good sealing properties
  • easy to visualise radiographically
  • not soluble
  • doesn’t interact with other materials
  • some antibacterial properties
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47
Q

Which 2 radiographs can be taken to investigate root fractures?

A
  • PA
  • upper standard occlusal

from at least 2 angles

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48
Q

What is the treatment for an undisplaced, not mobile root fracture?

A

soft diet and monitor vitality

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49
Q

What is the treatment for a displaced and mobile root fracture?

A
  • reposition
  • splint
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50
Q

How long should a tooth be splinted following a root fracture in the apical/middle third?

A

flexible splint for 4 weeks

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51
Q

How long should a tooth be splinted following a root fracture in the coronal third?

A

flexible splint for 4 months

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52
Q

Which type of root fractures require longer splinting for stability and take longer to heal?

A

coronal third fracture

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53
Q

What are 3 potential outcomes for a healing root fracture injury?

A
  • calcified tissue union across fracture line
  • connective tissue
  • calcified and connective tissue
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54
Q

What is a potential outcome for a non-healing root fracture injury?

A
  • granulation tissue (usually associated with loss of vitality)
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55
Q

What is the splinting time for a subluxation?

A

passive-flexible 2 weeks

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56
Q

What is the splinting time for an extrusion?

A

passive-flexible 2 weeks

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57
Q

What is the splinting time for a luxation?

A

passive-flexible 4 weeks

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58
Q

What is the splinting time for an avulsion?

A

passive-flexible 2 weeks

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59
Q

What is the splinting time for an apical/middle third root fracture?

A

passive-flexible 4 weeks

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60
Q

What is the splinting time for a coronal third fracture?

A

passive-flexible 4 months

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61
Q

What is the splinting time for a dento-alveolar fracture?

A

passive-flexible 4 weeks

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62
Q

What size wire should be used for splinting?

A

<0.4mm, labial placement

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63
Q

What is the definition of crown-root fractures not involving the pulp?

A

fracture involving enamel, dentine and cementum with loss of tooth structure, but not exposing the pulp

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64
Q

What is the definition of crown root fracture involving the pulp?

A

a fracture involving enamel, dentine and cementum with loss of tooth structure and exposure of the pulp

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65
Q

What are the treatment options for crown root fractures?

A
  • extract coronal portion: 1.root-fill, extrude root and restore, 2.root fill if possible then cover root with mucoperiostial flap and retain, this maintains height and width of alveolus
  • extract whole tooth and restore space
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66
Q

What are 5 requirements for extrusion?

A
  • good OH, low caries rate
  • sufficient adjacent teeth
  • eventual position - crown/root ratio not <50:50
  • will 4-6mm of rapid extrusion over 4-6 weeks bring the fractured surface coronal to the biological width?
  • some gingiva and bone removal often required after extrusion
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67
Q

What is the most common primary teeth trauma?

A

luxation

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68
Q

What is the peak incidence age of primary traumas?

A

2-4 years

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69
Q

What percentage of injury in the primary dentition are enamel cracks, enamel dentine fractures and enamel dentine pulp fractures?

A

7-13%

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70
Q

What percentage of injury in the primary dentition are crown root fractures?

A

2%

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71
Q

What percentage of injury in the primary dentition are root fractures?

A

2-4%

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72
Q

What percentage of injury in the primary dentition are luxations?

A

62-69%

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73
Q

What percentage of injury in the primary dentition are avulsions?

A

7-13%

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74
Q

What percentage of risk is there of risk of damage to the permanent tooth?

A

50%

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75
Q

A duller note with percussing tooth may indicate what?

A

root fracture

76
Q

What type of radiographs can be used to assess post injury?

A
  • intra oral
  • anterior occlusal
  • lateral pre-maxilla
  • OPG
  • soft tissue radiograph
  • CBCT
77
Q

What information does a trauma stamp/chart document?

A
  • mobility
  • displacement
  • occlusion
  • colour
  • sinus/tender in sulcus
  • radiograph
  • TTP
  • vitality
78
Q

What are the 9 classifications of dental trauma?

A
  • enamel fracture: uncomplicated
  • enamel-dentine fracture: uncomplicated
  • enamel-dentine-pup fracture: complicated
  • crown-root (pulp involved)
  • root fracture
  • alveolar fracture
  • concussion/subluxation
  • luxation: lateral, intrusive, extrusive
  • avulsion
79
Q

What advice should be given to all post injuries?

A
  • soft diet for 10-14 days
  • brush teeth with soft toothbrush after every meal
  • topical chlorhexidine by parent 2x daily for one week
  • after initial treatment, review after a week and then 1, 3, 6 monthly taking radiographs if possible 6 monthly
  • intrusion requires review 1 week then with diagnosis 4 week, 2 month, 6 month, 1 year
  • radiograph initially then 6 monthly
80
Q

After treatment, how often should patients attend for review of tooth?

A
  • 1 week after treatment
  • 1 monthly
  • 3 monthly
  • 6 monthly
81
Q

Intrusion injuries require how many reviews?

A
  • 1 week after treatment
  • 4 weeks with X-rays
  • 2 monthly
  • 6 monthly
  • 1 year
82
Q

How often should radiographs be taken to assess tooth post injury?

A

6 monthly

83
Q

What are the treatment guidelines for enamel fractures and enamel-dentine fractures?

A
  • smooth sharp edges
  • restore compomer/composite
84
Q

What are the treatment options for enamel-dentine-pulp fractures?

A
  • RCT
  • extract
85
Q

What are the treatment options for crown-root fractures and root fractures?

A
  • extract coronal fragment
  • fragments that aren’t obvious, should be left to resorb physiologically
86
Q

What are the treatment guidelines for alveolar fractures?

A
  • reposition segment, splint to adjacent teeth 3-4 weeks
  • teeth may need to be extracted after alveolar stability has been achieved
87
Q

What is the treatment guideline for a concussion/subluxation?

A

observation

88
Q

At what age does 65% pulp necrosis and 84% premature tooth loss occur as a complication post concussion/subluxation?

A

aged 4+

89
Q

What are the treatment decisions based upon following a lateral luxation?

A
  • degree of displacement
  • mobility
  • occlusal interference
90
Q

What percentage of cases following lateral luxation realign spontaneously within 1 year?

A

95%

91
Q

What is being assessed when taking a radiograph following lateral luxation?

A

increased periodontal ligament space apically

92
Q

What is the treatment guidelines for no occlusal interference following lateral luxation?

A

allow to position spontaneously

93
Q

What is the treatment guidelines for an occlusal interference following lateral luxation?

A

extract

94
Q

What is an indication as to no collision with the permanent tooth bud following a lateral luxation?

A
  • tooth would appear shorter on radiograph
  • crown would be pushed palatally, root would be pushed buccally therefore avoid permanent tooth
95
Q

What is an indication as to a collision with the permanent tooth bud following a lateral luxation?

A
  • tooth would appear longer on radiograph
  • crown would be pushed buccally, root would be pushed palatally therefore colliding with permanent tooth
96
Q

What are the treatment guidelines for an intrusion?

A
  • allow spontaneous eruption
  • follow up: 1 week then radiographs 4 weeks, 2 months, 6 months, 1 year
97
Q

When assessing radiographic findings post intrusive luxation, what would the following indicate?
- when the apex is displaced toward or through the labial bone plate the apical tip can be visualised and tooth appears shorter than the unaffected contralateral tooth

A

no collision with permanent tooth bud

98
Q

When assessing radiographic findings post intrusive luxation, what would the following indicate?
- when the apex is displaced toward the permanent tooth germ, the apical tip cannot be visualised and the tooth appears longer

A

collision with permanent tooth

99
Q

Which injury is the most likely to cause injury to the permanent successor?

A

intrusion

100
Q

What are the treatment guidelines for extrusion?

A
  • significant: extract
  • mild can be left
101
Q

What are the treatment guidelines for avulsion of a primary tooth?

A
  • radiograph to confirm
  • do not replant
  • risk of: aspiration, damage to permanent tooth
102
Q

What are 3 long term effects of injured primary tooth?

A
  • discolouration
  • infection
  • delayed exfoliation
103
Q

What are 3 long term effects of injured permanent successors?

A
  • enamel defects 44%
  • abnormal tooth/root morphology 8%
  • delayed eruption 1%
104
Q

What age range is most likely to have trauma to the permanent successor following injury?

A

under 4

105
Q

What may reddish colour immediately following injury indicate?

A

haemosiderin in tubules may regress/remain and maintain vitality

106
Q

What may brown/black colour in the following weeks after injury indicate?

A

pulp breakdown products in tubules
non-vital

107
Q

What may yellow/opaque colour in the following months after injury indicate?

A

pulp calcification

108
Q

What is the treatment for primary dentition for non vital tooth with sinus of periapical pathology?

A

RCT or extract

109
Q

What is the treatment for primary dentition for non vital tooth without sinus or periapical pathology?

A

leave and review

110
Q

If following injury, primary tooth does not resorb normally, XLA must be done to avoid what?

A

permanent successor erupting ectopically

111
Q

A potential long term defect to a permanent successor following injury could be hypo mineralisation. How would this present?

A

white/yellow spot, normal thickness of enamel

112
Q

A potential long term defect to a permanent successor following injury could be hypomineralsation and hypoplasia. How would this present?

A

yellow/brown with missing enamel

113
Q

What is the treatment for crown dilacerations?

A

surgical exposure, ortho realignment, improve appearance

114
Q

What is the treatment for root dilaceration/angulation/duplication?

A

combined surgical and ortho

115
Q

What is the treatment for arrest of root development?

A

RCT/XLA

116
Q

What is the treatment for odontome?

A

surgical removal

117
Q

What is the treatment for undeveloped tooth germ?

A

may sequestrate spontaneously or require removal

118
Q

Premature loss of a primary tooth can result in delayed eruption of 1 year due to what?

A

thickened mucosa
- take X-ray is greater than 6 month delay compared to contralateral tooth
- surgical exposure and ortho may be required if abnormal morphology

119
Q

Which type of PDL injury is the following?
- injury to the tooth supporting structures without increased mobility or displacement of the tooth, but with pain to percussion

A

concussion

120
Q

Which type of PDL injury is the following?
- injury to the tooth supporting structures resulting in increased mobility, but without displacement of the tooth, bleeding from the gingival sulcus confirms the diagnosis

A

subluxation

121
Q

What is the treatment for a subluxation?

A
  • occlusal relief
  • flexible splint 2 weeks
122
Q

Which clinical testing should be carried out for concussion, subluxation, extrusion and lateral luxation injuries?

A

trauma stamp

123
Q

What sensibility testing should be carried out for concussion, subluxation, extrusion and lateral luxation injuries and at what intervals?

A
  • thermal and electrical
  • at time of injury
  • 1 month, 3 months, 6 months, 1 year then annually for 5 years
124
Q

What should be assessed on radiographs following concussion, subluxation, extrusion and lateral luxation injuries?

A
  • root development - width of canal and length
  • comparison with other side
  • internal and external inflammatory resorption
125
Q

Which type of PDL injury is the following?
- partial displacement of the tooth out of its socket

A

extrusion

126
Q

Which type of PDL injury is the following?
- displacement of the tooth other than axially. Displacement is accompanied by fracture of either the labial or the palatal/lingual alveolar bone

A

lateral luxation

127
Q

What is the treatment for a lateral luxation?

A
  • reposition under LA
  • flexible splint 4 weeks
128
Q

What is the treatment for an extrusion?

A

flexible splint 2 weeks

129
Q

What is the 5 year pulp survival percentage for an open and closed apex post concussion?

A

open - 100%
closed - 96%

130
Q

What is the 5 year pulp survival percentage for an open and closed apex post subluxation?

A

open - 100%
closed - 85%

131
Q

What is the 5 year pulp survival percentage for an open and closed apex post extrusion?

A

open - 95%
closed - 45%

132
Q

What is the 5 year pulp survival percentage for an open and closed apex post lateral luxation?

A

open - 95%
closed - 25%

133
Q

What is the 5 year pulp survival percentage for an open and closed apex post intrusion?

A

open - 40%
closed - 0%

134
Q

What is the 5 year pulp survival percentage for an open and closed apex post avulsion/replantation?

A

open - 30%
closed - 0%

135
Q

What is the management of intrusion injuries with open apex?

A
  • allow re-eruption without intervention
  • if no re-eruption within 4 weeks, start orthodontic repositioning
  • monitor to see if root canal needed
136
Q

What is the management of intrusion injuries with closed apex?

A
  • depending on the degree of intrusion:
  • <3mm: allow re-eruption without intervention, if no re-eruption within 4 weeks, reposition surgically and splint for 2 weeks or reposition orthodontically
  • 3-7mm: reposition surgically or orthodontically
  • > 7mm: surgically reposition, flexible splint 4 weeks
137
Q

What is the 5 year resorption percentage rate for open and closed apex post concussion?

A

open - 1%
closed - 3%

138
Q

What is the 5 year resorption percentage rate for open and closed apex post subluxation?

A

open - 1%
closed - 3%

139
Q

What is the 5 year resorption percentage rate for open and closed apex post extrusion?

A

open - 5%
closed - 7%

140
Q

What is the 5 year resorption percentage rate for open and closed apex post lateral luxation?

A

open - 3%
closed - 38%

141
Q

What is the 5 year resorption percentage rate for open and closed apex post intrusion?

A

open - 67%
closed - 100%

142
Q

What is the 5 year resorption percentage rate for open and closed apex post avulsion/replantation?

A

frequent

143
Q

What sensibility tests should be done for an intrusion injury and at what intervals?

A
  • thermal and electrical
  • at time of injury, 1 month, 3 months, 6 months for an average of 2 years
144
Q

Which traumatic injury is the following?
- the tooth is completely displaced out of its socket. Clinically the socket is found empty or filled with a coagulum

A

avulsion

145
Q

What is the treatment for a avulsion injury with an open apex?

A

replant and splint for 2 weeks
- root canal treatment should be avoided unless there is evidence of pulp necrosis

146
Q

What is the treatment for an avulsion injury with a closed apex?

A

replant and splint for 2 weeks
- initiate root canal treatment within 2 weeks

147
Q

What first aid advice should be given for avulsion injuries?

A
  • hold by crown
  • rinse root in milk/saline/saliva (max 10 secs) to wash off any foreign debris
  • either:
    replant into socket; patients bites on gauze and goes to dentist OR
    place into storage medium and go to dentist
  • do not let the tooth get dry
148
Q

What are 4 storage mediums for an avulsion in order of preference?

A
  • milk
  • patient saliva
  • normal saline
  • HBSS
149
Q

Best outcomes are achieved if replantation is done within within time frame?

A

15 mins

150
Q

Extra-alveolar dry time post avulsion of over 5 mins leads to what?

A

significant root damage

151
Q

Extra-alveolar dry time post avulsion of 30 mins leads to what?

A

most PDL cells are non-viable

152
Q

Extra-alveolar dry time post avulsion of over 1 hour leads to what?

A

no vital PDL cells remain

153
Q

What is the critical extra-alveolar time (how long out the mouth even if tooth has been in storage medium)?

A

6 hours max

154
Q

What are 3 critical factors for replantation success?

A
  • extra alveolar dry time
  • extra alveolar time
  • type of storage medium
155
Q

Which class is the following for an avulsed tooth?
- PDL cells most likely viable. Tooth has been replanted immediately or less than 15 mins

A

1

156
Q

What class is the following for an avulsed tooth?
- PDL cells may be viable but compromised. Tooth has been in a storage medium and total EADT less than 60 mins

A

2

157
Q

Which class is the following for an avulsed tooth?
- PDL cells likely non-viable. Total EADT more than 60 mins regardless of having been in a medium or not

A

3

158
Q

What is the treatment for a replantation with a closed apex where the tooth has been replanted immediately or within 15 mins?

A
  • clean with saline, water or chlorhex
  • verify correct position clinically and radiographically
  • leave tooth (if slightly malpositioned, correct with digital pressure)
  • give LA (no evidence to support no vasoconstrictor)
  • if in wrong socket or rotated then correct within 48 hours
  • passive and flexible splint, labial surface for 2 weeks
  • if associated alveolar fracture - 4 weeks splinting
  • initiate RCT within 2 weeks
  • give systemic abx/check tetanus status
159
Q

If there is an associated alveolar fracture post avulsion injury, what is the splinting time?

A

4 weeks

160
Q

RCT should be initiated within which time frame of a closed apex avulsion injury?

A

within 2 weeks

161
Q

What is the ideal flexible splint size?

A

< 0.4mm

162
Q

What is the treatment for a replantation with a closed apex where the tooth has been in a storage medium and EADT <60 mins OR EADT > 60 mins?

A
  • rinse visible contamination on root surface with stream of saline
  • remove debris by agitating in a storage medium or saline soaked gauze
  • leave tooth in storage medium whilst getting history
  • give LA
  • irrigate socket with saline
  • examine socket, remove coagulum with stream of saline, if fracture then reposition with suitable instrument
  • reposition with slight digital pressure, verify position clinically and rad
  • passive and flexible splint - 2 weeks
  • if associated alveolar fracture - 4 weeks splinting
  • initiate RCT within 2 weeks
  • give systemic abx and check tetanus status
163
Q

What is the treatment for a replantation with an open apex where the tooth has been replanted immediately or within 15 mins?

A
  • clean injured area
  • verify position clinically and rads
  • leave tooth (if slightly malpositioned, correct with digital pressure)
  • give LA
  • if in wrong socket then correct within 48 hours
  • passive and flexible splint for 2 weeks
  • if associated alveolar fracture, splint for 4 weeks
  • if no revascularisation occurs then start RCT soon as pulp necrosis/infection identified
  • give system abx and check tetanus status
164
Q

What is the treatment for a replantation with a open apex where the tooth has been in a storage medium and EADT <60 mins OR EADT > 60 mins?

A
  • rinse visible debris on root surface with stream of saline or agitating in a storage medium
  • leave tooth in storage medium whilst getting history
  • give LA
  • irrigate socket with saline
  • examine socket, remove coagulum with stream of saline, if a fracture then reposition with suitable instrument
  • reposition with slight digital pressure, verify position clinically and rads
  • passive and flexible splint for 2 weeks
  • if associated alveolar fracture, 4 weeks splint
  • if no revascularisation occurs then start RCT as soon as necrosis/infection identified
  • give systemic abx/check tetanus status
165
Q

What are 3 benefits of replantation?

A
  • restore aesthetics, function whilst maintaining alveolar contour, width and height
  • keep future treatment options open
  • decision to replant is always the correct one, even if extra oral time is over 60 mins
166
Q

Which abx would be given for an avulsion injury?

A

penicillin

167
Q

Which abx would be given for an avulsion injury if penicillin allergy or under 12 years of age?

A

doxycycline

168
Q

What treatment would be done for a closed apex post avulsion injury and RCT is indicated?

A
  • calcium hydroxide within 2 weeks of replantation, left for 1 month then RCT
    OR
  • corticosteroid or corticosteroid/Ab placed immediately after replantation and left for 6 weeks then RCT
169
Q

What treatment would be done for an open apex post avulsion injury and RCT is indicated?

A
  • RCT if pulp necrosis and infection seen at follow up
  • specification procedure - MTA/biodentine apical plug then backfill with GP
  • regenerative endodontics
  • keeping calcium hydroxide in canal if progressive resorption
170
Q

If there is pulp necrosis/infection following avulsion in an open apex, then which process will be rapid in children?

A

infection related resorption

171
Q

What is the review cycle for patients with an open apex post avulsion injury?

A
  • 1 month, 2 month, 3 month, 6 months, 1 year then annually for 5 years
172
Q

Which type of injury is the following?
- a fracture of the alveolar process, may or may not involve the alveolar socket

A

dentoalveolar fracture

173
Q

What is the treatment for a dentoalveolar fracture?

A
  • reposition under LA - apical lock may be present
  • flexible splint for 4 weeks
  • abx
174
Q

Which type of resorption is the following?
- damage to PDL which subsequently heals
- non-progressive

A

external surface resorption

175
Q

Which type of resorption is the following?
- damage to PDL initially, maintained and propagated by necrotic pulp tissue via dentinal tubules
- progressive
- root surfaces indistinct, tramlines of root canal intact

A

external infection related resorption

176
Q

What is the treatment for an external infection related resorption?

A
  • pulp extirpation
  • mechanical and chemical irrigation, calcium hydroxide
  • change calcium hydroxide every 3 months to try and halt resorption
  • obturate when bone repair is visible radiographically
  • if progressive resorption then change calcium hydroxide every 6 months and plan ahead for prosthetic replacement
177
Q

Which type of resorption is the following?
- initiated by non-vital pulp
- progressive
- tramlines of root canal indistinct
- root surfaces intact

A

internal infection related resorption

178
Q

Which type of resorption is the following?
- initiated by severe damage to the PDL and cementum, normal repair does not occur, bone fused directly to dentine
- progressive, tooth gradually resorbed as it is now part of bone remodelling
- diagnosis: loss of PDL and lamina dura
- treatment: nil

A

ankylosis related resorption

179
Q

Which post injury complication is the following?
- commoner in open apex teeth with severe luxation
- common also in root fracture teeth
- indicates some vital pulp in canal
- progressive hard tissue formation within pulp cavity
- gradual narrowing of pulp chamber and pulp canal - total or partial obliteration
- treatment: conservative

A

pulp canal obliteration

180
Q

What damage may occur to permanent successor after an intrusion injury to a primary tooth during apposition?

A

hypoplasia

181
Q

What damage may occur to permanent successor after an intrusion injury to a primary tooth during calcification?

A

hypocalcification

182
Q

What damage may occur to permanent successor after an intrusion injury to a primary tooth during root formation?

A

dilaceration

183
Q

What percentage is the risk of damage to permanent successor following trauma to primary teeth?

A

50%

184
Q

What is the initial patient management following a trauma to primary teeth?

A
  • reassure
  • history
  • examination
  • photographs
  • diagnosis
  • emergency treatment
  • advise parent of 50% risk to permanent successor damage
  • further treatment and review
185
Q

What extra-oral examination should be undertaken for a primary trauma?

A
  • laceration
  • haematoma
  • haemorrhage/CSF
  • subconjuctival haemorrhage
  • bony step deformities
  • mouth opening
186
Q

What intra-oral examination should be undertaken for a primary trauma?

A
  • soft tissue
  • alveolar bone
  • occlusion
  • teeth

DG2016 - CK 2 (10 decks)

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