Trauma

Question 1

Cvek pulpotomy technique

Answer 1

Placement of powder CaOH onto hemostasis achieved pulp in 2x2mm, seal over vitrebond, dentin-only, then composite to buildup tooth (final restoration if possible)

Question 2

Tooth #9 of an 11 yo boy was avulsed. The tooth was immediately placed in cold milk after avulsion, kept in milk for 20 minutes and was replanted. Which statement is correct regarding splinting and pulp extirpation?

Answer 2

Since the tooth has closed apex, pulp extirpation is necessary regardless of the extra oral time

Question 3

Calcium Hydroxide is used as the treatment of choice in progressive inflammatory root resorption. Which statement is NOT correct about characteristics of Calcium Hydroxide that arrests root resorption?

Answer 3

Its alkaline pH is favorable for collagenase and acid hydrolase activity

Question 4

Pulp survival when DPC performed vs. Cvek pulpotomy

Answer 4

Pulp survival is increased when performing Cvek pulpotomy

Question 5

Pulp survival for immature vs mature roots after complicated fractures

Answer 5

Pulp survival much higher in immature root development vs. mature roots

Question 6

Revascularization of teeth after trauma happens when apical foramen size is larger than…

Answer 6

1mm in diameter

Question 7

Continued root development is dependent on survival of what type of cell?

Answer 7

Odontoblast survival for root formation

Question 8

Only teeth that have a chance for revascularization are ones with what type of root development?

Answer 8

Very immature root development

Question 9

Replacement resorption =

Answer 9

bone ingrowth and ankylosis

Question 10

What is the best transport medium after HBSS?

Answer 10

Milk

Question 11

What are the characteristics of milk as a storage medium?

Answer 11

Unique combination of ingredients
Maintains PDL cell vitality- shown to survive for 2-6 hrs when immersed
Physiological pH of 6.5-7.2
Commonly found storage medium
Low cost
Benefits of accessibility outweigh HBSS effectiveness
Should store teeth in cold milk (if storing for an extended period of time)

Question 12

What PDL component determines positive outcome for avulsed teeth?

Answer 12

Survivability of PDL cells

Question 13

Room temp or cold milk for storage of avulsed teeth?

Answer 13

Cold milk is much better than room temp

Question 14

External root resorption (ERR)typically results after…

Answer 14

Avulsion

Question 15

Types of external root resorption (ERR)

Answer 15

Inflammatory and replacement (resorption)

Question 16

Risk factors for ERR

Answer 16

younger patients
more immature tooth
poor transport medium
contamination
additional crown fracture
delay in pulpectomy
splinting type and time
systemic antibiotics

Question 17

Delayed pulpectomy increases risk of severe inflammatory ERR by what percentage/day?

Answer 17

0.5%
1.1-1.2% per day
Get the patient back in for pulp extirpation

Question 18

Replacement resorption is a function of growth because it is related to…

Answer 18

increased bone turnover, especially during periods of rapid growth

Question 19

10 y.o. vs 17 y.o. avulsion with all other factors the same- Replacement resorption, higher risk in which pt?

Answer 19

Higher risks in 10 y.o.; Better results in 17 y.o. concerning replacement resorption because of less bone resorption occurring

Question 20

Why do we do the pulp extirpation?

Answer 20

Removal of necrotic pulp leads to

Question 21

From dog study, the effect of corticosteroids on inflammatory root resorption…

Answer 21

Corticosteroids can reduce the amount of early external inflammatory root resorption, however, this is not necessarily clinically significant because of so many other factors that affect survival of teeth after avulsion

Question 22

Longer dry-time prior to reimplantation

Answer 22

Poorer prognosis for tooth survival

Question 23

Role of the splint

Answer 23

Keep the tooth in the socket
Not to prevent another avulsion
Not to totally immobilize the tooth

Question 24

How to evaluate teeth

Answer 24

Initial injury
EPT
Sensibility testing
Periapical response

Question 25

When reevaluating teeth after trauma, which responses to testing after PCO are considered healthy?

Answer 25

Teeth that had no clinical s/s, PAI <2, normal or high normal responses to EPT - should be considered healthy and no tx indicated

Question 26

Which testing results when reevaluating teeth after trauma, when to recommend yearly recalls after PCO?

Answer 26

Teeth that have mild s/s, PAI < /= to 2, norm to high norm or negative responses to EPT - recommend yearly recalls

Question 27

Which testing results when reevaluating teeth after trauma, when to initiate endodontic tx?

Answer 27

teeth with s/s, percussion tenderness, PAI >/=3, no response to EPT - endodontic tx should be initiated

Question 28

External resorption: progressive inflammatory

Answer 28

Ortho- due to tissue pressure and stops when treatment is done
Endo- infection sustained (complete RCT to stop)
Displacement injuries- extrusion, intrusion, repositioning

Question 29

CaOH characteristics

Answer 29

High pH to kill bacteria
Creates a favorable environment for repair
Neutralizes macrophages and osteoclasts
Inhibits collagenase and acid hydrolase activity of resorbing cells
Prevents continuation of resorptive process and stimulates late repair

Question 30

Cervical resorption