Trauma

Question 1

Displacement, single tooth mobility, radiograph sign of root fracture
what is the diagnosis

Answer 1

root fracture

Question 2

displacement, single tooth mobility, no radiographic sign of root fracture
what is the diagnosis

Answer 2

extrusion

Question 3

displacement, no single tooth mobility, multiple teeth moving as a unit
what is the diagnosis

Answer 3

alveolar fracture

Question 4

displacement, no single tooth mobility, no multiple teeth moving as a unit
what is the diagnosis

Answer 4

intrusion or lateral luxation

Question 5

what is the management of root fracture

Answer 5

if coronal fragment is displaced , reposition and confirm radiographically. Stabilise for 4 weeks with passive and flexible splint, monitor pulpal status for a year. If fracture is above the alveolar crest consider extraction of segment and post core crown. Other options are orthodontic/surgical extrusion, crown lengthening or extraction

Question 6

what is the management of extrusion

Answer 6

reposition and splint for 2 weeks, extra 4 weeks if fracture of the marginal bone. monitor pulpal status

Question 7

what is the management of alveolar fracture

Answer 7

reposition segment and splint with passive flexible for 4 weeks. suture gingival lacerations and do not start root treatment, monitor pulpal status

Question 8

what is the management of intrusion for a tooth with incomplete root formation

Answer 8

allow for re-eruption without intervention for 4 weeks. no re-eruption orthodontic repositioning, monitor pulp status, RCT if needed

Question 9

what is the management of intrusion for a tooth with complete root formation

Answer 9

< 3mm allow for re-eruption, if no re-eruption at 8 weeks, then surgical respositioning and splint. 3-7 mm resposition surgically/orthdontically. >7mm surgical resposition, pulp death is likely, initiate RCT at 2 weeks or when tooth position allows. Use a corticosteriod antibiotic cream or calcium hydroxide as an intra-canal medicament to prevent external resorption

Question 10

what is the management of lateral luxation

Answer 10

resposition and splint 4 weeks using a passive and flexible splint, additional splinting may be required if fracture of the marginal bone/alveolar socket wall. assess need for pulpal intervention at 2 weeks, therapy should be based on root formation if completing RCT then use a corticosteriod antibiotic cream or calcium hydroxide as an intra-canal medicament to prevent external resorption

Question 11

no displacement, mobility, tender to precussion
whats the diagnosis

Answer 11

subluxation

Question 12

no displacement, mobility, no tender to precussion
what is the diagnosis

Answer 12

no fracture, crown fracture or crown-root fracture

Question 13

no displacement, no mobility
what is the diagnosis

Answer 13

concussion

Question 14

what is the management of subluxation

Answer 14

no treatment needed, monitor pulp status for a year

Question 15

what is the management of enamel fracture

Answer 15

depending on fragment size, bond fragment back on or restore with composite resin

Question 16

what is the management of enamel-dentine fracture

Answer 16

if available, bond fragment back on after rehydrating in saline for 20 mins or restore with GIC/composite resin. if the exposed dentine is within 05mm of the pulp, place CaOH liner and restore with GIC

Question 17

what is the management of enamel-dentine-pulp fracture

Answer 17

partial pulpotomy/pulp cap followed by bonding rehydrated fragment or GIC/composite restoration if post required for crown retention then RCT first

Question 18

what is the management of crown-root fracture with no pulpal exposure

Answer 18

stabilise mobile fragment, if not possible extract and cover with GIC/composite. Long term options - orthodontic extrusion of non-mobile fragment +/- RCT or crown lengthening, extraction, autotranplantation or root submergence

Question 19

what is the management of crown-root fracture with pulpal exposure

Answer 19

stabilise or extract mobile fragment. Immature roots - carry out pulpotomy unless <1mm exposure and <24 hrs then perform partial pulpotomy. Mature roots - pulpectomy + GIC/composite restore. Long term - RCT and permanent restoration. Other managements: orthodontic/surgical extrusion, crown lengthening, extraction, autotransplantation and root submergence

Question 20

what is the management of concussion

Answer 20

no treatment, monitor pulp status for a year. if excessive mobility stabilise for 2 weeks

Question 21

what do you do if you have an avulsed tooth

Answer 21

clean and soak the tooth in saline to remove dead cells from root surface, irrigate socket with saline, resposition any socket fracture with suitable instruments, using gentle pressure replant tooth, suture any gingival lacerations, apply flexible splint for 2 weeks after 7-10 days start RCT

Question 22

what do you do if there is an avulsed tooth that has been out of the mouth for over 60 mins

Answer 22

remove attached non-viable soft tissue with guaze and consider carrying out any root treatment prior to reimplantation

Question 23

what type of splint do you use and for how long do you apply it for a root fracture

Answer 23

passive flexible splint for 4 weeks, if near cervical up to 4 months

Question 24

what type of splint do you use and for how long do you apply it for subluxation

Answer 24

passive flexible splint for 2 weeks

Question 25

what type of splint do you use and for how long do you apply it for extrusive luxation

Answer 25

passive flexible splint for 2 weeks

Question 26

what type of splint do you use and for how long do you apply it for lateral luxation

Answer 26

passive flexible splint for 4 weeks

Question 27

what type of splint do you use and for how long do you apply it for intrusive luxation

Answer 27

passive flexible splint for 4 weeks

Question 28

what type of splint do you use and for how long do you apply it for alveolar fracture

Answer 28

rigid/flexible splint for 4 weeks