Trauma Flashcards
Displacement, single tooth mobility, radiograph sign of root fracture
what is the diagnosis
root fracture
displacement, single tooth mobility, no radiographic sign of root fracture
what is the diagnosis
extrusion
displacement, no single tooth mobility, multiple teeth moving as a unit
what is the diagnosis
alveolar fracture
displacement, no single tooth mobility, no multiple teeth moving as a unit
what is the diagnosis
intrusion or lateral luxation
what is the management of root fracture
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
what is the management of extrusion
reposition and splint for 2 weeks, extra 4 weeks if fracture of the marginal bone. monitor pulpal status
what is the management of alveolar fracture
reposition segment and splint with passive flexible for 4 weeks. suture gingival lacerations and do not start root treatment, monitor pulpal status
what is the management of intrusion for a tooth with incomplete root formation
allow for re-eruption without intervention for 4 weeks. no re-eruption orthodontic repositioning, monitor pulp status, RCT if needed
what is the management of intrusion for a tooth with complete root formation
< 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
what is the management of lateral luxation
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
no displacement, mobility, tender to precussion
whats the diagnosis
subluxation
no displacement, mobility, no tender to precussion
what is the diagnosis
no fracture, crown fracture or crown-root fracture
no displacement, no mobility
what is the diagnosis
concussion
what is the management of subluxation
no treatment needed, monitor pulp status for a year
what is the management of enamel fracture
depending on fragment size, bond fragment back on or restore with composite resin
what is the management of enamel-dentine fracture
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
what is the management of enamel-dentine-pulp fracture
partial pulpotomy/pulp cap followed by bonding rehydrated fragment or GIC/composite restoration if post required for crown retention then RCT first
what is the management of crown-root fracture with no pulpal exposure
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
what is the management of crown-root fracture with pulpal exposure
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
what is the management of concussion
no treatment, monitor pulp status for a year. if excessive mobility stabilise for 2 weeks
what do you do if you have an avulsed tooth
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
what do you do if there is an avulsed tooth that has been out of the mouth for over 60 mins
remove attached non-viable soft tissue with guaze and consider carrying out any root treatment prior to reimplantation
what type of splint do you use and for how long do you apply it for a root fracture
passive flexible splint for 4 weeks, if near cervical up to 4 months
what type of splint do you use and for how long do you apply it for subluxation
passive flexible splint for 2 weeks
