Trauma Flashcards
Imaging for uncomplicated crown fracture (enamel only)?
- Missing fragments should be accounted for (soft tissue injuries - lips and cheeks).
- One parallel periapical radiograph.
Treatment for uncomplicated crown fracture (enamel only)?
- Bond back tooth fragment.
- Smooth tooth edges.
- Composite resin restoration.
Follow up for uncomplicated crown fracture (enamel only)?
- 6-8 weeks.
- 1 year.
Imaging for uncomplicated crown fracture (enamel-dentine)?
- Missing fragments should be accounted for (soft tissue injuries - lips and cheeks).
- One parallel periapical radiograph.
Treatment for uncomplicated crown fracture (enamel-dentine)?
- Bond back tooth fragment (rehydrate in saline for 20 minutes).
- Cover exposed dentine with glass ionomer or resin composite.
- If exposed dentine within 0.5mm of pulp (pink but no bleeding) place a calcium hydroxide lining and cover with GI.
Follow up for uncomplicated crown fracture (enamel dentine)?
- 6-8 weeks.
- 1 year.
Imaging for complicated crown fracture (enamel-dentine-pulp)?
- Missing fragments should be accounted for (soft tissue injuries - lips and cheeks).
- One parallel periapical radiograph.
Treatment for complicated crown fracture (enamel-dentine-pulp)?
-
FIRST LINE - VITAL/CONSERVATIVE PULP TREATMENT
- Immature teeth: Pulp capping/ partial pulpotomy to promote further root development (use non setting calcium hydroxide OR non staining calcium silicates).
- Mature teeth: partial pulpotomy. -
MATURE TEETH
- If post required for crown retention, RCT is preferred treatment. -
RESTORE CROWN
- Bond back tooth fragment (rehydrate).
- Cover exposed dentine with GI or composite.
Follow up for complicated crown fracture (enamel dentine pulp)?
- after 6-8 wk
- after 3 mo
- after 6 mo
- after 1 y
Imaging for uncomplicated crown-root fracture (enamel-dentine without pulp exposure)?
- Apical extension of fracture usually not visible.
- Account for missing fragments.
- One parallel periapical.
- Two additional radiographs at different vertical/ horizontal angulations.
- Occlusal radiographs.
- CBCT
Treatment for uncomplicated crown-root fracture (enamel-dentine without pulp exposure)?
- Until tx plan finalized, temporarily stabilize fragment to adjacent teeth.
- If PULP NOT EXPOSED –> remove coronal/ mobile segment and COVER exposed dentine with GI or resin composite.
- Future tx options: orthodontic extrusion, surgical extrusion, RCT (necrotic, infected pulp), root submergence, replantation, autotransplantation, extraction.
Follow up for uncomplicated crown-root fracture (enamel-dentine without pulp exposure)?
- 1 week.
- 6-8 weeks.
- 3 months.
- 6 months.
- 1 year.
- Yearly for at least 5 years.
Imaging for complicated crown-root fracture (enamel-dentine with pulp exposure)?
- Apical extension of fracture usually not visible.
- Account for missing fragments.
- One parallel periapical.
- Two additional radiographs at different vertical/ horizontal angulations.
- Occlusal radiographs.
- CBCT
Treatment for complicated crown-root fracture (enamel-dentine with pulp exposure)?
- Until tx plan finalized, temporarily stabilize fragment to adjacent teeth.
IMMATURE TEETH WITH INCOMPLETE ROOT FORMATION:
- Partial pulpotomy with rubber dam (non setting calcium hydroxide or non staining calcium silicates).
MATURE TEETH WITH COMPLETE ROOT FORMATION:
- Remove pulp, cover exposed dentine with GI or resin composite.
- Future tx options: completion of root canal treatment and restoration, orthodontic extrusion, surgical extrusion, root submergence, replantation, autotransplantation, extraction.
Follow up for complicated crown-root fracture (enamel-dentine with pulp exposure)?
- 1 week.
- 6-8 weeks.
- 3 months.
- 6 months.
- 1 year.
- Yearly for at least 5 years.
Imaging for root fracture?
- Fracture may be at any level of the root.
- One parallel periapical.
- Two additional radiographs at different vertical/ horizontal angulations.
- Occlusal radiographs.
- CBCT
Treatment of root fracture?
- Reposition displaced coronal fragment.
- Check repositioning radiographically.
- Cervical fracture splint 4 months (do NOT remove coronal fragment at emergency visit). Mid/ apical root fracture splint 4 weeks.
- NO endodontic treatment at emergency visit.
- MONITOR healing of fracture for AT LEAST ONE YEAR. Monitor PULP STATUS.
- IF PULP NECROSIS OCCURS: RCT of the coronal segment using apexification technique.
- MATURE TEETH WHERE FRACTURE IS ABOVE ALVEOLAR CREST: Remove coronal segment, RCT, post-retained crown.
- Future procedures: orthodontic/ surgical extrusion, crown lengthening, extraction.
Follow up times for root fracture?
- 4 weeks (mid/apical fracture).
- 6-8 weeks.
- 4 months (cervical fracture).
- 6 months.
- 1 year.
- yearly for at least 5 years.
Imaging for alveolar fracture?
- Parallel periapical.
- Two additional radiographs of the tooth taken with different vertical and/or horizontal angulations.
- Occlusal
- if insufficient consider DPT or CBCT.
Treatment for alveolar fracture?
- Reposition displaced segment.
- Stabilize segment by splinting teeth for 4 weeks.
- Suture gingival lacerations.
- RCT is CONTRAINDICATED at emergency appointment.
- MONITOR the pulp condition of all involved teeth to determine if/ when endo tx necessary.
Follow up for alveolar fracture?
- 4 weeks
- 6-8 weeks
- 4 months
- 6 months
- 1 year
- yearly for at least 5 years.
Imaging for concussion?
- No radiographic abnormalities.
- One parallel periapical.
Treatment for concussion?
- No treatment needed.
- Monitor pulp condition for at least one year but preferably longer.
Follow up for concussion?
- 4 weeks.
- 1 year.
Radiographic assessment for subluxation?
- One parallel periapical.
- Two additional radiographs at different vertical/ horizontal angulations.
- Occlusal radiographs.
Treatment for subluxation?
- Usually no treatment needed.
- Splint for 2 weeks if excessive mobility of tenderness when biting on the tooth.
- Monitor the pulp dor at least one year.
Follow up for subluxation?
- 2 weeks (splint removal).
- 3 months.
- 6 months.
- 1 year.
Radiographic assessment of extrusive luxation?
- Increased periodontal ligament space both apically and laterally.
- Tooth will not be seated in socket and appear elongated incisally.
- One parallel periapical.
- Two additional radiographs at different vertical/ horizontal angulations.
- Occlusal radiographs.
Treatment for extrusive luxation?
- Local anesthesia.
- Reposition tooth by gentily pushing it back into the socket.
- Splint for 2 weeks. Splint for a further 4 weeks if BREAKDOWN/ FRACTURE of marginal bone.
- Monitor pulp condition.
- RCT if pulp becomes necrotic.
Follow up for extrusive luxation?
- 2 weeks (splint removal).
- 4 weeks.
- 8 weeks.
- 3 months.
- 6 months
- 1 year.
- Yearly for at least 5 years.
- Advise patients (and parents) to watch for any unfavourable outcomes (symptoms, mobility) and return to clinic if they observe any.
Radiographic investigation of lateral luxation?
- Widened periodontal space which is best seen on radiographs taken with horizontal angle shifts or occlusal exposures.
- One parallel periapical.
- Two additional radiographs at different vertical/ horizontal angulations.
- Occlusal radiographs.
Treatment for lateral luxation?
- Local anesthesia.
- Reposition tooth digitally.
- Stabilize tooth for 4 weeks (additional splinting if marginal bone breakdown).
- Monitor pulp condition at follow up appointments.
-
2 weeks post injury make endodontic evaluation:
- INCOMPLETE ROOT FORMATION: spontaneous revascularization may occur. If pulp becomes necrotic and signs of ERR RCT ASAP.
- COMPLETE ROOT FORMATION:
Pulp will likely become necrotic, RCT.
Follow up for lateral luxation?
- 2 weeks.
- 4 weeks (splint removal).
- 8 weeks
- 3 months
- 6 months
- 1 year.
- yearly for at least 5 years.
- Advise patients (and parents) to watch for any unfavourable outcomes (symptoms, mobility) and return to clinic if they observe any.
Radiographic examination of intrusive luxation?
- The periodontal ligament space may not be visible for all or part of the root (especially apically).
- The cemento- enamel junction is located more apically in the intruded tooth than in adjacent non- injured teeth.
- One parallel periapical.
- Two additional radiographs at different vertical/ horizontal angulations.
- Occlusal radiographs.
Treatment for intrusive luxation?
TEETH WITH INCOMPLETE ROOT FORMATION
- Allow re-eruption without intervention for 4 weeks.
- If not re eruption within 4 weeks, initiate orthodontic repositioning.
- Monitor pulp condition.
- Revasculirization may occur. If pulp becomes necrotic/infected/ signs of root resorption start RCT ASAP.
- Inform parents of importance of follow up visits.
TEETH WITH COMPLETE ROOT FORMATION
- Intruded less than 3mm: if no re eruption within 8 weeks reposition surgically and splint for 4 weeks or reposition orthodontically.
- Intruded 3mm-7mm: reposition surgically (preferably) or orthodontically.
- Tooth intruded beyond 7mm: reposition surgically.
- Pulp almost always becomes necrotic. Start RCT at 2 weeks.
Follow up for intrusive luxation?
- 2 weeks.
- 4 weeks (splint removal).
- 8 weeks.
- 3 months
- 6 months
- 1 year
- yearly for the next 5 years.
- inform patients/ parent to watch for unfavourable outcomes.
First aid for avulsed teeth? (8)
- MAKE SURE IT IS A PERMANENT TOOTH.
- Keep the patient calm.
- Find the tooth and pick it up by the crown (the white part). Avoid touching the root. Attempt to place it back immediately into the jaw.
- If the tooth is dirty, rinse it gently in milk, saline or in the patient’s saliva and replant or return it to its original position in the jaw. It is important to encourage the patient/guardian/teacher/other person to replant the tooth immediately at the emergency site.
- Once the tooth has been returned to its original position in the jaw, the patient should bite on gauze, a handkerchief or a napkin to hold it in place.
- If replantation at the accident site is not possible, or for other reasons when replantation of the avulsed tooth is not feasible (eg, an unconscious patient), place the tooth, as soon as possible, in a storage or transport medium that is immediately available at the emergency site. This should be done quickly to avoid dehydration of the root surface, which starts to happen in a matter of a few minutes. In descending order of preference, milk, HBSS, saliva (after spitting into a glass for instance), or saline are suitable and convenient storage mediums. Although water is a poor medium, it is better than leaving the tooth to air-dry.
- The tooth can then be brought with the patient to the emergency clinic.
- See a dentist or dental professional immediately.
