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.