Trauma 2 Flashcards
What is a root fracture?
It is a dentine and cementum fracture involving the pulp.
What 3 things are used to classify root fractures?
- Position of fracture
- Displacement of fractures
- Stage of root development.
What are the 3 positions of root fractures?
- Apical 1/3
- Middle 1/3
- Coronal 1/3.
What are the two types of root fractures you can get?
Displaced and undisplaced.
What are the two stages of root development?
- Mature (closed apex)
- Immature (open apex).
What root fractures have a poor prognosis?
- Unfavourable crown to root radio
- Displacement fractures
If the root fracture occurs at an angle what can the radiograph look like?
It can appear like there is multiple fracture lines.
What does the prognosis of a fractured tooth depend on?
Age of child (immature or mature tooth) Degree of displacement Associated injuries eg. crown fractures Time between injury and treatment Presence of infection.
What special investigations would you use for a root fracture?
- Sensibility tests
- Radiographs from at least two angles (eg. two periapicals from different angles and one maxillary occlusal)
- Alternatively CBCT.
How do you treat a root fracture (apical or middle third displaced)?
-Clean area with water/saline/chlorahexidine
-Reposition tooth with digital pressure
-Place a flexible splint for 4 weeks
-Review 6-8 weeks, 6 months, 1 year and 5 years with radiographs
(soft diet for one week and good OH).
What are healing and non-healing outcomes of a root fracture?
Healing- calcified tissue union across fracture line, connective tissue, calcified&connective tissue, bone/osseous.
Non-healing- granulation tissue (associated with loss of vitality) or radiolucent area seen surrounding the fracture line.
What is eburnation?
Eburnation describes a degenerative process of bone.
What happens when the root undergoes osseous healing?
Separate parts of the root become discrete with no connection- each part has its own PDL space and bone is clearly seen between the two fragments.
What do you do if a tooth is root fractured and becomes non-vital?
Apical and middle third fractures- extipate to fracture line, dress ns CaOH then MTA just coronal to fracture line
Apical fragment of root- remain in situ with own PDLm resorbs and if infected (antibiotics/apicectomy).
What are the 6 classifications of PDL injuries?
- Concussion/subluxation
- Extrusive luxation
- Lateral luxation
- Intrusive luxation
- Avulsion
- Dentoalveolar fractures.
What is a concussion injury to the tooth?
Concussion injury to the tooth supporting structures without increased mobility, displacement of the tooth or gingival bleeding. There is pain on percussion and sensibility tests may be negative on initial assessment.
What is a subluxation injury?
Subluxation is where a traumatic injury has occured to the periodontal tissues leading to increased mobility but no displacement. Gingival bleeding is detected.
How do you treat and review a concussion or subluxation injury?
- Occlusal relief
- Flexible splint for 2 weeks if necessary to make patient more comfortable
- WITH ALL LUXATION INJURIES (instruct on OHI with chlorhexidine gluconate and gentle brushing, soft diet and avoid contact sports)
- Review= Clinical and radiographic control at 4, 6/8 weeks and 1 year.
What are the similarities and differences between a concussion and a subluxation injury?
A subluxation injury has increased mobility.
Both have TTP.
Subluxation injury needs a flexible splint for 2 weeks and a concussion injury doesn’t need one.
Both need a follow up after 2/4 weeks, 6/8 weeks and 1 year.
How do you monitor a concussion subluxation injruy?
- Clinical tests (trauma sticker)
- Sensibility tests (thermal and electrical)= at time of injury, transient lack of sensibility can occur, this can relate to future pulp necrosis.
- Radiographs= root development (width of canal and length, comparison with other side and internal/external inflammatory resorption)
What is included in a trauma sticker?
Mobility Displacement TTP Colour Sinus/tender in sulcus Thermal (Eth Cl) Electric (EPT) Radiograph.
What as an extrusion injruy?
Tooth injury characterised by partial or total separation of the PDL resulting in displacement of the tooth out of the socket. The alveolar socket is intact. This is a tearing injury within the PDL.
How do you treat an extruded permanent tooth?
Reposition under LA
Flexible splint for two weeks
Review and radiographic control at 4 weeks, 6-8 weeks, 6 months and yearly for 5 years.
What is a lateral luxation injury?
Displacement of a tooth rather than axially. Displacement is accompanied by comminution or fracture of either the labial or palatal/lingual bone. The PDL has suffered both tearing and crushing injury.
How do you treat a lateral luxation injury?
Reposition under LA (buccal and palatal)
Flexible splint for 4 weeks
Review at 4, 6-8 weeks, 6 months and yearly for 5 years.
What is an intrusion injury?
The tooth has been driven into the alveolar process due to an axially directed impact. This is the most severe form of displacement injury. It is more likely to occur in teeth with fully developed roots. This is a crushing injury to the PDL. HIGH RISK OF RESORPTION! Endodontic treatment usually necessary with closed apex- interim calcium hydroxide dressing recommended.
How do you treat an avulsion injury with a closed or an open apex?
OPEN= up to 7mm (spontaneous repositioning), over 7mm (orthodontic or surgical repositioning)
CLOSED= up to 3mm (spontaneous), 3-7mm (orthodontic or surgical) and over 7mm (surgical).
What is spontaneous tooth repositioning?
- Allow re diet and OH
- Review patient monthly to observe re-eruption
- Measure progress against fixed point eg. incisal edge of fully erupted non-displaced adjacent incisor.
What is the follow up for an intrusion injury?
Endodontic treatment to prevent the necrotic pulp from initiating infection-related root resorption. Endodontic therapy within 3-4 week post trauma A temporary filling with calcium hydroxide is recommended.
Review after 2 weeks, splint removal and review after 4 weeks, 6-8 weeks, 6 months and 1 year and yearly for 5 years.
