Trauma 2

Question 1

What is a root fracture?

Answer 1

A dentine and cementum fracture involving the pulp

Question 2

When do horizontal root fractures occur?

Answer 2

Dental trauma

Question 3

When do vertical root fractures occur?

Answer 3

From post crowns

To do with stresses from the restoration and the tooth being dead

Question 4

3 components to classifying root fractures

Answer 4

1. Position of fracture
   - Apical, middle, coronal 1/3rd
2. Displacement of fragments
   - Displaced
   - Undisplaced
3. Stage of root development
   - Mature (closed apex)
   - Immature (open apex)

Question 5

What does the prognosis of a root fractured tooth depend on? (5)

Answer 5

1. Age of child
   - Mature or immature teeth
2. Degree of displacement
3. Associated injuries
4. Time between injury and tx
5. Presence of infection

Question 6

What are examples of special investigation for root fractures?

Answer 6

1. Sensibility tests
   Ethyl chloride + EPT
2. Radiographs
   - from at least 2 angles
   2
   - 2 times

Question 7

How do we treat an apical or middle third root fracture - if displaced?

Answer 7

1. Clean area with water/saline/chlorrhexidine
2. Reposition tooth with digital pressure
3. Splint:
   Flexible splint for 4 weeks

4. Review:
6-8wks
6mths
1year
5years with radiographs

Question 8

If a patient has a coronal 1/3rd fracture, how long do they require a splint for + OHI + Diet advice ?

Answer 8

Splinting for 4 months with a flexible splint

Soft diet for 1 week + good OH

Question 9

What are the desired healing outcomes of splinting? (4)

Answer 9

1. Calcified tissue union across the fracture line
2. Connective tissue
3. Calcified + connective tissue
4. Bone/osseous

Question 10

What is the non healing outcomes of splinting?

Answer 10

Granulation tissue (usually associated with loss of vitality)

Radiolucent area seen on radiograph surrounding the fracture line

Question 11

How does granulation tissue feel?

Answer 11

If you went into a canal and hit granulation tissue with an end file it would feel bulky + lots of dark red bleeding

Question 12

What is osseous healing?

Answer 12

When 2 segments of the tooth become unique identities

Question 13

Prognosis if the tooth becomes non-vital

Answer 13

20% chance of pulp necrosis

Question 14

Tx for apical + mid third fractures

Answer 14

1. Extirpate to fracture line as you won’t have an apical stop
2. Dress CaOH then MTA/ Biodentine just coronal to the fracture line
   GP - root fill to fracture line