trauma 2 - dentine and enamel fractures

Question 1

what is enamel infractions?

Answer 1

> incomplete fracture of enamel without loss of tooth structure

Question 2

how do you treat enamel infractions ?

Answer 2

> Monitor

> Occasionally etch and seal if sensitive

Question 3

what is a minimal enamel fracture?

Answer 3

> Loss of tooth substance confined to enamel

Question 4

what is the treatment for a minimal enamel fracture?

Answer 4

> Leave (smooth if necessary)

> Composite restoration

> Splint if any mobility

> Periodic review = Radiographic + Sensibility

Question 5

if a patient has an enamel fracture in a primary tooth what is the treatment?

Answer 5

> Monitor

> Usually sufficient to smooth if possible to prevent soft tissue damage

Question 6

what is an uncomplicated enamel dentine fracture?

Answer 6

> Loss of tooth substance confined to enamel and dentine and not involving the pulp

Question 7

what are the treatment aims of uncomplicated enamel dentine fractures ?

Answer 7

> Protect the pulp (maintain vitality)
- Bacterial / thermal irritation to exposed dentinal tubules

> Restoration of the crown
- Maintain space

Question 8

what are the emergency treatment options for fractures teeth?

Answer 8

1. > Dress exposed dentine with glass ionomer
   Composite bandage / composite crown build up
2. reattachment of fragment

Question 9

describe option 2 of the emergency treatments? (reattachment)

Answer 9

> Immediately reattach fragment if possible

> If fracture close to pulp – indirect pulp cap

> Dress exposed dentine with glass ionomer
- Thin lining / cement over dentine, aim to maintain vitality
- Delay placement of fragment and store in milk / saline

Question 10

what is the technique for reattachment of fragments?

Answer 10

1. Check vitality of tooth
2. Check fit of fragment
3. Keep fragment hydrated
4. Isolate tooth - rubber dam
5. Attach fragment to gutta percha for handling
6. Etch enamel on both fracture sites & 2mm margins
7. Wash, dry, apply primer
8. Bonding agent

(Note - Do NOT dessicate fragments)

9. Place composite –remove excess
10. Finish
11. Follow up
    - Monitor vitality
    - Monitor colour changes

Question 11

how do you treat enamel dentine fractures in primary teeth?

Answer 11

> Glass ionomer dressing to protect dentine and decrease sensitivity if sufficient cooperation

> Smooth if possible to prevent soft tissue trauma

Question 12

what is a complicated fracture?

Answer 12

> when the pulp is involved

Question 13

what are factors to consider when a child has a pulp fracture?

Answer 13

> Time from pulp exposure

> Size of pulp exposure

> Stage of root development

> Age of child – cooperation

Question 14

what are the options to consider when a child has a pulp fracture?

Answer 14

> pulp cap

> pulpotomy

> pulpectomy

Question 15

when do you chose to pulp cap in a child with a pulp fracture?

Answer 15

> Short time

> pin point exposure

> poor co - operation

> Prognosis better if seen < 24 hrs

Question 16

how is a pulp cap placed?

Answer 16

> layer of CaOH2, placed directly over exposed pulp

> bandage of GI or comp

Question 17

what is the aim of a pulp cap?

Answer 17

> preserve vital pulp, bridge of reparative dentine

Question 18

when monitoring the vitality and taking radiographs of a pulp capped tooth, what do you exclude?

Answer 18

> exclude resorption and necrosis

Question 19

what would child who has had a pulp fracture have to present with for you to consider a pulptomy as a treatment option?

Answer 19

> Incomplete apex / complete apex

> Small exposure

> Vital pulp, not infected

> Patient co-operative

Question 20

what is the aim and success of a pulpotomy?

Answer 20

> Allow continued root growth – apexogenesis

> Avoid need for open apex RCT – apexification

> 80-96% success rate

Question 21

what is the treatment steps for a pulpotomy? (ASAP)

Answer 21

1.Local anaesthetic
2. Isolation
3. Remove non vital tissue (2-3mm)
4. Non setting Calcium Hydroxide
5. No pressure
6. Glass ionomer dressing
7. Other materials used –MTA or biodentine
8. Review = Radiographs at 1 month, then 3-6 month! Check hard tissue barrier formation! Check continued root growth

Question 22

when would you carry out a pulpectomy on a child with pulpal fracture?

Answer 22

> Gross exposure / extrusion of pulp

> Complex crown / root fracture

> Necrotic pulp in open apex

Question 23

what is the aim of a pulpectomy?

Answer 23

> maintain tooth

> weak tooth as no further development

Question 24

what are the two treatment options of a pulpectomy?

Answer 24

> closed apex - standard RCT

> open apex - apexification

Question 25

what are the treatment options for primary teeth when there is pulpal exposure?

Answer 25

Generally extraction due to limited cooperation for pulp treatment

Question 26

what are root fractures and what are the different types?

Answer 26

> fractures through the dentine, cementum and pulp

> apical, middle, coronal third

> displaced or undisplaced

Question 27

what is the treatment for a root fracture?

Answer 27

> Immediate repositioning

> Splint 4 weeks or until stable

> Soft diet and Chlorhexidine mouthwash

> Review vitality of coronal fragment

> Treat complications

Question 28

to diagnose a root fracture what may you need to do?

Answer 28

> May require 2 views radiographically to position + displacement

Question 29

what root fracture has the poorest prognosis and what will have to happen?

Answer 29

> Coronal

> May require extraction of tooth

> May require extraction of coronal fragment + extrusion of root

> May require endodontic treatment to fracture line

Question 30

when should you reposition a displaced tooth?

Answer 30

> ASAP

> May require =

• local anaesthetic
• Digital manipulation
• Forceps
• Orthodontics

Question 31

what is the aim of splinting?

Answer 31

to immobilise tooth in correct anatomical position preventing further trauma and allowing healing

Question 32

what does the type of splint chosen depend on?

Answer 32

> Injury

> Age of child / teeth present

> Facilities

Question 33

what does a functional splint include?

Answer 33

> a tooth on either side of the traumatised tooth?

Question 34

how long does a patient have to have a functional splint post root fracture?

Answer 34

> 4 weeks of functional splint

> Previously recommended rigid fixation (2 teeth either side of traumatised tooth)

Question 35

what is the treatment for root fractures in primary teeth?

Answer 35

> Root fractures – Assess position of root fracture

> If coronal fragment is stable then it can be monitored

> If coronal fragment is displaced / mobile then extraction may be required