trauma 2 - dentine and enamel fractures Flashcards
what is enamel infractions?
> incomplete fracture of enamel without loss of tooth structure
how do you treat enamel infractions ?
> Monitor
> Occasionally etch and seal if sensitive
what is a minimal enamel fracture?
> Loss of tooth substance confined to enamel
what is the treatment for a minimal enamel fracture?
> Leave (smooth if necessary)
> Composite restoration
> Splint if any mobility
> Periodic review = Radiographic + Sensibility
if a patient has an enamel fracture in a primary tooth what is the treatment?
> Monitor
> Usually sufficient to smooth if possible to prevent soft tissue damage
what is an uncomplicated enamel dentine fracture?
> Loss of tooth substance confined to enamel and dentine and not involving the pulp
what are the treatment aims of uncomplicated enamel dentine fractures ?
> Protect the pulp (maintain vitality)
- Bacterial / thermal irritation to exposed dentinal tubules
> Restoration of the crown
- Maintain space
what are the emergency treatment options for fractures teeth?
- > Dress exposed dentine with glass ionomer
Composite bandage / composite crown build up - reattachment of fragment
describe option 2 of the emergency treatments? (reattachment)
> 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
what is the technique for reattachment of fragments?
- Check vitality of tooth
- Check fit of fragment
- Keep fragment hydrated
- Isolate tooth - rubber dam
- Attach fragment to gutta percha for handling
- Etch enamel on both fracture sites & 2mm margins
- Wash, dry, apply primer
- Bonding agent
(Note - Do NOT dessicate fragments)
- Place composite –remove excess
- Finish
- Follow up
- Monitor vitality
- Monitor colour changes
how do you treat enamel dentine fractures in primary teeth?
> Glass ionomer dressing to protect dentine and decrease sensitivity if sufficient cooperation
> Smooth if possible to prevent soft tissue trauma
what is a complicated fracture?
> when the pulp is involved
what are factors to consider when a child has a pulp fracture?
> Time from pulp exposure
> Size of pulp exposure
> Stage of root development
> Age of child – cooperation
what are the options to consider when a child has a pulp fracture?
> pulp cap
> pulpotomy
> pulpectomy
when do you chose to pulp cap in a child with a pulp fracture?
> Short time
> pin point exposure
> poor co - operation
> Prognosis better if seen < 24 hrs
how is a pulp cap placed?
> layer of CaOH2, placed directly over exposed pulp
> bandage of GI or comp
what is the aim of a pulp cap?
> preserve vital pulp, bridge of reparative dentine
when monitoring the vitality and taking radiographs of a pulp capped tooth, what do you exclude?
> exclude resorption and necrosis
what would child who has had a pulp fracture have to present with for you to consider a pulptomy as a treatment option?
> Incomplete apex / complete apex
> Small exposure
> Vital pulp, not infected
> Patient co-operative
what is the aim and success of a pulpotomy?
> Allow continued root growth – apexogenesis
> Avoid need for open apex RCT – apexification
> 80-96% success rate
what is the treatment steps for a pulpotomy? (ASAP)
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
when would you carry out a pulpectomy on a child with pulpal fracture?
> Gross exposure / extrusion of pulp
> Complex crown / root fracture
> Necrotic pulp in open apex
what is the aim of a pulpectomy?
> maintain tooth
> weak tooth as no further development
what are the two treatment options of a pulpectomy?
> closed apex - standard RCT
> open apex - apexification
what are the treatment options for primary teeth when there is pulpal exposure?
Generally extraction due to limited cooperation for pulp treatment
what are root fractures and what are the different types?
> fractures through the dentine, cementum and pulp
> apical, middle, coronal third
> displaced or undisplaced
what is the treatment for a root fracture?
> Immediate repositioning
> Splint 4 weeks or until stable
> Soft diet and Chlorhexidine mouthwash
> Review vitality of coronal fragment
> Treat complications
to diagnose a root fracture what may you need to do?
> May require 2 views radiographically to position + displacement
what root fracture has the poorest prognosis and what will have to happen?
> Coronal
> May require extraction of tooth
> May require extraction of coronal fragment + extrusion of root
> May require endodontic treatment to fracture line
when should you reposition a displaced tooth?
> ASAP
> May require =
- local anaesthetic
- Digital manipulation
- Forceps
- Orthodontics
what is the aim of splinting?
to immobilise tooth in correct anatomical position preventing further trauma and allowing healing
what does the type of splint chosen depend on?
> Injury
> Age of child / teeth present
> Facilities
what does a functional splint include?
> a tooth on either side of the traumatised tooth?
how long does a patient have to have a functional splint post root fracture?
> 4 weeks of functional splint
> Previously recommended rigid fixation (2 teeth either side of traumatised tooth)
what is the treatment for root fractures in primary teeth?
> 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
