Trauma 2 - hard tissue injuries Flashcards
1
Q
how would you treat an ED# in an emergency situation where there is little time
A
- clean area with water spray or saline
- disinfect with NaOCl or CHx
- account for fragment
- bond fragment back on, or place composite bandage
- clinical follow up 1 week, 6-8 weeks and 1 year
- radiographic follow up 1 year after RCT or pulpotomy
- take 2 PA’s to rule out root # or luxation, evaluate tooth maturity
- radiograph any soft tissue injuries if can’t find fragment
2
Q
when are more radiographs needed to be taken after initial ones
A
- indicated where clinical findings are suggestive of pathosis = unfavourable outcome
3
Q
what should parents be advised about regarding possible complications after ED#
A
- swelling, dark discolouration of the crown, increased mobility or a fistula
4
Q
what definitive restoration would you place after ED#
A
- composite build up to restore crown of tooth
5
Q
when getting radiographic follow-ups what are you looking fro
A
- root development = width and length of canal
- comparison with other side
- Internal and external inflammatory resorption
- any periapical pathology
6
Q
if you think patient has inhaled tooth fragment what do you do
A
- send for a chest x-ray
7
Q
if you think fragment in soft tissues what d o you do
A
- want a soft tissue radiograph to check lacerations
8
Q
if you think patient has swallowed fragment what do you do
A
- nothing
9
Q
what is a subluxation injury
A
- an injury to the tooth supporting structures resulting in increased mobility, but without displacement of the tooth
- bleeding from gingival sulus confirms the diagnosis
10
Q
what are the treatment options for an EDP#
A
- pulp capping
- partial pulpotomy
- avoid full extirpation unless tooth clearly non-vital
11
Q
when do you do a pulp cap and when do you do a partial pulpotomy
A
- pulp cap if exposure <1mm and its <24hrs since injury
- pulpotomy if exposure >1mm and it’s been >24hrs since injury
12
Q
how do you do pulp capping
A
- apply LA
- is possible, isolate tooth with rubber dam
- clean area with water spray, saline or CHx
- disinfect with NaOCl
- apply pulp capping material = CaOH or MTA
- sealed exposed dentine with GI or composite
- restore tooth with composite
- follow up 1week, 6-8 weeks, 3 months, 6 months and 1 year
13
Q
how to do partial pulpotomy
A
- apply LA
- isolate if possible with dam
- disinfect with NaOCl
- perform pulpotomy to a depth of 1-2mm using round diamond
- place saline moistened cotton pellet upon pulp wound until bleeding ceased
- apply pulpotomy material = CaOH
- seal exposed dentine with GI or composite
- restore with composite
- follow up = 1 week, 608 weeks, 3 months, 6 months and 1 year
14
Q
when may full pulpotomy be indicated
A
- if pulp necrotic or hyperaemic
15
Q
what is the problem with a full pulpotomy on immature teeth
A
- no apical stop for obturation
16
Q
what are the options when obdurating an immature tooth
A
- CaOH placed in canal aiming to induce hard tissue barrier to form = can take 9 months and has holes in it
- MTA/biodentine placed at apex of canal to create cement barrier
- or regenerative Endodontic technique to encourage hard tissue formation at apex
17
Q
what is the first choice of splint
A
- composite and wire splint using 0.4mm stainless steel wire
18
Q
when might you need to use an acrylic URA type splint
A
- if not got any abutment teeth to splint a wire on
19
Q
what type of splint and how long for would you want it in a luxation injury
A
- flexible for 4 weeks
20
Q
what is external inflammatory resorption initiated by and how is it treated
A
- damage to pdl
- maintained and propagated by necrotic pulp tissue via dentinal tubules
- pulp extirpation and mechanical debridement and chemical irrigation, non-setting CaOH 4-6 weeks then obturate
21
Q
what is internal inflammatory resorption initiated by and how is it distinguished from other types and how is it treated
A
- damage to pulp
- initiated by non-vital pulp
- tramlines or root canal indistinct
- extirpation
22
Q
what is an extrusion injury
A
- tooth characterised by partial or total separation from pal resulting in displacement of tooth out of socket
- aveolar socket intact
- tearing injury
23
Q
treatment of extrusion injruy
A
- apply LA
- exposed dentine root surface of displaced tooth cleansed with saline
- reposition tooth by gently re-inserting it into the tooth socket with axial digital pressure
- stabilise for 2 wks with flexible splint
24
Q
what is included on trauma stamp
A
- colour
- sinus
- TTP
- percussion note
- EPT
- ethyl chloride
- radiographs
- mobility
25
what is lateral luxation injury
- displacement of tooth other than axially
- displacement is accompanied by communication or fracture of either labial or palatal/lingual bone
- pdl suffered both tearing and crushing
26
what type of splint is used for lateral luxation
- flexible for 4 weeks
27
what is the process of making a composite and wire splint
- cut and bend 0.3mm SS wire
- apply composite resin to traumatised tooth and those adjacent
- sink contoured, passive wire into composite
- shape and cure composite
- smooth rough edges
28
what is an avulsion injury
- where tooth comes completely out of the socket
- separation of the pdl and exposure of the root surface
29
advice to give parents if phoning about avulsed tooth
- hold tooth by crown only
- wash tooth in cold running water if there is obvious debris - no longer than 10 seconds
- replace in socket and get child to bite down on some tissue
- If can't replant, store in milk or saliva or blood
- get immediate dental advice
30
what are the possible periodontal healing outcomes after avulsion has occurred
- regernation - most likely to occur if tooth put back in socket
- pdl/cemental healing - this can occur if tooth was not put straight back in
- uncontrolled infection - not healing at all, create granulation tissue, infection, abscesses etc
31
what type of injury is most likely to be locked in bone
- intrusion
32
what does a yellow tooth mean after trauma
- enamel thins
- tertiary dentine protects tooth
- pulp canal obliteration from tertiary dentine being laid down
- dentine is yellow so shines through
33
what would be the clinical findings of a permanent tooth with a concussion injury
- normal mobility
- tooth is TTP
- will respond to pulp sensibility testing
34
clinically what would a tooth that has has an extrusion injury look like
- elongated incisally
35
what is lateral luxation injury
- displacement of tooth in any lateral direction, usually associated with a fracture or compression of the alveolar socket wall or facial cortical bone
36
what fracture is usually associated with a lateral luxation injury
- fracture of alveolar bone
37
why are teeth that have had a lateral luxation injury often immobile
- because apex of teeth are locked in by the bone fracture
38
what can happen differently after a lateral luxation injury in immature teeth compared to mature
- open apex can get spontaneous revascularisation but closed apices more likely to become necrotic
39
what kind of sound will percussion give on an intrusive luxation injury
- high metallic sound = ankylosed
40
what thickness of wire is used for splinting
- less than 0.4mm SS
