Trauma 2 - PDL injuries Flashcards
List examples of PDL injuries (7)
- Concussion
- Subluxation
- Extrusive luxation
- Lateral luxation
- Intrusive luxation
- Avulsion
- Dento-alveolar fractures
Where should we consider the impact of the PDL injury on?
- Surrounding bone - fracture
- Neurovascular bundle
- Root surface
What is a concussion injury?
> Injury to tooth without increased mobility, displacement of tooth or gingival bleeding
> There is pain on percussion and sensibility tests may be negative on initial assessment (nerve not working)
What is a subluxation injury?
> Traumatic injury to PDL has occurred leading to increased mobility but no displacement
> Gingival bleeding is often detected
- Often bleeding around gingival margin
Tx for concussion/subluxation (2)
- Occlusal relief
2. Flexible splint 2 weeks if necessary to make patient feel more comfortable (don’t need to for subluxation)
What is occlusal relief? (2)
- Take away a bit of tooth structure
2. Or build up tooth with GI on the posterior teeth which will then take pressure off the anterior teeth
Compare concussion + subluxation for:
- Increased mobility
- TTP
- Follow up clinical + radiographs
- Splint
- INCREASED MOBILITY
Concussion - No
Subluxation - Yes - TTP
Concussion - Yes
Subluxation - Yes - CLINICAL FOLLOW UP + XRAYS
Concussion - 4wks, 6-8wks, 1yr
Subluxation - 2wks, 4wks, 6-8wks, 1yr - SPLINT
Concussion - No
Subluxation - 2 weeks flexible
OHI + diet advice for all PDL luxation injuries (3)
- Instruct on OHI with chlorhexidine gluconate + gentle brushing
- Soft diet
Bite gently
Cant avoid eating as we need proper healing from PDL so we must stimulate it or the PDL will stop regenerating - Avoid contact sports
How do we monitor concussion + subluxation injuries? (3)
- Clinical test - trauma sticker
2. Sensibility tests: Thermal + electrical > At time of injury > Lack of sensibility can occur > This can relate to future pulp necrosis
3. Radiographs > Root development Width of canal + length > Comparison with other side > Internal + external inflammatory resorption
What does a trauma sticker include? (8)
- Mobility
- Displacement
- TTP
- Colour
- Sinus/tender in sulcus
- Thermal (Ethyl chloride)
- Electric (EPT)
- Radiograph
What type of PDL injury has the highest 5 year pulpal survival for open/closed apex?
- Concussion
2. Subluxation
What type of PDL injury has the lowest 5 year resorption survival for open/closed apex?
- Avulsion
2. Intrusion
What is an extrusion injury? (2)
- Partial or total separation of PDL resulting in displacement of the tooth out of the socket
- Alveolar socket intact
- Tooth hangs lower than it should
- Tearing injury
Radiographic finding for extrusion injury (theres no radiographic findings for subluxation + concussion)
Increased PDL space apically
Tx protocol for extruded permanent tooth
- Reposition under LA (buccal + palatal)
- Flexible splint
- 2 weeks
REVIEW Clinical + radiographic control: 4weeks 6 -8 weeks 6 months Yearly for 5 years
What injuries have the highest 5 year pulpal + resorption survival? (4)
Concussion
Subluxation
Extrusion
Lateral luxation
What is a lateral luxation injury?
Displacement of tooth other than axially (not just up and down)
Displacement accompanied with fracture of either labial or lingual bone
PDL SUFFERED TEARING + CRUSHING INJURIES
Comparison of extrusion injury to lateral luxation
Alveolar bone intact in an extrusion injury, as opposed to a lateral luxation
Tx protocol for lateral luxation
- Reposition under LA (Buccal + palatal
- Flexible splint for 4 weeks
REVIEW Clinical + radiographie control 4 weeks 6-8 weeks 6 months Yearly for 5 years
What is an intrusion injury?
Tooth driven into the alveolar process due to an axially directed impact (straight up injury)
Crushing injury to PDL
What is the most severe form of displacement injury?
Intrusion injury
What injuries act as crushing injuries to PDL? (2)
Intrusion
Lateral luxation
Intrusion tx option for an open apex up to 7mm
Spontaneous repositioning
Intrusion tx option for a closed apex more than 7mm
Orthodontic / surgical repositioning
Intrusion tx option for a closed apex up to 3mm
Spontaneous repositioning
Intrusion tx option for a closed apex between 3-7mm
Orthodontic / surgical repositioning
Intrusion tx option for a closed apex more than 7mm
Surgical repositioning (with forceps)
Then comp wire splint for 4 weeks
How should spontaneous tooth repositioning be reviewed?
Review patient monthly to observe re-eruption
Measure progress against fixed point (incisal edge of fully erupted non-displaced adjacent incisor)
What type of injury has the highest risk of resorption + 0% pulpal survival ?
- Intrusion
- Endo tx usually necessary within 3-4wks post trauma to closed apex
- Interim CaOH dressing recommended
Review period for intrusion injuries (7)
- Control after 2 weeks
- Splint removal + control after - 4 weeks
- 6-8 weeks
- 6 months
- 1 year
- Yearly for 5 years
Why is endo advised after an intrusion injury?
Can prevent the necrotic pulp from intimating infection related root resorption
Consider in all cases with completed root formation where the chance of pulp revascularusation is unlikely
What type of injury has the lowest 5 year pulpal survival for an open/closed apex?
Avulsion
Intrusion
