Trauma 3 Flashcards
when is a flexible splint used for 2 weeks
- subluxation
- extrusion
- avulsion only if under 60 mins EADT
when is a flexible splint used for 4 weeks
- luxation
- apical/middle 1/3 root fracture
- intrusion
- dento-alveolar fractures
- avulsion if closed apex and >60 minsEADT
when do you use a flexible splint for 4 months
- if coronal 1/3 fracture
which is the best splint to do
- composite wire
how do you do composite splint
- bend wire to appropriate shape and then fix it in place with composite
which is a good material to use for splinting but is expensive
- titanium helix
how do you splint a re-implanted tooth
- cut and bend 0.3mm stainless steel wire
- apply composite resin to traumatise tooth and those adjacent
- sink contoured, passive wire into composite
- shape and cure composite
- smooth rough composite and wire ends
why is it best not to use ortho wire for splints
- it is very difficult to get them to be passive
what are vacuum splints
- gum shield splints
- mouthguard type splint
what is a problem with vacuum splints
- oral hygiene is often very poor
- patients are scared to take them in and out incase tooth was to move
when are acrylic splints useful
- when there are few abutment teeth
what is foil temporary splint
- very old method of splinting
- bit of foil cemented with Kalzinol
- doesn’t last long
- temporary fix
what is kalzinol
- a ZOE based material to cement it in place
what are dento-alveolar fractures
- don’t have displacement of teeth in sockets
- some mobility
- there has been damage to alveolar bone holding teeth in
- normally 3 or 4 teeth
- teeth are secure in sockets but bone holding them in has been fractured
how do you fix dento-alveolar fracture
- numb area and lift bone and put it back where it should be
- reposition
- flexible splint for 4 weeks
- antibiotics
what is apical lock
- a bit of bone from a dento-alveolar fracture is unable to get back into its proper place
what is the follow-up for dento-alveolar fracture
- monitor clinically and radiographically
- checking for root development
- check for signs of inflammatory resorption
what should patient do after dento-alveolar fracture
- soft diet for 7 days
- avoid contact sports whilst splint in place
- careful OH with use of chlorohexidine gluconate mouthwash 0.1%
what is the follow up timeline for a dento-alveolar fracture
- 2 weeks
- 4 weeks
- 8 weeks
- 4 months
- 6 months
- 1 year
- yearly for 5 years
what is included in a trauma sticker/stamp
- mobility
- TTP
- percussion note
- colour
- sinus/tender
- thermal
- Electric
- radiograph
what is an avulsion
- tooth comes completely out of socket
what are the critical factors for avulsion re-implantation
- extra-alveolar dry time (EADT)
- extra-alveolar time (EAT)
- type of storage medium
what is EADT
- extra alveolar dry time
- tooth out of mouth in air, not in any storage medium or anything
what is EAT
- extra-alveolar time
- amount of time out of mouth and dry including time it has been in storage medium
what do you do if patient attend with tooth already replanted
- do not remove
- follow instructions on splinting
- radiograph to establish root development
when is PDL viable mostly after avulsion
- replanted immediately or very shortly after
when is PDL viable but compromised after avulsion
- kept in saline/milk, total dry time <60 mins
when is PDL non-viable after avulsion
- dry time >60 mins regardless of what happened after this time
when are all PDL cells non-viable after avulsion
- after dry time of 60 mins or more
what advice should you give teacher/parent over phone if tooth has avulsed
- hold tooth by crown only
- wash in cold running water for 10 seconds
- replace in socket and child bites on tissue
- or store in milk/saliva/normal saline if person doesn’t want to replant tooth
- seek immediate dental advice
what are the periodontal outcome of healing after avulsion
- regeneration
- PDL/cemental healing
- bony healing
- uncontrolled infection
what are the pulpal outcomes of healing after avulsion
- regeneration
- controlled necrosis
- uncontrolled infection
what is controlled necrosis for pulpal outcomes after avulsion
- elective disinfection
- know that tooth is going to become non-vital so take live bit out of tooth before it dies and causes infection
- stopping the inevitable
what do you do if EAT<60 minutes and tooth has been stored in appropriate storage medium after avulsion
- replant tooth under La
- flexible splint 14 days
- consider antibiotics and check tetanus status
- carry out pulp extirpation at 0-10 days unless apex is open
what do you do for immature teeth if EAT<60 mins after avulsion
- if not going to root treat then need to monitor clinically and radiographically for signs of continued growth vs loss
- review after 2 weeks to remove splint, 4 weeks, 2 months, 3 months, 6 months then yearly
- if tooth non-vital extirpate pulp and refer to paeds specialist
what do you do for mature teeth if EAT<60 mins after avulsion
- after replantation and splinting, remove pulp ASAP
- place antibiotic-steroid with non-setting CaOH
- obturation with GP within 4-6 weeks
- refer to specialist
- review 3,6,12 months then yearly
what to do for teeth than have been >60 mins EAT and apex is closed after avulsion
- aim for bony healing
- extra-oral endo can be carried out before replantation
- replant tooth under LA
- splint for 4 weeks
- review 3, 6, 12 months then yearly
why can you do extra-oral endo if tooth has been >60 mins EAT after avulsion
- time isn’t a worry anymore as PDL cells are already lost now
what to do for teeth that have been >60 mins EAT and apex is open
- not going to get PDL healing
- small chance pulp will revascularise
- don’t root treat unless signs of loss of vitality
- replant tooth under LA
- splint for 4 weeks
- consider antibiotics
- check tetanus
- monitor closely for signs of necrosis and root development
- review 2 weeks, 4 weeks, 2 months, 3 months, 6 months then yearly
when should you not replant tooth after avulsion
- almost never
- if very immature apex and EAT>90mins
- child is immunocompromised
- child needs other emergency treatment
- young child finding it difficult to cope
when should you carry out sensibility tests on avulsed teeth
- at time of injury
- 1 month, 2 , 3 then 6-monthly for an average of 2 years
what do you monitor with radiographs on avulsed teeth
- root development = width or canal and length
- comparison with other side
- internal and external inflammatory resorption
what should you do for pulpectomy
- extirpate pulp and place CaOH for no longer than 4-6 weeks
- MTA plug and heated GP obturation
what is the name of MTA we use
- MTA angelus
- sets in 15 minutes
what is the 5-year pulp survival for avulsions
- open apex = 30%
- closed apex = 0%
what is the 5-year resorption for avulsions
- frequent in both open and closed apex
