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Clinical Knowledge 2 > Trauma 4 > Flashcards

Trauma 4 Flashcards

1
Q

What is avulsion?

A

this is when the tooth is completely displaced out of its socket. Clincally the socket is found empty or filled with coagulum

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2
Q

How should you manage an avulsion injury in an open apex permanent tooth?

A
  • replant
  • splint for 2 weeks
  • root canal should be avoided unless there is evidence of pulpal necrosis
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3
Q

How should you manage an avulsion injury in a closed apex permanent tooth?

A
  • replant
  • splint for 2 weeks
  • initiate root canal within 2 weeks
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4
Q

What first aid advice can be given for avulsion injuries in permanent teeth?

A
  • hold by the crown (blunt end)
  • rinse in milk/saline/saliva for a maximum of 10 seconds to wash off foreign debris

They can either
* replant into socket, patient bites down on gauze and goes to dentist
* place in storage medium and go to dentist
* DO NOT LET TOOTH GET DRY

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5
Q

Outline the storage medium for avulsed teeth in order of preference

A
  1. milk
  2. patient saliva
  3. normal saline (first aid kit)
  4. HBSS

(HBSS down the peking order because it is less readily available)

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6
Q

What does HBSS stand for ? What is the benefit of HBSS?

A

Hanks balance salt solution

Can keep tooth and associated PDL alive for 24 hours

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7
Q

When are the best outcomes achieved for replantation of avulsed teeth?

A

when they are replanted immediated or within 15 minutes

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8
Q

What are the critical factors for higher chances of survival following an avulsion injury?

A
  • extra-alveolar dry time
  • type of storage medium
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9
Q

What is the state of an avulsed tooth with an EADT of >5 minutes?

A

leads to significant root damage

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10
Q

What is the state of an avulsed tooth with an EADT of 30 minutes?

A

most PDL cells are non-viable

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11
Q

What is the state of an avulsed tooth with an EADT of 1 hour ?

A

no vital PDL cells remain

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12
Q

What is the maximum EADT for an avulsion injury ?

A

6 hours

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13
Q

How can you classify avulsed teeth?

A
  1. PDL cells most likely viable- tooth implanted immediately or within 15 minutes
  2. PDL cells may be viable but compromised. Tooth has been in storage medium and EADT <60minutes
  3. PDL cells likely non-viable. Total EADT >60 minutes regardless of being in storage medium
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14
Q

Outline the procedure for replantation of an avulsed tooth with a closed apex

A
  • clean injured area with water, saline or CHX
  • verify correct position clincally and radiographically
  • leave tooth if already implacted (if slightly malpositioned, correct with digital pressure)
  • give LA ( no evidece to support no vasoconstrictor)
  • if in wrong socket or rotated correct within <48 hours
  • passive flexible splint (<0.4mm) placed on labial surface for 2 weeks
  • if associated alveolar fracture, leave splint for 4 weeks
  • initiate RCT in 2 weeks
  • give systemic antibiotics/check tetanus status
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15
Q

Outline the procedure for the replantation of a closed apex avulsed tooth with an EADT of >60 minutes that has been stored in storage medium

A
  • rinse visible contamination on root surface with a stream of saline
  • remove debris by agitating in a storage medium or saline soaked gauze
  • leave tooth in storage medium while questioning and preparing patient
  • give LA
  • irrigate socket with saline
  • examine socket, remove coagulum with stream of saline
  • plant teeth in correct position, confirm clincally and radiographically
  • passive flexible labial splint placed for 2 weeks
  • if alveolar fracture involved leave splint for 4 weeks
  • initiate RCT within 2 weeks
  • give systemic antiobiotics/check tetanus status
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16
Q

Outline the procedure for the replantation of an open apex tooth replanted immediately or within 15 minutes

A
  • clean injured area with saline, water or CHX
  • verify correct position clinically and radiographically
  • leave tooth if slightly malpostioned but correct with digital pressure
  • give LA
  • if in wrong socket or rotated then correct <48 hours
  • passive flexible labial splint for 2 weeks
  • leave splint for 4 weeks if dento-alveolar fracture involved
  • pulp revascularisation is the goal here so leave tooth. Risk of infection related resorption is high and weighed against chance of revascularisation. If no revascularisation occurs then start RCT as soon as pulp necrosis/infection identified
  • systemic antibiotics/check tetanus status
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17
Q

Outline the procedure for replantation of an open apex tooth with an EADT of >60 minutes left in storage medium

A
  • rinse visible contamination on root surface with a stream of saline
  • remove debris by agitating in a storage medium or saline soaked gauze
  • leave tooth in storage medium while questioning and preparing patient
  • give LA
  • irrigate socket with saline
  • examine socket, remove coagulum with stream of saline
  • plant teeth in correct position, confirm clincally and radiographically
  • passive flexible labial splint placed for 2 weeks
  • if alveolar fracture involved leave splint for 4 weeks
  • pulp revascularisation is the goal here so leave tooth. Risk of infection related resorption is high and weighed against chance of revascularisation. If no revascularisation occurs then start RCT as soon as pulp necrosis/infection identified
  • give systemic antiobiotics/check tetanus status
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18
Q

What is the main goal of open apex replantation of avulsed teeth regardless of the EADT?

A

Revascularisation

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19
Q

If revascularisation of the tooth occurs, what is no longer indicated?

A

RCT

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20
Q

Why are RCTs always indicated after replantation of closed apex avulsed teeth?

A

this is because revascularisation is unlikely to occur in these teeth hence pulpal necrosis can occur

In order to prevent this, RCT is undertaken

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21
Q

What is the expected outcome when the PDL becomes necrotic ?

A

ankylosis (resorption of root cementum and ingress of bone tissue)

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22
Q

What is the goal of replantation ?

A
  • restore aesthetics and function whilst also maintaining alveolar contour, width and height
23
Q

The decision to replant is almost always the right one even when the EADT is >60 minutes. True or false

A

true

24
Q

Replantation of the tooth keeps treatment options open. True or false

A

true

25
Q

What is the rate of ankylosis dependent on?

A

the growth rate (of cementum?)

26
Q

When are antibiotics recommended for avulsion tooth injuries? What antibiotics can be recommended in such cases?

A
  • prevent infection related reactions
  • decrease occurence of infection related to root resorption
  • medical satus may warrant use
  • systemic amoxicillin/penicillin
  • if allergic prescribe doxycycline (tetracycline)- should not be prescribed to children under 12- intrinsic discolouration of teeth
27
Q

What ways can endodontic treatment be initiated for replanted closed apex teeth?

A
  • pulp extirpation and placement of CaOH within 2 weeks of replantation, left for up to a month then endodontic treatment
  • corticosteroid/ Corticosteroid/ab placed immediately after replantation and left for 6 weeks before endodontic treatment
28
Q

If revascularisation following replanatation of an open apex tooth fails, what can the RCT treatment involve?

A
  • apexification procedure- using MTA/biodentine apical plug then backfilling with GP
  • regenerative endodontics
  • keeping CaOH in canal if progressive resorption
29
Q

What happens in children after replantation of open apex tooth where pulpal necrosis or infection is present?

A

infection related (inflammatory) resorption is rapid

30
Q

How should you monitor avulsion/replantation injuries?

A
  • clinical tests- trauma stamp
  • sensibility tests (electrical,thermal)- at time of injury, 1 month, 3 months, 6 months, 1 year and then annually for at least 5 years
  • radiographs: monitor root development- width and length of canal, compare to contralateral tooth, infection related/ankylosis related resorption
31
Q

What is the 5 year survival rate for avulsion injuries in open apex teeth?

A

30%

32
Q

What is the 5 year survivcal rate for avulsion injuries in closed apex teeth?

A

0%

33
Q

What is the 5 year resorption rate for avulsion injuries in closed and open apex teeth?

A

frequent

resorption frequently occurs

34
Q

What is a dentoalveolar fracture?

A

a fracture of the alveolar process; may or may not involve the alveolar socket

35
Q

How are dentoalveolar fractures characterised?

A

they are characerised by the mobility of the alveolar process

36
Q

Several teeth typically move as a unit when mobility is checked in a dentoalveolar fracture. True or false

A

true

37
Q

What clinical disturbance is often present in dentoalveolar fractures ?

A

occlusal interference

38
Q

How long should a passive-flexible splint be place following a a dentoalveolar fracture?

A

4 weeks

39
Q

How should dento-alveolar fractures be monitored?

A
  • clinical tests- trauma stamp
  • sensibility tests (thermal, EPT)- at time of injury, 1 month, 3 months, 6 months 1 year then annually for at least 5 years
  • radiograph- root development- width and length of canal, compare with contralateral side, infection/ankylosis related resorption
40
Q

What is external surface resorption?

A

this occurs after damage to the PDL which subsequently heals
there is resorption on the outer surface of the root

the bodys own immune system dissolves the tooth root strutures

41
Q

Give examples of instance where external surface resorption occurs

A

maxillary canine on maxillary laterals (unerupted maxillary canine)
excessive orthodontic forces

42
Q

What is external infection related resorption?

A
  • damage to PDL initially
  • infection then becomes maintained and propagated by the pulp via dentinal tubules- pulp becomes infected with bacteria- necrotic pulp
  • progressive disease
43
Q

How can you arrive at a diagnosis for external infection related resorption ?

A
  • root surfaces appear indistinct on radiograph
  • tramlines of the root canal are intact
44
Q

What is the treatment for external infection related resorption?

A
  • pulp extirpation
  • mechanical and chemical irrigation, non setting CaOH
  • change CaOH every 3 months to try and halt resorption
  • obturate when bone repair is visible radiographically
  • if progressive resorptio then change CaOH every 6 months and plan ahead for prosthetic treatment

treatment is essentiall the use of intracanal medicaments for complete debridement of bacteria

45
Q

What is internal infection related resorption?

A

resorption is intiated by the necrotic pulp
also progressive

46
Q

How can you diagnose internal infection related resorption?

A
  • tram lines of the root canal are indistinct
  • root surfaces are intact
47
Q

What is the treatment for internal infection related resorption?

A
  • extirpation and mechanincal+ chemical irrigation, non setting CaOH
  • change nsCaOH every 3months to try and halt resorption
  • if no progression of resorption for 12 months then obturate with GP
  • if progressive resorption then change nsCaOH every 6 months and plan ahead for prosthetic replacement
48
Q

What is ankylosis related resorption?

A

initiated by severe damage to PDL and cememtum
normal repair of PDL and cementum does not occur
bone fuses directly to dentine/cementum
progressive
tooth gradually resorbed and bone laid down as it is now part of the bone remodelling

49
Q

How is diagnosis of ankylosis related resorption arrived at?

A

loss of PDL and lamina dura

50
Q

What is the treatment for ankylosis related resorption?

A

no treatment
do nothing?

51
Q

Pulp canal obliteration is more common in what kind of permanent teeth?

A

open apex permanent teeth

common in root fractured teeth

52
Q

Pulp canal obliteration is often an indication of …

A

vitality

blood supplying the minerals to lay along the walls of the canal

53
Q

What is pulp canal obliteration?

A

gradual narrowing of pulp chamber and pulp canal
total or partial obliteration

54
Q

What is the treatment for pulp canal obliteration?

A

treatment is conservative

only 1% will give rise to periapical pathology

Clinical Knowledge 2 (40 decks)

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