trauma Flashcards
crown infarction
incomplete fracture of the enamel without loss of tooth structure
complicated crown fractur
INVOLVES PULP
Ellis class I
only in enamel
ellis class II
enamel and dentin fracture
ellis class III
pulpy pulp
root fractures
involve cementum, dentin and pulp
ellis class VI
apparently your whole root breaks like horizontally
concussion
injury to tooth supporting structures WITH NO ABNORMAL LOOSENING, tooth is tender to percussion
subluxation
injury to tooth supporting structures WITH LOOSENING but NO clinical or radiographic evidence of displacement
intrusive luxation
displacement of tooth deeper into alveolar bone, communition/fracture of alveolar bone
extrusive luxation
partial displacement of tooth out of socket
lateral luxation
displacement in a direction other than axially, fracture of socket
exarticulations
complete avulsion (totally displaced out of socket)
communition of alveolar socket
cracked of socket, associated with intrusive or lateral luxation
a fracture of the alveolar socket wall is confined to…
facial or lingual socket wall
laceration
shallow or deep wound in mucosa resulting form a tear
contusion
bruise, usually not accompanied with a break in mucosa
abrasion
superficial wound produced by rubbing or scraping and leaving a raw, bleeding surface
what percentage of battered children/spouse get facial injuries
50%
predisposing factors to dental trauama
increased overate with protrusion and insufficient closure
tooth injuries TWICE as frequentt in children with protrusive incisors
prevalence of dental trauma
4-14% (probably higher)
are boys or girls more affected by dental truama
boys
what tooth most commonly gets fucked up
anterior teeth, usually single tooth
what type of injury do primary teeth usually get
luxation and/or avulsion
what type of injury do permanent teeth usually get
crown fractures
what questions to ask when a pt comes in
when? (affects prognosis, tx plan)
where? (tetanus booster, abtcs?)
how? (type of injury)
pain (past, present, duration, type, location)
previous oral injuries (could be a neurologic cause)
objective info to gather when pt comes in
extraoral wounds? palpate facial bones for fracture intraoral soft tissue--check for tooth fragments/FB crown fracture? displaced or missing teeth? abnormal occlusion? mobililty? percussion? vitality tests? intraoral photos
PA radiographs
take form multiple angles to determine fracture!
tx of uncomplicated crown fracture (no dentin)
no treatment, smooth rough edges or repair
tx of uncomplicated crown fracture (dentin involved)
decal or GI cement covered with composite resin or temporary crown
prognosis for uncomplicated crown fracture with dentin exposed
5-13% incidence of pulp necrosis, better for younger teeth!
treatment options for complicated crown fracture
pulp capping with CAOH, MTA, bioceramics
partial pulpectomy
pulpotomy/ RCT
what impacts the treatment plan for complicated crown fracture
maturity of tooth
pulp capping indications for complicated crown fracture
small, recent (less than one day) exposure
no associated luxation injuries
absences of caries/restorations
young pulp has better prog
partial pulpotomy indications for complicated crown fracture
large exposure or immature tooth
exposure less than one week old
allows for vitality testing and cervical maturation
prognosis: 7-28% incidence of necrosis
pulpectomy indications for complicated crown fracture
mature tooth, post and core required to restore tooth
pulp regeneration indications for complicated crown fracture
pulp tissue is necrotic and immature (open) apex present
disinfect canal space, place scaffold to induce bleeding in canal, seal with MTA and composite and monitor
ONLY WHEN YOU HAVE OPEN APEX!!
for crown root fractures, what extra things do you need to assess?
depth of fracture….tooth fragment must be removed, consider biologic wdith
t/f: pulp treatment for crown-root fractures is the same as just a regular crown fracture
true
what root fracture has the poorest prognosis
near crestal bone
if you have a long rooted tooth that gets fractured…what are your options?
could do ortho extrusions and periodontal sx
coronal 1/3 root fracture tx
conservative…reduce and stabilize with splint for 10-12 weeks (take post reduction radiograph)
periodic pulp testing
incidence of pulp necrosis w/i first two months in coronal 1/3 root fracture
20-44%
t/f: the apical segment of a tooth with a coronal 1/3 root fracture often remains vital
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what are the four types of healing for root fractures
healing w/…
calcified tissue
connective tissue
bone and connective tissue
granulation tissue
when a root fracture heals with granulation tissue what is this due to
pulp necrosis causing inflammation at fracture line
what are treatment options for apical root fractures if pulp necrosis occurs?
RCT of coronal segment
RCT of coronal sement followed by surgical removal of apical segment
intraradicular splint
endoosseous implant (stablilizer) following removal of apical segment
luxation injuries are _____% of trauma to permanent teeth
20-40%
luxation injuries are ____% of trauma to primary teeth
62%
treatment for concussion and subluxation
adjust occlusion
periodic recalls
treatment for extrusive luxation
reduction and stabilization of tooth
remove splint after 10-14 days
begin RCT in mature teeth
monitor pulp status in immature teeth
how long to leave splint on for extrusive luxation
10-14 days
what type of tooth probably needs RCT following extrusive luxation?
mature tooth (monitor pulp status in immature teeth)
lateral luxation treatment
reduction and stabilization within 48 hours
concomitant alveolar fracture requires splinting for 3-8 weeks
ortho tx may be required if reduction not possible (if after 48 hours after injury)
what is the time limit for reducing a laterally luxated tooth
48 hours
how long to splint if you have an alveolar fracture associated w/ luxation
3-8 weeks
t/f intrusive luxation of immature and mature teeth usually DO NOT experience pulp necrosis
FALSE 96% OF INTRUSIVE LUXATION = NECROSIS
if an immature tooth is less than 7 mm intruded during injury….
it may spontaneously erupt. if it hasn’t started moving in 3 weeks start doing ortho
when to do surgical repositioning of an immature tooth that has been intruded
more than 7 mm intrusion
when should you start ortho treatment for a mature tooth that has been intruded?
if it has been intruded less than 7 mm start within 3 weeks of trauma
for a mature tooth that has been intruded, what and when should tx start?
start RCT within 2 weeks using CaOH as inter-appointment medication
mature tooth intruded more than 7 mm needs…
surgical repositioning and stabilization for two weeks
when can a mature tooth spontaneously erupt after intrusion injury
intrusion less than 3 mm, pt less than 17 yo
what are three prognosis factors for luxation injuries
nature and severity of injury
time duration before treatment rendered
stage of root development
pulp canal obliteration occurs in ____% of all luxation injuries combined
22%
pulpal necrosis ___% in concussion
2%
pulpal necrosis ___% in subluxation
26%
pulpal necrosis ___% in extrusive/lateral luxation
64%
pulpal necrosis ___% in intrusive luxation
96%
what injury has the highest rate of pulpal necrosis
intrusive luxation
list in order from highest percentage to lowest percentage of pulpal necrosis: subluxation, intrusive luxation, concussion, subluxation
intrusive
extrusive/lateral
subluxation
concussion
what injury is most likely to have progressive root resorption
intrusive luxation (52%)
are you likely to get progressive root resorption with subluxation or extrusive/lateral
no (4% and 7%)
follow up treatments for laxation injuries
vitality and radiographic checks RCT treatment of root resorption apexification extraction
what material do you use to prevent root resorption
CaOH
how often do you recall a pt with a primary tooth luxation injury
for concussion and subluxation: periodic recall once a year
extrusive luxation: EXT
when do you extract an injured primary tooth
extrusive luxation…yank it
if intrusive/lateral impinges on permanent tooth bud
what ages/what teeth/what sex for avulsion injuries
7-10 years old
maxillary centrals
boys
relationship between extra oral time and root resorption:
0-30 mins?
over two hours?
0-30 mins: 10%
over 2 hrs: 90%
options for transport media for avulsed teeth
HBSS viaspan/custodiol milk physiologic saline saliva water contact lens solution gatorade
initial tx for avulsions
irrigate and aspirate socket to remove blood clot
do not curette socket
do not handle root of avulsed tooth
do not scrape or rub root surface
replant tooth as soon as possible
verify with x ray
stabilize tooth
should you treat the root surface of an avulsed tooth with medications or chemicals
no, only if the root has been dry for over and hour
what do you do if the root of an avulsed tooth is dirty
rinse with saline gently
are abtx recommended for avulsions?
yes
doxy 100 mg bid for 7 days
penicillin V 500 mg bid for 7 days
why refer to physician for avulsions
tetanus coverage…refer within 48 hours
drug therapy for avulsions
abtcs
tetanus?
CHX for 10 days
analgesics
post op instructions for avulsions
dont bite on splinted teeth
soft diet
increase fluid intake
keep area clean
what are 4 contraindications to replantation
deciduous teeth
evidence of decay/perio dz
fractured/crusehd roots
other emergency considerations
what sort of endo treatment do you do for an avulsed tooth with a closed apex
extirpate pulp 1-2 weeks after preimplantation
CaOH for 7 days to 6 months (longer better)
gutta percha dat shit
what do you do for an avulsed tooth that has been DRY for more than one hour
can do endo in hand before you reimplant
soak tooth for 20 min in 2.4% sodium flurodie
what do you soak a dry tooth in and whats the pH
2.4% sodium fluoride, pH 5.5
what do you do for an avulsed tooth with an open apex
reimplant ASAP
Soak in doxycycline if contaminated
SYSTEMIC ABTS
monitor for pathological changes, do extirpation/CaOH
therapy if anything comes up, try to do pulp regeneration
four healing patterns for avulsed teeth
normal
surface resorption
inflammatory resorption
replacement resorption/ankylosis
what is the biggest factor affecting survival of avulses teeth?
stage of root development
MATURE TEETH SURVIVE LONGER
what sort of follow up do you want for avulsions
annual radiographs
f/u eval for at least 5 years
