Trauma

Question 1

Systematic approach

Answer 1

1. Observation
2. Enquiry
3. Clinical exams
4. Radiographs

Question 2

Extra oral exam (signs of possible mandibular fracture)

Answer 2

• step formation
• paresthesia
• range of movement
• pain or swelling
• racoon eyes or battle sign🐼

Question 3

Hard tissue injuries🦷

Answer 3

Class I- #of enamel, pulp not involved

Class II- #of enamel and dentine, pulp
not involved

Class III- #of enamel and dentine, pulp exposure

Class IV- root #

Class V- avulsion/ total displacement

Question 4

Soft tissue injuries

Answer 4

1. Concussion (sensitive tooth that isn’t loose)
   - monitor soft diet, reinforce OH
2. Subluxation (loose tooth, not displaced, bleeding might be present)
   - soft diet, carefully reposition tooth and splint for 7-10 days
3. Luxation (loose and displaced)
   - extrusive luxation is splinted for 2 weeks
   - lateral luxation is splinted for 4 weeks
4. Intrusion (forced into socket)
   - half of crown palatally placed
   - orthodontic repositioning
   - RCT if non vital
5. Extrusion (forced partially out of socket)
   - XLA
6. Avulsion (complete displacement)
   - no re implantation

ACSLIE

Question 5

How do we treat a primary Class III fracture? (NB-4)

Answer 5

• pulp involved
• never DPC
• always pulpotomy
• GI/ STRIP CROWN
• extensive fracture requires Xtr

Question 6

Avulsion Tx options

Answer 6

1. Time outside the mouth
   - <20 min you’ll get ideal outcome
   - re-implant within 20-25 min
2. Transport medium
   - cold storage such as dentosafe, milk, saline, patient’s mouth, not tap water
3. Open or closed apices
   - OPEN- better prognosis and revascularization is possible
   - CLOSED- no revascularization possible
4. Treating root surface
   - antibiotics for open apices
   - fluoride for closed apices

Question 7

Ideal splinting

Splinting is either fixed (rigid or flexible <0.4mm) or removable

Answer 7

• passive
• allows physiologic movement
• non irritating
• does not interfere with occlusion
• easy access for endo
• easy to remove and clean

Question 8

Fixed splints

Answer 8

• rigid are for dento- alveolar fractures, splint for 4 weeks
• flexible allows for normal physiologic movement splint for 2-4 weeks

Question 9

How do we treat a permanent Class III fracture?

Answer 9

1. DPC
2. Pulpotomy (cvek)
3. Pulpotomy (cervical)
4. Pulpectomy
5. XLA
6. Revascularization

Question 10

Cvek method

Answer 10

1. LA
2. Enlarge exposure site by 2mm in all directions
3. Rinse thoroughly
4. Control bleeding
5. Calcium hydroxide and dycal and life
6. GI
7. Restore with composite
8. Follow up after 3 months

Question 11

Cervical pulpotomy

Answer 11

For young permanent tooth with open apex

Facilitated closure of apices

Question 12

Revascularization

Answer 12

Indicated for non vital teeth with open apices
Stimulates closure of apex using vital pulp cells

Root fractures

Question 13

How does tooth react to trauma?

Answer 13

• internal resorption
• necrosis
• haemorrhage
• root resorption
• calcification
• ankylosis