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ABPD 2021 > Trauma Guidelines > Flashcards

Trauma Guidelines Flashcards

1
Q

Primary tooth enamel fracture follow up

A

No follow up required

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2
Q

Primary tooth crown fracture follow up

A

1 week
8 weeks
1 year

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3
Q

Primary tooth crown/root fracture follow up

A

1 week
8 weeks
1 year
*radiograph at 1 year if endo treatment completed

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4
Q

Primary tooth root fracture follow up

A

1 week
4 weeks (splint removal if completed)
8 weeks
1 year

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5
Q

Primary tooth alveolar fracture follow up

A

1 week
4 weeks splint removal + radiograph
8 weeks
1 year + radiograph

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6
Q

Primary tooth concussion follow up

A

1 week
8 weeks

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7
Q

Primary tooth subluxation follow up

A

1 week
8 weeks

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8
Q

Primary tooth extrusion follow up

A

1 week
8 weeks
1 year

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9
Q

Primary tooth lateral luxation follow up

A

1 week
4 weeks (+ splint removal)
8 weeks
6 months
1 year

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10
Q

Primary tooth intrusion follow up

A

1 week
8 weeks
6 months
1 year

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11
Q

Primary tooth avulsion follow up

A

1 week
8 weeks

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12
Q

Permanent tooth infraction follow up

A

no follow up needed

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13
Q

Permanent tooth enamel fracture follow up

A

6-8 weeks + radiograph
1 year + radiograph

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14
Q

Permanent tooth enamel dentin fracture

A

6-8 weeks + radiograph
1 year + radiograph

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15
Q

Permanent tooth crown fracture follow up

A

6-8 weeks + radiograph
3 months + radiograph
6 months + radiograph
1 year + radiograph

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16
Q

Permanent tooth crown/root fracture follow up

A

6-8 weeks + radiograph
3 months + radiograph
6 months + radiograph
1 year + radiograph
Yearly up to 5 years

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17
Q

Permanent tooth root fracture (apical or middle third) follow up

A

4 weeks splint removal + radiograph
6-8 weeks + radiograph
4 months + radiograph
6 months + radiograph
1 year + radiograph
Yearly up to 5 years

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18
Q

Permanent tooth root fracture (coronal third) follow up

A

4 weeks + radiograph
6-8 weeks + radiograph
4 months splint removal + radiograph
6 months + radiograph
1 year + radiograph
Yearly up to 5 years

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19
Q

Permanent tooth alveolar fracture follow up

A

4 weeks splint removal + radiograph
6-8 weeks + radiograph
4 months + radiograph
6 months + radiograph
1 year + radiograph
Yearly up to 5 years

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20
Q

Permanent tooth concussion follow up

A

4 weeks + radiograph
1 year + radiograph

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21
Q

Permanent tooth subluxation follow up

A

2 weeks for possible splint removal + radiograph
3 months + radiograph
6 months + radiograph
1 year + radiograph

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22
Q

Permanent tooth extrusion follow up

A

2 weeks splint removal + radiograph
4 weeks + radiograph
6-8 weeks + radiograph
3 months + radiograph
6 months + radiograph
1 year + radiograph
Yearly up to 5 years

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23
Q

Permanent tooth lateral luxation follow up

A

2 weeks + radiograph
4 weeks splint removal + radiograph
6-8 weeks + radiograph
3 months + radiograph
6 months + radiograph
1 year + radiograph
Yearly up to 5 years

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24
Q

Permanent tooth intrusion follow up

A

2 weeks + radiograph
4 weeks + splint removal + radiograph
6-8 weeks + radiograph
3 months + radiograph
6 months + radiograph
1 year + radiograph
Yearly up to 5 years

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25
Q

Permanent tooth avulsion (mature apex) follow up

A

2 weeks splint removal + radiograph
4 weeks + radiograph
3 months + radiograph
6 months + radiograph
1 year + radiograph
Yearly up to 5 years

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26
Q

Permanent tooth avulsion (immature apex) follow up

A

2 weeks splint removal + radiograph
4 weeks + radiograph
6-8 weeks + radiograph
3 months + radiograph
6 months + radiograph
1 year + radiograph
Yearly up to 5 years

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27
Q

Splint duration permanent tooth subluxation

A

2 weeks (if splinted at all)

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28
Q

Splint duration permanent tooth extrusion

A

2 weeks

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29
Q

Splint duration permanent tooth lateral luxation

A

4 weeks

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30
Q

Splint duration permanent tooth intrusion

A

4 weeks

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31
Q

Splint duration permanent tooth avulsion

A

2 weeks

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32
Q

Splint duration permanent tooth root fracture (middle, apical thirds)

A

4 weeks

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33
Q

Splint duration permanent tooth root fracture (coronal third)

A

4 months

34
Q

Splint duration permanent tooth alveolar fracture

A

4 weeks

35
Q

Splint duration primary tooth root fracture

A

4 weeks (if splinting required)

36
Q

Splint duration primary tooth lateral luxation

A

4 weeks (if splinting required)

37
Q

Splint duration primary tooth alveolar fracture

A

4 weeks

38
Q

Type of dental injury most common in primary dentition

A

Lateral luxation

39
Q

Type of dental injury most common in permanent dentition

A

Crown fracture

40
Q

Consequences of primary tooth trauma to permanent teeth

A

Tooth malformation
Impacted teeth
Eruption disturbances

41
Q

Radiograph recommendations for fractures and luxations of permanent teeth

A

Several conventional 2D imaging projections and angulations (but needs to be justified and individualized)
Justification is based on if the image obtained will impact the management of the injury
-one parallel PA aimed through midline
-one parallel PA aimed at right tooth (with trauma tooth visible)
-one parallel PA aimed at left tooth (with trauma tooth visible)
-occlusal radiograph
-opposing arch PA

42
Q

Favorable outcomes in permanent tooth trauma

A

Asymptomatic
Positive response to pulp sensibility testing
Good quality restoration (as needed)
Continued root development in immature teeth
Periodontal healing

43
Q

Unfavorable outcomes in permanent tooth trauma

A

Symptomatic
Pulp necrosis and infection
Discoloration
Apical periodontitis
Lack of further root development in immature teeth
Loss or breakdown of restoration (if placed)
Breakdown of marginal bone
Resorption
Ankylosis

44
Q

Treatment for permanent tooth enamel infraction

A

If severe, etch and seal
Otherwise no treatment necessary

45
Q

Treatment for permanent tooth enamel fracture

A

If tooth fragment is available, rebond
Tooth edges can be smoothed, composite resin restoration placed

46
Q

Treatment for permanent tooth enamel dentin fracture (uncomplicated)

A

If tooth fragment is available, rebond (soak in water or saline for 20min)
Cover exposed dentin with GI or bonding agent and resin
If exposed dentin is within 0.5mm of pulp (pink but no bleeding), place calcium hydroxide lining and cover material with GI

47
Q

Treatment for permanent tooth enamel dentin fracture (complicated)

A

With open apices, partial pulpotomy to preserve root development
Conservative pulp treatment also preferred treatment in teeth with complete root development
Calcium hydroxide or calcium silicate cements can be placed on pulp wound
If post is required for retention of crown, endo should be completed (for complete root development)
If tooth fragment is available it can be rebonded after rehydration and pulp treated
Otherwise build up with composite

48
Q

Treatment for permanent tooth uncomplicated crown-root fracture

A

Temporary stabilization of loose fragment until treatment plan is finalized
If pulp is not exposed, removal of coronal/mobile fragment and subsequent restoration
Cover exposed dentin with GI or bonding agent
Future options (pending pt age and behavior):
-ortho extrusion of apical or non-mobile fragment
-surgical extrusion
-RCT and restoration
-root submergence (decoronation)
-intentional replantation with or without rotation of the root
-extraction
-autotransplantation

49
Q

Treatment for permanent tooth complicated crown-root fracture

A

Temporary stabilization of loose fragment until treatment plan is finalized
In immature tooth, partial pulpotomy
In mature teeth, removal of pulp is indicated
Cover exposed dentin with GI or bonding agent
Future options (pending pt age and behavior):
-completion of RCT and restoration
-ortho extrusion of apical or non-mobile fragment
-surgical extrusion
-RCT and restoration
-root submergence (decoronation)
-intentional replantation with or without rotation of the root
-extraction
-autotransplantation

50
Q

Treatment for permanent tooth root fracture

A

If displaced, reposition coronal fragment ASAP
Check repositioning radiographically
Stabilize coronal segment with passive and flexible splint
Do not start RCT at the emergency visit
Monitor healing for at least 1 year
RCT may be needed for coronal segment
In mature teeth with coronal fracture, removal of coronal segment, RCT and post/crown usually required
-other options like ortho extrusion, surgical extrusion and others can also be considered)

51
Q

Treatment for permanent tooth alveolar fracture

A

Reposition any displaced segment
Stabilize segment with splint (passive/flexible)
Suture gingival lacerations if present
RCT contraindicated at emergency visit
Monitor pulp condition of all teeth involved

52
Q

Treatment for permanent tooth concussion

A

No treatment needed
Monitor pulp for at least 1 year

53
Q

Treatment for permanent tooth subluxation

A

No treatment usually needed
Splint may be considered if excessive mobility
Monitor pulp for at least 1 year

54
Q

Treatment for permanent tooth extrusive luxation

A

Reposition tooth (push back with use of LA)
Stabilize tooth for 2 weeks using passive/flexible splint
Monitor pulp condition

55
Q

Treatment for permanent tooth lateral luxation

A

Reposition tooth digitally under LA
Stabilize with flexible/passive splint 4 weeks
Monitor pulp condition (make endo eval at 2 week visit)
Immature teeth may spontaneously revascularize; if any resorption visible endo should be started ASAP
Mature teeth will likely necrose; endo treatment started when they do

56
Q

Treatment for permanent tooth intrusive luxation (immature apex)

A

Allow re-eruption without intervention
If no re-eruption in 4 weeks, initiate ortho repositioning
Monitor pulp condition
Spontaneous pulp revascularization can occur, but if necrotic or resorption, initiate endo ASAP

57
Q

Treatment for permanent tooth intrusive luxation (mature apex)

A

Allow re-eruption without intervention if tooth is intruded less than 3mm
If no re-eruption within 8 weeks, reposition surgically and splint for 4 weeks or reposition orthodontically before ankylosis develops
If tooth is intruded 3-7mm, reposition surgically (preferably) or orthodontically
If tooth is intruded beyond 7mm, reposition surgically
Pulp almost always will necrose; RCT should be started at 2 weeks or as soon as position of tooth allows

58
Q

Contraindications for replantation of avulsed permanent tooth

A

Severe caries
Severe periodontal disease
Uncooperative patient
Severe cognitive impairment requiring sedation
Severe medical conditions such as immunosuppression or severe cardiac conditions
*not reimplanting is irreversible decision, so in most cases it should be attempted

59
Q

Treatment for permanent tooth avulsion - closed apex and replanted at site of injury or very quickly after

A
  1. Clean injured area with water, saline or CHX
  2. Verify correct position of replanted tooth clinically and radiographically
  3. Leave tooth/teeth in place (unless malpositioned, then use digital pressure to reposition)
  4. Administer LA preferably without vasoconstrictor
  5. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks)
  6. Suture gingival lacerations, if present
  7. Initiate RCT within 2 weeks
  8. Administer systemic antibiotics
  9. Check tetanus status
  10. Provide post-op instructions
  11. Follow up
60
Q

Treatment for permanent tooth avulsion - closed apex and kept in storage media or non-physiologic conditions extraoral dry time less than 60 min

A
  1. If there is visible contamination, rinse root surface with stream of saline or osmolality-balanced solution
  2. Put or leave the tooth in the storage medium while taking history, examining patient, and preparing for replantation
  3. Administer LA preferably without vasoconstrictor
  4. Irrigate socket with sterile saline
  5. Examine the alveolar socket; if there is a fracture of the socket wall, reposition the fractured fragment into its original position
  6. Removal of coagulum with saline stream may allow better repositioning of the tooth
  7. Replant the tooth slowly with slight digital pressure; don’t use excessive force
  8. Verify the correct position of the replanted tooth clinically and radiographically
  9. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks)
  10. Suture gingival lacerations, if present
  11. Initiate RCT within 2 weeks
  12. Administer systemic antibiotics
  13. Check tetanus status
  14. Provide post-op instructions
  15. Follow up
61
Q

Treatment of permanent avulsed tooth with closed apex, extraoral dry time greater than 60 minutes

A
  1. If there is visible contamination, rinse root surface with stream of saline or osmolality-balanced solution
  2. Put or leave the tooth in the storage medium while taking history, examining patient, and preparing for replantation
  3. Administer LA preferably without vasoconstrictor
  4. Irrigate socket with sterile saline
  5. Examine the alveolar socket; if there is a fracture of the socket wall, reposition the fractured fragment into its original position
  6. Removal of coagulum with saline stream may allow better repositioning of the tooth
  7. Replant the tooth slowly with slight digital pressure; don’t use excessive force
  8. Verify the correct position of the replanted tooth clinically and radiographically
  9. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks)
  10. Suture gingival lacerations, if present
  11. Initiate RCT within 2 weeks
  12. Administer systemic antibiotics
  13. Check tetanus status
  14. Provide post-op instructions
  15. Follow up

Poor long-term prognosis; expected outcome is ankylosis

62
Q

Treatment of permanent tooth avulsion - open apex, tooth replanted immediately/very soon

A
  1. Clean injured area with water, saline or CHX
  2. Verify correct position of replanted tooth clinically and radiographically
  3. Leave tooth/teeth in place (unless malpositioned, then use digital pressure to reposition)
  4. Administer LA preferably without vasoconstrictor
  5. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks)
  6. Suture gingival lacerations, if present
  7. Pulp revascularization is the goal; risk of external resorption should be weighed against chances of revascularization. If spontaneous revasc does not occur, apexification, pulp revitalization/revascularization, or RCT should be initiated when pulp necrosis is identified
  8. Administer systemic antibiotics
  9. Check tetanus status
  10. Provide post-op instructions
  11. Follow up
63
Q

Treatment of permanent tooth avulsion - open apex, physiologic storage medium with extraoral dry time less than 60 minutes

A
  1. If there is visible contamination, rinse root surface with stream of saline or osmolality-balanced solution
  2. Put or leave the tooth in the storage medium while taking history, examining patient, and preparing for replantation
  3. Administer LA preferably without vasoconstrictor
  4. Irrigate socket with sterile saline
  5. Examine the alveolar socket; if there is a fracture of the socket wall, reposition the fractured fragment into its original position
  6. Removal of coagulum with saline stream may allow better repositioning of the tooth
  7. Replant the tooth slowly with slight digital pressure; don’t use excessive force
  8. Verify the correct position of the replanted tooth clinically and radiographically
  9. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks)
  10. Suture gingival lacerations, if present
  11. Pulp revascularization is the goal; risk of external resorption should be weighed against chances of revascularization. If spontaneous revasc does not occur, apexification, pulp revitalization/revascularization, or RCT should be initiated when pulp necrosis is identified
  12. Administer systemic antibiotics
  13. Check tetanus status
  14. Provide post-op instructions
  15. Follow up
64
Q

Treatment of permanent tooth avulsion - open apex, extra-oral dry time more than 60 minutes

A
  1. If there is visible contamination, rinse root surface with stream of saline or osmolality-balanced solution
  2. Put or leave the tooth in the storage medium while taking history, examining patient, and preparing for replantation
  3. Administer LA preferably without vasoconstrictor
  4. Irrigate socket with sterile saline
  5. Examine the alveolar socket; if there is a fracture of the socket wall, reposition the fractured fragment into its original position
  6. Removal of coagulum with saline stream may allow better repositioning of the tooth
  7. Replant the tooth slowly with slight digital pressure; don’t use excessive force
  8. Verify the correct position of the replanted tooth clinically and radiographically
  9. Stabilize tooth for 2 weeks using passive flexible splint (unless alveolar fracture present, then more rigid splint for 4 weeks)
  10. Suture gingival lacerations, if present
  11. Pulp revascularization is the goal; risk of external resorption should be weighed against chances of revascularization. If spontaneous revasc does not occur, apexification, pulp revitalization/revascularization, or RCT should be initiated when pulp necrosis is identified
  12. Administer systemic antibiotics
  13. Check tetanus status
  14. Provide post-op instructions
  15. Follow up

Poor long-term prognosis; PDL is not expected to regenerate, leading to ankylosis

65
Q

Antibiotics for avulsion recommendations

A

Amoxicillin or penicillin is first choice
If allergic, can use another type of antibiotic
Doxycycline or tetracycline is appropriate if pt is older than 12

66
Q

Splint size recommendations

A

Stainless steel wire up to diameter of 0.016” or 0.4mm
Nylon fishing line (0.13-0.25mm) (caution if not enough permanent teeth to bond to though)
Place composite/wire on labial surfaces
Keep composite away from gingiva to facilitate OH

67
Q

Pt/parent instructions for post-op for avulsion

A
  1. Avid participation in contact sports
  2. Maintain soft food diet for up to 2 weeks, according to tolerance of patient
  3. Brush their teeth with a soft toothbrush after each meal
  4. Use CHX mouth rinse twice a day for 2 weeks

Reference manual does not mention pain medication, but can suggest OTC pain medication

68
Q

Alternative treatment options for avulsed tooth, or tooth that was avulsed and replanted that fails

A

Decoronation
Autotransplantation
Resin-retained bridge
RPD
Ortho space closure with or without composite resin modification
Implant treatment after growth is completed

69
Q

Treatment for primary tooth enamel fracture

A

Smooth any sharp edges
Encourage good OH; can consider CHX

70
Q

Treatment for primary tooth with enamel dentin fracture

A

Cover exposed dentin with GI or composite
Encourage good OH; can consider CHX

71
Q

Treatment for primary tooth with complicated enamel dentin fracture

A

Preserve pulp with partial pulpotomy
Treatment depends on child’s ability to tolerate treatment
Encourage good OH; can consider CHX

72
Q

Treatment for primary tooth with crown-root fracture (with or without pulp exposure)

A

Remove loose fragment and determine if crown can be restored
If restorable and no pulp exposed, cover exposed dentin with GI; if pulp is exposed, perform pulpotomy or RCT
If unrestorable, extract all loose fragments, taking care not to damage permanent successor
Treatment depends on child’s ability to tolerate treatment
Encourage good OH; can consider CHX

73
Q

Treatment of primary tooth with root fracture

A

If coronal fragment is not displaced, no treatment is required
If coronal fragment is displaced and not excessively mobile, leave coronal fragment to spontaneously reposition, even if there’s some occlusal interference
If coronal fragment is displaced, excessively mobile and interfering with occlusion, 2 options are available:
-extract only the loose fragment
-reposition the loose coronal fragment, stabilize with flexible splint for 4 weeks
Treatment depends on child’s ability to tolerate treatment
Encourage good OH; can consider CHX

74
Q

Treatment of primary tooth with alveolar fracture

A

Reposition any displaced segment that is mobile or causing occlusal interference
Stabilize with flexible splint for 4 weeks
Encourage good OH; can consider CHX

75
Q

Treatment of primary tooth with concussion

A

No treatment needed
Observation

76
Q

Treatment of primary tooth with subluxation

A

No treatment is needed
Observation

77
Q

Treatment of primary tooth with extrusive luxation

A

Depends on degree of displacement, mobility, interference with occlusion, root formation, and ability of child to tolerate emergency situation
If tooth is not interfering with occlusion, let tooth spontaneously reposition
If excessively mobile or extruded >3mm, extract

78
Q

Treatment of primary tooth with lateral luxation

A

If there is minimal or no occlusal interference, the tooth should be allowed to spontaneously reposition itself
Spontaneous repositioning usually occurs within 6 months
In situations of severe displacement, two options:
-extraction when risk of ingestion or aspiration
-gently reposition the tooth, if unstable splint for 4 weeks

79
Q

Treatment of primary tooth with intrusive luxation

A

Tooth should be allowed to spontaneously reposition itself, irrespective of direction of displacement
Spontaneous improvement in position of intruded tooth usually occurs within 6 months (can take up to 1 year)

80
Q

Treatment of primary tooth avulsion

A

Do not replant

ABPD 2021 (14 decks)

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