Trauma II Flashcards
What are the two ways to perserve pulp vitality
pulp capping
partial pulpotomy
What is the treatment of choice in a tooth with an enamel/dentin/pulp fracture with a closed apex
RCT
What are the condiitons required for a Cvek pulpotomy
- Vital root
- No adverse symptoms
- No radiographic pathology
What is a critical factor for Cvek pulpotomy success
degree of pulp inflammation
Up to _ days between the time of trauma and Cveck treatment there will be little effect on the success
9
The size of the exposure doesn’t affect the success of a Cvek pulpotomy as long as it is less than _mm
4
Cvek pulpotomy has a better chance of success with a (open/closed) apex
open
Inflammed pulp tissue for a Cvek is removed up to _-_mm
1-3mm (until pulpal hemorrhage stops
Steps of a Cvek
- Inflammed pulp tissue removal
- Control pulpal bleeding
- Bacteriocidal irrigant (bleech and chlorhexidine)
- Cover pulp with CaOH and MTA
- GI
- Restore
Inflammed pulp should be removed with (slow speed/high speed)
high speed
To achieve proper hemostasis bleeding should stop after - min
3-5 min if it takes longer the pulp is deemed unhealthy
Which has the capacity to induce hard-tissue formation? Which has a high pH
both
What are the advatages of MTA over CaOH
- Dentin bridge forms faster
- Resistance to bacterial leakage
- Requires moisture to set (good to place over a bleeding pulp)
Which form of caOH is not sensitive to moisture
paste form
What is the success rate of Cvek pulpotomies in PERMENANT teeth
94-96%
What is the most commonly avulsed tooth
maxillary central incisor
What is the most common age to avulse a tooth and why
7-9 because the PDL is loosely structured and the bone is low mineralization
A (rigid/flexible) splint is used for avulsed teeth
flexible
What are the two types of pathology associated with tooth replantation
-Pulpal and periodontal reaction
T/F Prognosis of the avulsed tooth doesn’t change when the time out of the socket increases
f- worsens the longer it is out of the tooth
What is the purpose of HBSS
Hanks balanced salt solution is a cell culture medium used to keep the PDL cells alive
What is the next best storage option to HBSS
Cold milk
Why is water a bad transport solution for a tooth
it is hypotonic- will cause the PDL cells to swell and burst
What is another name for ankylosis
replacement resorption
Replacement resorption develops in two different directions depending on
extent of PDL damage
What are the two types of replacement resorption
- Progressive replacement resorption (gradual resorption of the entire root)
- Transient replacement resorption (once-established angkylosis disappears later)
Progressive replacement resorption is always initiated when
the entire PDL is removed before replantation or after excessive drying
Replacement resorption can first be recognized radiographically after how long
2 months (but in most cases it takes 6 mo-1 year)
Ankylosed teeth are (mobile/immobile)
immobile
percussive tone of an ankylosed tooth is (low/high) this test can often detect ankylosis (before/after) X-ray
high….before
Will the percussion tone change in transient replacement resorption once ankylosis disappears
yes it will be low again
Inflammatory resorption appears how
bowl shaped cavities in the cementum and dentin
What is the cause of inflammatory inflammation
injury to the PDL/cementum due to trauma or contamination with bacteria
What can intensify the inflammatory response in inflammatory resportion
exposure of the dentinal tubules
Inflammatory resportion is a (fast/slow) process
fast
First radiographic sign of inflammatory resporption takes how long
2 weeks
Where along the root is inflammatory resopriton first seen
cervical third
Percussion tone of a tooth with inflammatory inflammation is (sharp/dull)
dull
T/F inflammatory resorption –> percussion sensitivity
t
Why is doxycycline recommended after avulsion
anti-resoprtive properties
What should you use for an antibiotic after evulsion if the kid is less than 12
pen VK (due to staining)
Why is long term rigid splinting not recommended for avulsed teeth
increased risk of replacment resorption
A pulpectomy on a mature avulsed tooth should be done how long after the incident
within 7-10 days
How long should CaOH stay in the tooth before obturation
until X-ray signs of healing are noted
How long should a tooth be soaked in fluoride for after >60 min dry time and why
20 min- slows replacement resorption
Why do we remove the dead PDL cells after dry time >60 min
Slows replacement resorption if these cells remain they act as inflammatory stimulators
why do we want to slow replacement resorption when it will happen regardless
maintain the height and width of the socket for an extended period of time
What is the main reason why revascularization can fail and how can we prevent it
bacteria in the apical third… doxycycline (antibacterial and antiresorptive properties)
What is the conc. of doxyxlycine used on teeth we want to revascularize
50 mg of doxycycline in 5 cc of saline for 5 mins
Why should you not let infraposition to progress
because even an uncomplicated extraction can lead to large loss of the alveolar ridge
When would minor infraocclusion be expected
when the alveolar growth is finished/almost finished
Describe decoronation
Remove the crown and leave the root. Remove the pulp in the root. The root will be substituted for bone
