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Trauma II Flashcards

1
Q

Enamel fracture types? (2)

A

Incomplete & complete

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2
Q

Incomplete enamel fracture? (3)

A
  • Vertical line of fracture (generally because of occlusal trauma)
  • Diagnosis: transilumination
  • It does not need treatment on any dentition
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3
Q

Complete enamel fracture? (3)

A
  • There is loss of dental structure.
  • No clinical symptoms
    (no exposed dentin tubules)
  • Oblique or horizontal line of fracture
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4
Q

Complete enamel fracture esthetic problems? (2)

A

Yes

Do a restoration with composite

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5
Q

Complete enamel fracture pain?

A

No

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6
Q

Complete enamel fracture pulpar?

A

No pulp treatment, check evolution

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7
Q

COMPLETE ENAMEL FRACTURE: TREATMENT permanent dentition ? (3)

A
  • If it is small (<2mm) polish and fluoride
  • If >2mm: restoration with composite
  • There usually are no pulp problems with time, but the
    Andreassen Check-up guidelines are kept in case there is any
    complication
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8
Q

COMPLETE ENAMEL FRACTURE: TREATMENT primary dentition?

A

Same treatment as permanent dentition

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9
Q

ENAMEL-DENTIN FRACTURE? (3)

A

• MORE SEVERE
• It always have to be treated: affectation of the dentin tubules and
posible pulp lesion
• Sensitivity to cold, sweet, brushing,…

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10
Q

ENAMEL-DENTIN FRACTURE line of fracture? (2)

A
  • more frequent is oblique

- may also be parallel to the incisal border

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11
Q

ENAMEL-DENTIN FRACTURE: aesthetic problems? (2)

A
  • Yes

- Restore with composite

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12
Q

ENAMEL-DENTIN FRACTURE: Pain? (2)

A

Yes

analgesics

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13
Q

ENAMEL-DENTIN FRACTURE: pulpar? (2)

A

No

Tubules exposure –> protection

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14
Q

ENAMEL-DENTIN FRACTURE paermanent tooth treatment?

A

The treatment can be done in 1 or 2 days:
- 1º.- Pulp protection with calcium hydroxide and composite (or
with glass ionomer)
( URGENT )
- 2º.- Reconstruction with composite or reposition of the
fragment (previous rehidration)

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15
Q

ENAMEL-DENTIN FRACTURE primary tooth treatment? (3)

A

• Composite restoration
• Check the pulp condition: If there is necrosis do pulpectomy or extraction
• If it has passed time since the trauma and there is pathological
reabsorptions: extraction

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16
Q

ENAMEL-DENTIN FRACTURE primary tooth treatment risks?

A

It may delay the eruption of the

permanent tooth

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17
Q

ENAMEL-DENTIN-PULP FRACTURE? (2)

A
  • Much more severe

* Mandatory and urgent treatment: great spontaneous pain and evolution to pulp necrosis if it is not treated

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18
Q

ENAMEL-DENTIN-PULP FRACTURE: Diagnosis? (2)

A
  • It is basically clinic: fracture with bleeding pulp exposure in a first moment. When time passes, the exposure changes of color due to pulp necrosis.
  • X-ray: If it is not treated … radiographic signs of necrosis
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19
Q

ENAMEL-DENTIN-PULP FRACTURE: aesthetic problem? (2)

A

Yes

Restoration with composite

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20
Q

ENAMEL-DENTIN-PULP FRACTURE: pain? (2)

A
  • Yes

- Analgesics and urgent treatment

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21
Q

ENAMEL-DENTIN-PULP FRACTURE: Pulpar? (2)

A
  • Yes

- Urgent pulp treatment

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22
Q

ENAMEL-DENTIN-PULP FRACTURE: factors to take into account? (3)

A
  • Size of the pulp exposure
  • Time passed
  • Apex condition
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23
Q

ENAMEL-DENTIN-PULP FRACTURE: Size of pulp exposure?

A

If it is smaller <1 mm a dentin bridge may be formed with

calcium hydroxide

24
Q

ENAMEL-DENTIN-PULP FRACTURE: Time passed?

A

if it is <24 hours, there is no contamination

25
ENAMEL-DENTIN-PULP FRACTURE: Apex condition? (2)
- open or closed | - if it is open, see if there is affectation of cameral or radicular pulp)
26
ENAMEL-DENTIN-PULP FRACTURE: Minimum pulp exposure and no contamination?
Direct pulp capping + | restoration
27
ENAMEL-DENTIN-PULP FRACTURE: Rest of cases?
Pulp treatment
28
ENAMEL-DENTIN-PULP FRACTURE: treatment on permanent dentition with pulp exposure <1mm & <24h ? (2)
Direct pulp capping with calcium hydroxide and composite reconstruction
29
ENAMEL-DENTIN-PULP FRACTURE: treatment on permanent dentition rest of cases with open apex - cameral affectation? (2)
- Pulp treatment | - pulpotomy with calcium hydroxide + composite reconstruction
30
ENAMEL-DENTIN-PULP FRACTURE: treatment on permanent dentition rest of cases with open apex - radicular pulp affectation?
apexification (or revascularization ) + reconstruction
31
ENAMEL-DENTIN-PULP FRACTURE: treatment on permanent dentition rest of cases with closed apex?
-root canal treatment + composite restoration
32
ENAMEL-DENTIN-PULP FRACTURE: Treatment | on primary dentition (4)
• In a first moment we will try to do pulpotomy (with formocresol, pherric sulphate, MTA,…) • If the radicular pulp is already affected we will do the pulpectomy • Always composite restoration • If it fails: extraction
33
CROWN-ROOT FRACTURE? (6)
``` •Very severe • There is pulp affectation almost always •Very bad prognosis • In the child we have to preserve the growth of the alveolar bone Very intense pain, the coronal fragment sticks like a knife and the occlusion is almost impossible • We have to act fast ```
34
CROWN-ROOT FRACTURE: types? (2)
- Vertical fracture (very bad prognosis) | - Oblique fracture( it sometimes seems horizontal)
35
CROWN-ROOT FRACTURE: Factors to take into account? (3)
1º. Is it posible the esthetic restoration on the pediatric patient? If the fracture is beneath the cervical third, the only option is the extraction 2ºIs it posible to do a prosthetic restoration in the future? 3º Is an implant the only possibility? Can we maintain the alveolar bone ?
36
CROWN-ROOT FRACTURE: Aesthetic problem? (2)
yes | composite restoration
37
CROWN-ROOT FRACTURE: Pain? (2)
Yes | Removal of coronal fragment
38
CROWN-ROOT FRACTURE: Pulpar ? (2)
Yes | Pulp treatment
39
CROWN-ROOT FRACTURE: Placement? (2)
Yes | Traction
40
CROWN-ROOT FRACTURE: Treatment of permanent teeth? (3)
1º- Anesthesia 2º- Extraction of the coronal fragment with tweezers or a luxator (that has to be done as an emergency, eventhough the rest of the treatment is delayed) + extrusión of the radicular fragment 3ºRadicular pulp treatment 4º- Reconstruction
41
CROWN-ROOT FRACTURE: Treatment of permanent teeth options? (6)
1º- Extraction of the mobile fragment + reconstruction 2º- Extraction of the mobile fragment + gingivectomy (and osteotomy if necessary) + pulp treatment (if necessary) + reconstruction 3º- Extraction of the mobile fragment + orthodontic extrusion + pulp treatment + reconstruction 4º- Surgical repositioning + pulp treatment + reconstruction 5º- Root submergence 6º- Extraction
42
CROWN-ROOT FRACTURE: Treatment of | permanent teeth pulp?
• Root treatment when you are able to see the entrance of the root canal: 1 . Open apex: apexification / revascularization 2. Closed apex: Root canal treatment
43
CROWN-ROOT FRACTURE: Treatment of primary teeth? (2)
If the radicular fracture is very small, we may extract the coroanl fragment and reconstruct • The most common treatment is the EXTRACTION( big lesions or displacement)
44
Root fracture: Types (3)?
* Of the cervical third * Of the central third * Of the apical third
45
Root fracture: Cervical third? (2)
- The most severe, they affect the gingival margin and are difficult to stabilize - The always have mobility. They have bad prognosis
46
Root fracture: central third? (2)
- The most frequent at the dental clinic | - They may move or not
47
Root fracture: Apical third? (2)
- Casual finfing as they do not have symptoms. They are the most frequent among the general population - They do not have mobility because the coronal fragment is the longest
48
Root fracture: Characteristics (4)
• The fragments usually dont suffer displacement. This helps a healing callus to be formed. • If we see displacement of the fragments, we must suspect a fracture of the alveolar bone • 80% do not have pulp affectation (Andreassen). They usually appear on teeth with open apex (bigger capacity of regeneration) • 20% have pulp affectation: usually on teeth with closed apex
49
Root fracture treatment: aesthetic?
no
50
Root fracture treatment: pain?
no
51
Root fracture treatment: pulpar? (2)
- yes/no | - Pulp treatment / no
52
Root fracture treatment: mobility? (2)
- Yes/no | - ferulization (splint) / no
53
Root fracture: general treatment? (2)
• Treat on the first 24-48 hours after the treatment( afterwards a pathological healing callus will be formed) • On all the root fractures: If there is pulp affectation, we will treat the pulp ( root canal treatment up to the line of fracture )
54
Root fracture: Treatment coronal third?
- Always have mobility - Splint 1-2 months , some authors talk of splinting up to 4 months The longer the time, the bigger the risk of ankylosis)
55
Root fracture: Treatment middle third? (2)
* No mobility: Check | * Mobility: Splint 1-2 months
56
Root fracture: Treatment apical third?
They are not treated very frequently and heal without problem
57
Root fracture: Treatment of primary teeth? (4)
• Almost always, extraction of the affected tooth - On the fractures of the apical third, the apical fragment will not be extracted. • If the child is small and the tooth does not move: Keep the tooth • Pulpectomies will not be done.

Peds II (11 decks)

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