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Peds II > Trauma II > Flashcards

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
Q

ENAMEL-DENTIN-PULP FRACTURE: Apex condition? (2)

A
  • open or closed

- if it is open, see if there is affectation of cameral or radicular pulp)

26
Q

ENAMEL-DENTIN-PULP FRACTURE: Minimum pulp exposure and no contamination?

A

Direct pulp capping +

restoration

27
Q

ENAMEL-DENTIN-PULP FRACTURE: Rest of cases?

A

Pulp treatment

28
Q

ENAMEL-DENTIN-PULP FRACTURE: treatment on permanent dentition with pulp exposure <1mm & <24h ? (2)

A

Direct pulp capping with calcium hydroxide and composite reconstruction

29
Q

ENAMEL-DENTIN-PULP FRACTURE: treatment on permanent dentition rest of cases with open apex - cameral affectation? (2)

A
  • Pulp treatment

- pulpotomy with calcium hydroxide + composite reconstruction

30
Q

ENAMEL-DENTIN-PULP FRACTURE: treatment on permanent dentition rest of cases with open apex - radicular pulp affectation?

A

apexification (or revascularization ) + reconstruction

31
Q

ENAMEL-DENTIN-PULP FRACTURE: treatment on permanent dentition rest of cases with closed apex?

A

-root canal treatment + composite restoration

32
Q

ENAMEL-DENTIN-PULP FRACTURE: Treatment

on primary dentition (4)

A

• 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
Q

CROWN-ROOT FRACTURE? (6)

A 
•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
Q

CROWN-ROOT FRACTURE: types? (2)

A
  • Vertical fracture (very bad prognosis)

- Oblique fracture( it sometimes seems horizontal)

35
Q

CROWN-ROOT FRACTURE: Factors to take into account? (3)

A

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
Q

CROWN-ROOT FRACTURE: Aesthetic problem? (2)

A

yes

composite restoration

37
Q

CROWN-ROOT FRACTURE: Pain? (2)

A

Yes

Removal of coronal fragment

38
Q

CROWN-ROOT FRACTURE: Pulpar ? (2)

A

Yes

Pulp treatment

39
Q

CROWN-ROOT FRACTURE: Placement? (2)

A

Yes

Traction

40
Q

CROWN-ROOT FRACTURE: Treatment of permanent teeth? (3)

A

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
Q

CROWN-ROOT FRACTURE: Treatment of permanent teeth options? (6)

A

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
Q

CROWN-ROOT FRACTURE: Treatment of

permanent teeth pulp?

A

• 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
Q

CROWN-ROOT FRACTURE: Treatment of primary teeth? (2)

A

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
Q

Root fracture: Types (3)?

A
  • Of the cervical third
  • Of the central third
  • Of the apical third
45
Q

Root fracture: Cervical third? (2)

A
  • The most severe, they affect the gingival
    margin and are difficult to stabilize
  • The always have mobility. They have bad prognosis
46
Q

Root fracture: central third? (2)

A
  • The most frequent at the dental clinic

- They may move or not

47
Q

Root fracture: Apical third? (2)

A
  • 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
Q

Root fracture: Characteristics (4)

A

• 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
Q

Root fracture treatment: aesthetic?

A

no

50
Q

Root fracture treatment: pain?

A

no

51
Q

Root fracture treatment: pulpar? (2)

A
  • yes/no

- Pulp treatment / no

52
Q

Root fracture treatment: mobility? (2)

A
  • Yes/no

- ferulization (splint) / no

53
Q

Root fracture: general treatment? (2)

A

• 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
Q

Root fracture: Treatment coronal third?

A
  • 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
Q

Root fracture: Treatment middle third? (2)

A
  • No mobility: Check

* Mobility: Splint 1-2 months

56
Q

Root fracture: Treatment apical third?

A

They are not treated very frequently and heal without problem

57
Q

Root fracture: Treatment of primary teeth? (4)

A

• 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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