Trauma II Flashcards
What is a root fracture
a dentine and cementum fracture that involves the pulp
What is an example of a vertical root fracture
would be a fracture caused by a post crown
What is a root fracture classified by
position of fracture
displacement of fragments
stage of root development
How can you classify based on the position of the fracture
○ Apical 1/3
○ Middle 1/3
○ Coronal 1/3
How can you classify based on the displacement of the fragment
○ Displaced
○ Undisplaced
How can you classify based on the stage of root development
○ Mature (closed apex)
○ Immature (open apex)
What fracture has best prognosis
apical third
• If it heals well at the fracture line it may be undetectable in future radiographs
How can a middle third root fracture be fixed
- It is important to reduce the fracture as much as possible and to get both halves touching again like a jigsaw
- This can be done by repositioning it
- It may be useful to get different views of the same tooth as it can be useful for diagnosis in some cases
Which fracture has the worst prognosis
Coronal third
Very poor prognosis due to very little periodontal ligament support to keep the crown in position during function
It creates a very unfavourable crown:root ratio
They are very mobile
Why can the appearance of a fracture on a radiograph be fooling
• Sometimes it looks like there are multiple fracture lines when there is only one but it has occurred at an angle cutting across the beam but it is just one fracture line
What does the prognosis of a fracture depend on
○ Age of child: mature/immature tooth
○ Degree of displacement
○ Associated injuries - e.g crown fractures
○ Time between injury and treatment
○ Presence of infection
What can occur between two displaced fractured halves
there will be a blood clot between the two halves of the tooth
What does the investigation of a root fracture consist of
clinical exam
special investigations
What does the clinical exam consist of
○ Fill out a trauma stamp to help with diagnosis and allow for long term monitoring
What does the special investigation consist of
○ Sensibility tests (ethyl chloride or EPT)
○ Radiographs from at least 2 angles (e.g 2 periapicals from different angles and 1x maxillary occlusal)
○ Alternatively can use cone beam CT
How do you treat a root fracture for apical or middle third fracture
- La may not be required but may want to use if it is uncomfortable
- Clean area with water/saline/chlorhexidine
- Reposition tooth with digital pressure
- Splint for 4 weeks using flexible splint
- Review 6-8 weeks, 6 months, 1 year and 5 years with radiographs
- Soft diet for 1 week and good OH
How do you treat a coronal 1/3 fracture
• Splint for 4 months with flexible splint
What are the different healing outcomes
calcified tissue union across fracture line
connective tissue healing
calcified and connective tissue healing
bone/osseous healing
What is calcified tissue union
healed with dentine like material
What is connective tissue healing
fracture lines remain visible and the edges of the fracture show signs of eburnation where the bone cells come and remove the sharp edges
What is bone osseous healing
the separate parts of the root become discrete entities with no connection, each part has its own distinct PDL space and bone is clearly seen between the fragments
What are non healing outcomes
• Granulation tissue (usually associated with loss of vitality)
How does granulation tissue appear
○ Radiolucency area is seen on the radiograph surrounding the fracture line
○ If you went into the root canal and hit granulation tissue with an endo file it feels spongy and bleeds darkly
What are the chances of a tooth becoming non vital
• There is 20% chance of pulp necrosis
What do you do if a tooth w/ apical / middle third fracture becomes non vital
- Extirpate to fracture line
- Dress with non setting calcium hydroxide then MTA/bio dentine just coronal to the fracture line as there is no apical stop so a barrier must be created
- Back fill with gutta percha to the fracture line
What can happen to the apical fragment of the root
- Remains in situ with its own PDL
- Resorb
- If infected then may require antibiotics/apicectomy
What are the different PDL injuries
- Concussion, subluxation
- Extrusive luxation
- Lateral luxation
- Intrusive luxation
- Avulsion
- Dentoalveolar fractures
What should you consider the impact of the injury on
- Surrounding bone (fracture?)
- Neurovascular bundle
- Root surface