Trauma III Flashcards
1
Q
What is another name for concussion?
A
- AKA contussion
2
Q
Concussion: periodontal ligament?
A
Doesn’t break
3
Q
Concussion: Mobility? (2)
A
no mobility or displacement
4
Q
Intrusive luxation treatment on permanent dentition: options?
A
- Leave it to reerupt
- Orthodontic reposition
- surgical reposition
5
Q
Intrusive luxation treatment on primary dentition? (3)
A
- Let it reerupt
- Pulpectomy
- Extraction
6
Q
Concussion: bleeding?
A
Usually no bleeding on the gingival margin
7
Q
Concussion: pain?
A
Pain to percussion
8
Q
Concussion: X-ray?
A
No findings
9
Q
Concussion: esthetic problem?
A
No
10
Q
Concussion: Pain problems? (2)
A
Yes.
Analgesics and soft diet?
11
Q
Concussion: Pulpar problems? (2)
A
no
Check up
12
Q
Concussion: Mobility problems? (2)
A
no
Check up
13
Q
Concussion: Aftercare on permanent teeth? (3)
A
• CHECK-UPS
• SOFT DIET FOR 2 WEEKS
• GOOD ORAL HYGIENE
(CLORHEXIDINE)
14
Q
Concussion: Aftercare on primary teeth? (4)
A
Same as permanent dentition • CHECK-UPS • SOFT DIET FOR 2 WEEKS • GOOD ORAL HYGIENE (CLORHEXIDINE)
15
Q
What is subluxation? (2)
A
- Traumatic injury to the periodontal tissue
- tooth has increased mobility (i.e., is loosened) but has not been displaced from its tooth socket
16
Q
Subluxation: periodontal ligament?
A
Breaking of a bigger number of fibers of the periodontal ligament
17
Q
Subluxation: Mobility?
A
Yes
18
Q
Subluxation: Displacement?
A
No
19
Q
Subluxation: Bleeding?
A
OF the gingival margin
20
Q
Subluxation: pulp affectation?
A
Sometimes
21
Q
Subluxation: Aesthetic problem?
A
No
22
Q
Subluxation: Pain? Aftercare? (3)
A
Yes
Analgesics
Soft diet
23
Q
Subluxation: Pulpar problems? (2)
A
- Rarely
- Check the pulp
24
Q
Subluxation: Mobility? (3)
A
Yes
No occlusion/ferulization
25
Subluxation: treatment on permanent teeth? (2)
- Same as in permanent dentition, except….
| - NO FERULIZATION
26
Intrusive luxation: periodontal fibers? (2)
- Very intense trauma
| - Breaking of great number of periodontal fibers
27
Intrusive luxation: displacement?
Towards apical and is introduced in the alveolus
28
Intrusive luxation: Pulpar problems? (3)
- Check evolution - pulp tx
- 60%
- Until 2008 it was considered very severe, with a 100% of
cases with pulp affectation
29
Intrusive luxation: mobility? (2)
- Mobility in a first moment and displacement
| - The posterior blood clot immobilizes the tooth
30
Intrusive luxation: bleeding?
Bleeding of the gingival margin
31
Intrusive luxation: occlusion?
Does not alter occlusion
32
Intrusive luxation: pain? (3)
- To palpation
- to percussion
- analgesics
33
Intrusive luxation: percussion?
Sounds similar to ankylosis
34
Intrusive luxation: Clinic? (3)
• The spontaneous re-eruption in the following 3-12 months in
70% of the cases
• Pulp necrosis in 60 % of the cases with open ápex and
almost 100% when the ápex was closed.
• The root reabsorption is smaller in those teeth that re-erupt spontaneously.
35
Intrusive luxation: aesthetic problem? (2)
Yes
| Re-erupt
36
Intrusive luxation: mobility?
No
37
Intrusive luxation: Treatment types on permanent dentition? (3)
1. Leave it to re-erupt
2. Orthodontic reposition
3. SURGICAL REPOSITION
38
Intrusive luxation: Treatment permanent dentition - re-eruption apexes? (2)
- Up to 7 mm with open ápex
| - 3mm with closed apex
39
Intrusive luxation: Treatment permanent dentition - re-eruption: How long do we wait? (2)
- 3 months with open apex
- 3-4 weeks with closed apex (some authors leave it for a
longer time)
40
Intrusive luxation: Treatment permanent dentition - re-eruption: further treatments if necessary ?
- Root canal treatments
| - Apexification
41
Intrusive luxation: Treatment permanent dentition - Orthodontic reposition: apexes?
- More than 7 mm with open apex
| - 3mm with closed apex
42
Intrusive luxation: Treatment permanent dentition - Orthodontic reposition? (3)
* If the tooth does not re-erupt after the convenient time
* There are more complications
* Root canal treatment or apexification if necessary
43
Intrusive luxation: Treatment permanent dentition - Surgical reposition apexes?
• More than 7 mm with open ápex
| - 3mm with closed apex
44
Intrusive luxation: Treatment permanent dentition - Surgical reposition? (2)
* it has better results if we do it shortly after the trauma
| * Root canal treatment or apexification if necessary
45
INTRUSIVE LUXATION: PULP TREATMENT ON PERMANENT DENTITION - closed apex? (2)
- Root canal in almost 100% of cases.
| - Place calcium hydroxide inside canal for 3-4 weeks and then obturate with guttaperhca
46
INTRUSIVE LUXATION: PULP TREATMENT ON PERMANENT DENTITION - open apex? (2)
- Pulp treatment not always necessary
| - If necessary apexification or revascularization
47
INTRUSIVE LUXATION. TREATMENT ON PRIMARY DENTITION ? (3)
```
• Let it re-erupt: wait 1-3 months
• If it shows signs of pulp
necrosis (very frequent) we
may try to do pulpectomy or do
extraction.
• If the tooth is in contact with
the permanent tooth germ, we
will extract
```
48
Extrusive luxation: periodontal fibers?
Breaking of many periodontal fibers (less than in the intrusive
luxation)
49
Extrusive luxation: displacement? (2)
- Towards occlusal and comes
partially out of the alveolus
- Mobility and displacement in a first moment (24hrs) then the tooth may have more mobility (because of interference with the occlusion) or stop moving (blood clot)
50
Extrusive luxation: pulp? (2)
• Pulp affectation on a high % of cases
| - Check pulp vitality - pulp tx
51
Extrusive luxation: clinic? (4)
• Smaller % of teeth with pulp affectation if apex is open.
100% if apex is closed
• It alters the occlusion (it may make impossible to close the
mouth)
• Pain to palpation and percussion. Bleeding
• X-ray: Periodontal ligament is widened
52
Extrusive luxation: Pain? (2)
Yes
| analgesics
53
Extrusive luxation: Mobility problems? (2)
Yes
| Reduce luation and splint
54
Extrusive luxation: Aesthetic problems ? (2)
Yes
| Reposition
55
Extrusive luxation: treatment on permanent teeth? (5)
1º.- Soft reduction of the luxation with the fingers (on the first day)
2º.- Splint 1- 2 weeks
• If there are signs of necrosis
- Open apex: apexification or revascularization
- Closed apex: Root canal treatment
56
Extrusive luxation: treatment on primary teeth? (2)
• If < 3mm: It repositions spontaneously
• If > 3mm: Make extraction (it interferes with the occlusion and
gives great pain to the child)
57
Lateral luxation: Displacement?
Displaced to a side, generally towards palatal
58
Lateral luxation: peridontal fibers?
Breaking of big number of fibers (similar to the
| extrusive luxation)
59
Lateral luxation: pulp?
- Affectation in many cases
| - Check pulp - pulp tx
60
Lateral luxation: alveolar bone?
Sometimes there is a fracture
61
Lateral luxation: clinic? (3)
• Clínic: alteration of the occlusion, pain to percussion and palapation
• X-RAY : reduction of the periodontal ligament on one side
and widening on the opposite
• Percussion : sound similar to ankylosis
62
Lateral luxation: aesthetic problem? (2)
Yes
| Reposition
63
Lateral luxation: Pain? (2)
Yes
| Analgesics
64
Lateral luxation: mobility? (2)
Yes
| Reduce and splint
65
Lateral luxation: Permanent teeth treatment? (3)
```
• 1º.Reduction in 2 times
(entrampment or click
phenomenon)
• 2º.- Splint 4 weeks
• 3º.- Control of the pulp vitality
```
66
Lateral luxation: Primary teeth treatment? (3)
• If there is no interference with the occlusion, it will reposition
itself spontaneously
• If the displacement is mild, softly reposition
• If the displacement is severe or the root may be in contact
with the permanent tooth germ (Crown towards labial),
extraction
67
Avulsion: periodontal ligament?
- Fibers broken and tooth comes completely out of alveolus
68
Avulsion: Pulp? (2)
* Open apex the pulp may regenerate
| * Closed apex, there is always pulp affectation
69
Avulsion: conflicts?
Multiple and combined traumas are staring to be very
| frequent (due to car accidents) = conflicts for deciding best treatment
70
Avulsion: Factors that condition the treatment? (2)
- Time passed since trauma
| - Storage media
71
Avulsion: Time passed since trauma? (5)
```
*Always less than 2 hours
• <60 minutes ……………100% success
• 60 min- 120 minutes …………..Possible necrosis of periodontal ligament
• >2 hours…………... 100% failure
**Immediate reimplant Best prognosis
```
72
Avulsion: Storage media? (2)
* The best: Hanks balanced saline solution. It avoids necorsis in 90% of the cases
* Others : milk (keep fibroblast vitality 3h, better skim cow milk), saliva (2 hours, has bacterias)
73
Avulsion: Factors that condition the treatment? (2)
• Only 24% of the teeth are carried in a correct storage
media and for the correct time
• Rescue –Box make batter the prognosis
74
Avulsion emergency treatment on the phone? (5)
• Clean the tooth with tap water for 10 seconds
• Take the tooth by the crown and reimplant it (encourage
the person to do it)
• Once the tooth is reimplanted the child will bite a tissue or
gauze
• If it is not posible to reimplant it, introduce it in Hanks
balanced saline solution, milk or saliva (never water)
• Go to the dental clinic as fast as possible
75
Avulsion: general treatment in every case? (2)
1. Systemic antibiotic ( amoxycillin)
| 2. Antitetanic vaccine
76
Avulsion: In every case...
The tooth is reimplanted at the clinic
77
Avulsion: what not to do with tooth reimplantation?
Do not remove and reimplant back again if it comes already
| reimplanted
78
Avulsion: Reimplantation steps? (6)
1. Local anesthesia.
2. Suture the soft tissues if necessary and remove the blood clot from the
alveolus
3. Clean the alveolus softly with saline solution and clorhexidine
4. Pick the tooth by the crown (do not scrpae the root
5. Splint for 1-2 week
6. Pulp treatment on teeth with closed apex (if it is done on the first 14
days the risk of root reabsorption). If the apex is open, see evolution.
79
Avulsions: Drugs that can improve prognosis? (3)
- Doxicycline/minocycline
- 2% Sodium fuoride solution
- Emdogain
80
Avulsions: Doxicycline/minocycline (3)
- Introduce the tooth for 5 minute in a solution of
1mg of antibiotic/20ml saline solution
- helps pulp revascularization
- Used in teeth with open apex reimplanted in <
60 minutes
81
Avulsions: 2% Sodium fuoride solution (3)
- For 20 minutes on the surface of the tooth
- Slow down the osseus replacement of the tooth
- Used in teeth with closed apex reimplanted after >60 minutes
82
Avulsions: Emdogain? (3)
- inside the alveolus
- Controversial results
- not accepted 100%
83
Avulsions: To determine the treatment plan, we take into account? (4)
1. If the tooth has open or closed apex
2. If it has been reimplanted at the place of the accident
3. If it is not reimplanted immediatly, which storage media
was used.
4. If the storage media was not good, how much time
does it pass until it is reimplanted (> or < 60 minutes)
84
Avulsion: Clinical situationa - tooth with closed apex? (3)
1.1 Already reimplanted
1.2 With dry period < 60 minutes and/or good storage media (Hanks balanced saline solution, milk or saliva)
1.3 With dry period >60 minutes or other situations that suggest
cell necrosis
85
Avulsion: Clinical situationa - tooth with open apex? (3)
2.1 Already reimplanted
2.2 With dry period < 60 minutes and/or good storage media ( Hanks balanced saline solution, milk or saliva)
2.3 With dry period >60 minutes or other situations that suggest
cell necrosis
86
Avulsion: tooth with closed apex already reimplanted? (4)
1. Do not extract the tooth
2. Verify that it has been correctly reimplanted
3. Flexible splint for 1-2 weeks
4. Root canal treatment in 7-10 days (before removing the splint): Apply calcium hidroxyde or antibiotics + corticoids for 1 month and then obturate with gutapercha.
87
Avulsion: Tooth with closed apex and dry period < 60 minutes and/or good storage media ( Hanks balanced saline solution, milk or saliva)? (3)
1. Reimplant softly picking the tooth from the crown and verify it is in a correct position
2. Flexible splint for 1-2 weeks
3. Root canal treatment in 7-10 days (before removing the
splint) : Apply calcium hidroxyde or antibiotics + corticoids for 1 month and then obturate with gutapercha.
88
Avulsion: Tooth with closed apex and dry period >60 minutes or other
situations that suggest cell necrosis? (4)
- Periodontal ligament will be necrotic and can not be expected to heal.
- The goal in delayed replantation is, in addition to restoring the tooth for
esthetic, functional and psychological reasons, to maintain alveolar bone
contour.
- However, the expected eventual outcome is ankylosis and resorption of the root and the tooth will be lost eventually.
- Use sodium fluoride to delay the resorption of the root
89
Avulsion: Tooth with closed apex and dry period >60 minutes or other
situations that suggest cell necrosis treatment? (4)
1. Submerge the tooth in sodium fluoride 2% for 20 minutes
2. Reimplant softly
3. Splint for 4 weeks
4. Root canal treatment may be done prior reimplantation or
after 7-10 days
90
Avulsion: Tooth with open apex already reimplanted (4)
1. Do not extract the tooth
2. Verify that it has been correctly reimplanted
3. Flexible splint for 1-2 weeks
4. Usually the tooth suffers revascularization. If it suffers
necrosis, then we will di pulp treatment
91
```
Avulsion: Tooth with open apex and dry period < 60 minutes and/or good
storage media ( Hanks balanced saline solution, milk or saliva) properties?
```
It has been proven that introducing the tooth in a solution of doxicycline/minocycline for 5 minutes increaees the chances of
revascularization to happen.
92
```
Avulsion: Tooth with open apex and dry period < 60 minutes and/or good
storage media ( Hanks balanced saline solution, milk or saliva) treatment? (4)
```
1. Introduce the tooth in the solution for 5 minutes
2. Reimplant
3. Flexible splint for 1-2 weeks
4. Check pulp evolution
93
Avulsion: Tooth with open apex and dry period >60 minutes
| or other situations that suggest cell necrosis? (4)
1. Submerge the tooth in sodium fluoride 2% for 20
minutes
2. Reimplant softly
3. Splint for 4 weeks
4. Root canal treatment may be done prior reimplantation
or after 7-10 days
94
Avulsion: Immediate reimplantation closed apex? (4)
* Do not reimplant again
* Splint 1-2 weeks
* Root canal treatment
* Good prognosis
95
Immediate reimplantation open apex? (4)
```
• Do not reimplant again
• Splint 1-2 weeks
• Revascularization
(natural or induced)
• Good prognosis
```
96
Avulsion: Dry period < 60 minutes and/or good storage media closed apex? (2)
* Reimplant
| * Same as immediate reimplantation
97
Avulsion: Dry period < 60 minutes and/or good storage media open apex? (3)
• Put the tooth in ATB
solution
• Reimplant
• Same as immediate reimplantation
98
Avulsion: dry period >60 minutes or other
| situations that suggest cell necrosis open and closed apex? (5)
* Introduce the tooth in sodium fluoride
* Reimplant
* Splint 4 weeks
* Root cana treatment
* Bad prognosis
99
Avulsions check ups? (3)
• Following Andreassen guidelines
• FAVORABLE : asymptomatic, no mobility , normal xray
• DESFAVORABLE : symptomatic mobility , X-ray: root
resorption
100
Avulsions treatment on primary teeth? (2)
• We never reimplant
• If it happens in very small
children, there may be a delay in the eruption of the permanent
tooth
