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BDS3 paeds > Trauma III > Flashcards

Trauma III Flashcards

1
Q

avulsion replantation

A

Successful healing can occur if there is only minimal damage to the pulp and the PDL

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2
Q

3 critical factors for successful healing after avulsion replantation

A

Extra-alveolar dry time - EADT

Extra-alveolar time - EAT

Type of storage medium

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3
Q

EADT

A

Extra-alveolar dry time

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4
Q

EAT

A

Extra-alveolar time

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5
Q

what to do if pt attends with tooth already replanted after avulsion

A

Do not remove. Leave as is and follow instructions regarding splinting etc dependent on circumstance

Radiograph important to establish status of root development

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6
Q

3 options for tooth life post avulsion

A

PDL viable mostly (replanted immediately or v shortly after)

PDL viable but compromised (kept in saline/milk, total dry time <60 mins)

PDL non-viable (dry time >60 mins regardless of what happened after this time)
- After dry time of 60 mins or more, ALL PDL cells are NON VIABLE

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7
Q

if tooth replanted immediately/v shortly after avulsion

A

PDL viable mostly

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8
Q

if tooth kept in saline/milk, and total dry time is <60 mins

A

PDL viable but compromised

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9
Q

if tooth dry time >60mins, regardless of what has happened in that time

A

PDL non-viable

After dry time of 60 mins or more, ALL PDL cells are NON VIABLE

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10
Q

public advice for avulsed tooth

A

Essential for parents/sports coaches/teachers

Hold by crown only

Wash in cold running water

Replace in socket and child bites on tissue

Or Store in milk/saliva/normal physiological saline (not contact lenses)

Seek immediate dental advice

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11
Q

replantation initial decision making based on

A

Extra alveolar dry time EADT

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12
Q

2 main time categories to consider when replanting

A

EADT < 30 mins

EADT > 30 mins

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13
Q

healing outcomes after avulsion

periodontal (4)

A

Regeneration

PDL/cemental healing

Bony Healing

Uncontrolled infection

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14
Q

healing outcomes after avulsion

pulpal (3)

A

Regeneration

Controlled necrosis (elective disinfection)

Uncontrolled infection

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15
Q

EAT < 60 mins and stored in an appropriate storage medium (e.g. milk, physiological saline or saliva)

Tx

A

then there is a chance of cemental/PDL healing.
- AIM: PDL healing

Replant tooth under LA

Flexible splint 14 days

Consider antibiotics and check tetanus status e.g. occurred in muddy environment

Carry out pulp extirpation at 0-10 days UNLESS apex is open (immature root)

Teeth with an open apex may revascularize

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16
Q

EAT < 60 mins immature teeth

Tx after replantation

A

If the decision is made not to root treat the tooth it must be closely monitored clinically and radiographically for signs of continued growth vs loss of vitality

Review Interval: 2wks (splint removal), 4wks, 2mths, 3mths, 6mths then yearly.

If the tooth is found to be non vital extipate pulp and refer to paediatric specialist. Inter-disciplinary management is recommended

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17
Q

EAT < 60 mins closed apex (mature teeth)

Tx after replantation

A

After replantation and splinting, remove pulp as soon as possible. (Ideally day 0)

Following extirpation and disinfection, place antibiotic-steroid paste as intra-canal medicament- leave in place for 2 weeks

Remove splint after 14 days

At 2 weeks- clean and replace intracanal medicament with NSCaOH
- Don’t want CaOH in tooth more than 4-6 weeks and cause dentine necrosis

Obturation with GP should take place within 4-6 weeks

Refer to a specialist paediatric dental team for interdisciplinary management

Review 3, 6, 12 monthly then yearly

18
Q

teeth > 60 mins EAT and closed apex

Tx

A

Unlikely to get PDL healing

The aim is for bony healing (by ankylosis)
- so scrub root clean of dead PDL cells

Extra-oral endodontics can be carried out prior to replantation
- Harder but possible

Replant tooth under LA

Splint: 4 weeks flexible splint

Consider antibiotic prescription

If extra-oral endodontics not carried out- extirpate at 7-10 days and use NSCaOH as initial intra-canal medicament for 4wks prior to obturation with GP
- Review 3, 6, 12 monthly and then yearly

19
Q

teeth > 60 mins EAT and closed apex

Tx
If extra-oral endodontics not carried out

A

extirpate at 7-10 days and use NSCaOH as initial intra-canal medicament for 4wks prior to obturation with GP
- Review 3, 6, 12 monthly and then yearly

20
Q

teeth > 60 mins EAT and open apex

Tx

A

Unlikely to get PDL healing

Very small chance that pulp may still revascularize

Do not root treat unless signs of loss of vitality on follow-up

Replant tooth under LA

Splint: 4 weeks flexible splint

Consider antibiotic prescription

Check tetanus status

Monitor closely for signs of necrosis vs continued root development

Review 2 weeks, 4 weeks (splint removal), 2 months, 3 months, 6 months then yearly

21
Q

When not to replant tooth

A

Almost never

If very immature apex and EAT> 90mins (may still be best to replant)

Child is immunocompromised
- Cancer etc

The child has other serious injuries and warrant preferential emergency treatment and / or intensive care being dealt with.

? Very immature lower incisors in young child finding it difficult to cope?
- May only last 6 months, space can close easy

Even as a temporary space maintainer- the right choice is usually to replant esp when guiding position of adjacent erupting tooth
- Prevent drifting that child is too young for orthodontic Tx

22
Q

monitoring of avulsion/replantation

A

Open Apex Teeth require close monitoring

If pulpal necrosis detected- pulp extirpation must be carried out as soon as possible to avoid inflammatory resorption

Clinical tests - Trauma Stamp

Sensibility tests: thermal + electrical

  • at time of injury
  • 1 month, 2months, 3 months, then 6-monthly for an average of 2 years

Radiographs:

  • root development - width of canal and length
  • comparison with other side
  • internal + external inflammatory resorption
23
Q

what to look for on radiographs of avulsed replanted teeth

A
  • root development - width of canal and length
  • comparison with other side
  • internal + external inflammatory resorption
24
Q

when to carry out sensibility tests (thermal and EPT) for avulsed replanted teeth

A
  • at time of injury

- 1 month, 2months, 3 months, then 6-monthly for an average of 2 years

25
Q

pulpectomy

A

open apex, best practice

Extipate pulp and place CaOH for no longer than 4-6 weeks after identified as non-vital
- (Problems with CaOH apexification)

MTA plug and heated GP obturation (MTA sets in 15mins - check; then GP will take 24hrs)

26
Q

5 year pupal survival rate for avulsion/replantation

A

open apex 30%

closed apex 0%

27
Q

5 year resorption for avulsion/replantation

A

frequent for both open and closed apex

28
Q

flexible 2 week splinting for (3)

A

Subluxation

Extrusion

Avulsion – open and closed apex <60 mins EADT

29
Q

flexible 4 week splinting for (5)

A

Luxation

Apical/middle 1/3 root #

Intrusion

Dento-alveolar fractures

Avulsion- closed apex >60mins EADT

30
Q

flexible 4 month splints for (1)

A

coronal 1/3 root fractures

31
Q

types of splint

A

composite wire (best)

acrylic wire - also option

titanium helix - very good but expensive

32
Q

how to splint a re-implanted tooth

A

Cut and bend 0.3mm stainless steel wire.

Apply composite resin to traumatised tooth and those adjacent.

Sink the contoured, passive wire into the composite.

Shape and cure composite.

Smooth rough composite and wire ends.

33
Q

vacuum formed splints

A

Gumshield’ splint.

Oral hygiene is often very poor.

Essix retainer also vacuum formed but much thinner and better.

34
Q

ortho brackets and wire

wire must be

A

PASSIVE

if wire ‘active’ then teeth will be moved

35
Q

first choice splint

A

composite wire

acrylic useful when few abutment teeth

36
Q

dento alveolar fractures

A

Don’t have displacement of teeth in sockets

Mobility yes but not teeth in sockets been damaged to alveolar bone

Happens in segmented
- Teeth secure in their socket but it is the bone that is fracture

37
Q

dento alveolar fractures Tx

A

LA

Reposition - ‘apical lock; may be present

  • Moved a bit of bone so unable to get back in place
  • Numb, lift over back into right place

Flexible splint 4 weeks

Antibiotics

38
Q

follow up dento alveolar fractures

A

Monitor Clinically and Radiographically

  • Checking for root development-canal width and length, compare with neighbouring unaffected tooth
  • Check for signs of inflammatory resorption
  • Follow up: 2wk,4wk, 8 weeks, 4 months, 6 months, 1 year and yearly for 5 years
  • Risk of pulpal necrosis where closed apex is 50% at 5 years.
39
Q

advice for all dental injuries

A

Soft diet for 7 days

Avoid contact sport whilst splint in place

Careful OH with use of chlorhexidine gluconate mouthwash 0.1%

40
Q

follow up times for dento alveolar fractures

A

Follow up: 2wk,4wk, 8 weeks, 4 months, 6 months, 1 year and yearly for 5 years

BDS3 paeds (15 decks)

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