Trauma- injuries To Permanent Flashcards
How do you manage an enamel fracture?
- Take a PA to rule out any root #
- Restore with either composite
Take new X-ray at 6-8weeks and then 1 yr
How do you manage an enamel infraction?
Need to review as energy from the blow maybe transmitted to the periodontal tissues or pulp
How do you manage an uncomplicated fracture?
- Need to treat immediately to avoid bacterial ingression and osmotic irritation to pulp via the dentine, tubules
- As emergency Place composite or GIC
- Long term: composite build up or crown reattach spent
Under which circumstances would you reattach a crown fragment immediately?
If the fracture is not close to the pulp
Under which circumstances would you reattach a crown fragment later?
If the fracture is close to the pulp so need to place CaOH over the area and then restore
How should you store the crown fragment if you are going to replace it later on?
It should be stored in saline
How do you perform fragments re attatch emt ?
Welbury 2012
- Check vitality of tooth
- Check fit of fragment
- Clean fragment and tooth with a pumice-water slurry
- Isolate the tooth with rubber dam
- Etch enamel for 30secs along fracture line and extend onto tooth fragment
- Bon
What is the problem with a complicated fracture in a young patient?
Pulpal death means that root formation will not be complete and this the means that the root wall will remain thin, divergent and weak
How long does it take for root formation to compete?
2-3yrs after eruption
What are the problems with loss of tooth vitality in an immature tooth?
The tooth is more susceptible to fracture
Unfave crown root ratio
Endo is hard
What is the emergency treatment of a complicated fracture?
Prevent physical,chemical,microbial invasion into the pulp to maintain vitality to allow root to complete
How can we preserve the vitality of the root pulp?
By getting rid of any of the infected coronal pulp
If the tooth it vital and immature but there has been an exposure what are the options?
Pulp cap
Partial or complete pulpotomy
If the tooth it non vital and immature and there has been an exposure what are the options?
Pulpectomy
When must you do a pulp cap?
- Within 24 hours of the incident
- Rubber dam
- Bleeding controlled with saline/Na hypochlorite
- CaOH cement placed on the exposure and then composite ontop
What should a successful pulp cap allow for?
A dentine bridge to form and retain pulp vitality to allow apexogenesis
What should be the follow up interval for pulp cap?
1 Month
three months
6 monthly for 4 years
Assess for root maturation and ensure root is growing and canal is narrowing
When would you perform a pulpotomy?
Immature tooth
Trauma was more than 24 hours ago
Tooth still vital but pulp exposed
What is the amount of pulp removal in a pulpotomy related to?
The time since exposure since more bacteria would ingress
How much would you remove of the coronal pulp if the trauma was 24-48 hours ago? What is this process called ?
2-4mm
Cvek pulpotomy
How do you perform a Cvek pulpotomy?
- LA and Rubber dam
- 2-4 mm Pulp removed with high speed and water
- Excessive bleeding that cannot be controlled with cotton wool or no bleeding means need to remove more pulp
- Rinse with saline or sodium hypochlorite (1-2%)
- Remove any remaining tags in the coronal portion
- Apply CaOH in the remaining cavity and allow calcify repair
- Place a hard cement over the CaOH and then restore (this prevents forceful injection into pulp during mastication)
How often would you review a Cvek?
One month
3 month
6 monthly for. 4 years
How can a Cvek pulpotomy become a complete pulpotomy?
When you remove only a small amount if pulp and if you find that more and more of it is necrotic you keep going until you find healthyh pulp which may mean a complete coronal pulpotomy
What is the purpose of the vital pulp therapies?
Apexogenesis
What does a Pulpectomy aim to do?
Apexification
What are the processes of a Pulpectomy in a non vital immaturely tooth?
- Access with high speed
- Remove any loose fragments in the pulp chamber with gently irrigation
- gates glidden can be used to help improve access but be very careful not to over prepare sice walls v thin
- Clean and shape the canals
- Dry the canals and fill canal with non setting CaOH
- Fill the access with GIC or composite which is about 3mm thick
How often should you review the Pulpectomy?
Review every 3 months
And see if the calcific baronies has formed by testing gently with paper point
How long should it take for the barrier to form?
9-18 months but can be up to 2 yrs
What material other than CaOH can be used to create the calcific barrier?
MTA
What are the advantages of using MTA?
Forms a hard biocompatible seal within 30mins
Can access and obturation in same session
What is the name of a new method used with pulpectomies?
RET
Regenerative endo technique
How does the RET work? Ref
Branches and Trope 2004
Use stem cells at the apex SCAP s it can be re-populated by vital tissue which may then promote root closure and lay down dentine
How do you manage an uncomplicated crown root fracture?
Remove the piece of tooth and then restore
Where do most root fractures occur?
Middle
Apical third
How would you manage a root fracture?
If the coronal fragment has been displaced then this needs to be repositioned ASAP to favour hard tissue formation at the join can consider splinting
How can a root fracture repair?
Repair with calcified tissue
Repair with connective tissue
Repair with bone and connective tisse
How does a repair with calcified tissue appear in a radiograph?
Invisible
How does a repair with connective tissue appear on a radiograph?
Narrow radiolucent line with rounding of the fracture at the edges
How does a boney repair look?
Repair is separated by a boney bridge
How do you manage a cervical root fracture?
- Ensure no communication with the gingival crevice
2. If there is communication then XLA crown, internally splint or XLA crown and root
What must you do if you decide to retain the root in a crown root fracture?
Remove the pulp and obturate and then
- Post and core
- Cover root for implant later
What is the risk of pupal necrosis in a root fracture and what is the biggest indicator whether or not the tooth will necrose?
20%
The extent to which the coronal portion has become displaced is the biggest indicator
What happens generally to the apical third of the fracture?
This usually retains it’s vitality
How do you manage non vital root fracture?
You extirpate the pulp in midlle and coronal third fractures at the level of the coronal fragment only and place CaOH or MTA down the canal to achieve a calcific barrier and then union between the coronal aspect and the apical aspect will be by connective tissue and the apical part usually sclerosis
