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