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5th ACS - Paeds > Trauma IV - hard tissue injury permanent > Flashcards

Trauma IV - hard tissue injury permanent Flashcards

1
Q

How are trauma injuries classified?

A 
Enamel 
Enamel-dentine (C/U)
Crown-root (C/U)
Root fracture
Alveolar fractures
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2
Q

What is enamel infarction?

A

Disruption of enamel prism, extend surface of ADJ

No loss tooth tissue

Fracture light seen under light

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3
Q

What is uncomplicated enamel-dentine fracture?

A

Not involving pulp

Loss enamel/dentine

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4
Q

Emergency tx of U enamel-dentine fracture?

A

Composite ideally

Excessive bleeding - RMGIC

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5
Q

Definitive tx of U e-d fracture?

A

Consider buccal bevel
Direct composite
Fragment replacement

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6
Q

How carry out fragment replacement?

A

Etch and bond fragment to tooth - use flowable to bond

Warn pt of discolouration

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7
Q

What does tx of complicated e-d fracture depend on?

A

Extent fracture
Time exposure
Development

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8
Q

3 options for complicated fracture?

A
  1. pulp cap
  2. pulpotomy
  3. pulpectomy
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9
Q

When can pulp cap be used for complicated fractures?

A

Used for pin-point exposure w/ minimal exposure time

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10
Q

What is pulpotomy vs pulpectomy?

A

Pulpotomy = partial removal coronal pulp

Pulpectomy = complete removal coronal and radicular pulp

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11
Q

When should pulpotomy be used in complicated fracture?

A

Be used in immature or mature teeth

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12
Q

When should pulpectomy be carried out?

A

Non-vital teeth e.g irreversible pulpits
Prolonger exposure time
Complete apical development
Large exposure

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13
Q

What is Cvek pulptomy?

A 
Partial pulpotomy
Amputate pulp to gingival level
Arrest haemorrhage w/ saline 
Place calcium hydroxide onto pulp
Place GI liner
Restore compposite
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14
Q

How do trauma guidelines suggest to tx crown fracture with exposed pulp?

A 
LA/ rubber dam
Clean area w/ saline 
Disinfect tooth sodium hypochlorite 
Pulpotomy depth 2mm 
Saline on cotton pledget arrest bleed
Apply calcium hydroxide/ MTA
Seal exposed dentine
Restore composite
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15
Q

Why would avoid doing pulpectomy in immature teeth?

A

Open apex - wide canal - lead fracture

Need artificially create apical barrier

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16
Q

Tx options for crown-root fractures?

A

Fragment removal and restoration
Fragment removal and ortho extrusion
Fragment removal, root burial and removable denture

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17
Q

How are root fractures classified?

A

Apical 1/3
Middle 1/3
Cervical 1/3

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18
Q

How diagnose root fracture?

A

Need two angle - usually PA/ USO

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19
Q

What does prognosis of root fracture depend on?

A

Concomitant injuries
Maturity of tooth
Location fracture

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20
Q

What fractures have worst prognosis?

A

Cervical

21
Q

What does healing of root fractures depend on?

A

Aproximation of fragments time of injury
Stabilisation injury
Presence/ absence injury

22
Q

What are different healing options of root fracture?

A

Hard tissue union
Interposition connective tissue
Interposition connective tissue and bone
Granulation tissue

23
Q

What get in hard tissue healing of root fracture?

A

PDL established around whole tooth

24
Q

What get in connective tissue healing of root fracture?

A

Both parts tooth remain vital

PDL around both portions, tooth two pieces

25
Q

What see in CT and bony healing of root fracture?

A

Bone growth between fragment

PDL form around both fragments

26
Q

What has happened if granulation tissue between fragment in roots fracture?

A

No healing

Coronal portion pulp has become necrotic leading formation granulation tissue

27
Q

Can get bony healing following formation granulation tissue?

A

No

28
Q

What expect to see regarding vitality of root fracture?

A

Apical fragment usually remain vital if not displaced

29
Q

How to tx root fracture if lose vitality coronal fragment?

A

Extirpate and root fill to fracture line

30
Q

Should root fractures be splinted if no-displaced fragments?

A

No

31
Q

Is displacement and root fracture how manage?

A

Reposition and splint for 4 weeks

32
Q

How to manage cervical root fracture?

A

Splint4 months

Poor prognosis

33
Q

What might see in alveolar fracture?

A

Fracture of segment - several teeth move as one block

Gingival laceration

34
Q

Tx of alveolar fracture?

A

Reposition

Splint 4 weeks

35
Q

Issue w/ non-vital immature teeth?

A 
Open apex
Thin dentine walls
Short roots
Prone fracture
No apical barrier
36
Q

How to overcome lack of apical barrier in non-vital immature teeth?

A

Provide apexification - chemically induced hard tissue barrier formmation

37
Q

How is apexification carried out?

A

Placement of non-setting CaOH to apex - dressing replaced 3 month intervals
Take 12-18 months

38
Q

Step by step of apexification?

A

Extirpation of pulp
Mechanical prep often not required - large canal
Irrigate sodium hypochlorite
Place non-setting CaOH with syringe - small file to WL so no air bubbles
Cotton wool in access - CaOh compressed so in contact apical tissue
Dress IRM
Replace 3 month

39
Q

How test if apical barrier formed when carrying out apexification?

A

Test w/ paper points

40
Q

Disadv of apexification with CaOH?

A

Multiple visits

Dehydration of dentine

41
Q

When carrying out apexification what can be used as alternative CaOH?

A

MTA - tricalcium silicate

Sets in 12 minutes

42
Q

Management of infraoccluded incisor?

A

Incisal edge build up
Surgical luxation and ortho reposition
XLA
Decorination

43
Q

What is decoration?

A

Removal of crown of tooth

44
Q

When is decorination considered?

A

Infraocclused teeth

Anklyosed teeth

45
Q

Adv of decoronation of infra-occluded teeth?

A

Help maintain bone width

Promote vertical bone growth over root surface

46
Q

What is tooth auto-transplantation?

A

Moving one tooth another site in mouth

47
Q

When is tooth auto-transplantation used?

A

Traumatic loss anterior teeth
Premolar apliasia
Ectopic development of teeth

48
Q

Which teeth are ideal for auto-transplant?

A

Mandibular premolars

49
Q

Which teeth are not good for auto-transplant?

A

Maxillary first premolar

5th ACS - Paeds (4 decks)

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