Trauma IV - hard tissue injury permanent

Question 1

How are trauma injuries classified?

Answer 1

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

Question 2

What is enamel infarction?

Answer 2

Disruption of enamel prism, extend surface of ADJ

No loss tooth tissue

Fracture light seen under light

Question 3

What is uncomplicated enamel-dentine fracture?

Answer 3

Not involving pulp

Loss enamel/dentine

Question 4

Emergency tx of U enamel-dentine fracture?

Answer 4

Composite ideally

Excessive bleeding - RMGIC

Question 5

Definitive tx of U e-d fracture?

Answer 5

Consider buccal bevel
Direct composite
Fragment replacement

Question 6

How carry out fragment replacement?

Answer 6

Etch and bond fragment to tooth - use flowable to bond

Warn pt of discolouration

Question 7

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

Answer 7

Extent fracture
Time exposure
Development

Question 8

3 options for complicated fracture?

Answer 8

1. pulp cap
2. pulpotomy
3. pulpectomy

Question 9

When can pulp cap be used for complicated fractures?

Answer 9

Used for pin-point exposure w/ minimal exposure time

Question 10

What is pulpotomy vs pulpectomy?

Answer 10

Pulpotomy = partial removal coronal pulp

Pulpectomy = complete removal coronal and radicular pulp

Question 11

When should pulpotomy be used in complicated fracture?

Answer 11

Be used in immature or mature teeth

Question 12

When should pulpectomy be carried out?

Answer 12

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

Question 13

What is Cvek pulptomy?

Answer 13

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

Question 14

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

Answer 14

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

Question 15

Why would avoid doing pulpectomy in immature teeth?

Answer 15

Open apex - wide canal - lead fracture

Need artificially create apical barrier

Question 16

Tx options for crown-root fractures?

Answer 16

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

Question 17

How are root fractures classified?

Answer 17

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

Question 18

How diagnose root fracture?

Answer 18

Need two angle - usually PA/ USO

Question 19

What does prognosis of root fracture depend on?

Answer 19

Concomitant injuries
Maturity of tooth
Location fracture

Question 20

What fractures have worst prognosis?

Answer 20

Cervical

Question 21

What does healing of root fractures depend on?

Answer 21

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

Question 22

What are different healing options of root fracture?

Answer 22

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

Question 23

What get in hard tissue healing of root fracture?

Answer 23

PDL established around whole tooth

Question 24

What get in connective tissue healing of root fracture?

Answer 24

Both parts tooth remain vital

PDL around both portions, tooth two pieces

Question 25

What see in CT and bony healing of root fracture?

Answer 25

Bone growth between fragment | PDL form around both fragments

Question 26

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

Answer 26

No healing | Coronal portion pulp has become necrotic leading formation granulation tissue

Question 27

Can get bony healing following formation granulation tissue?

Answer 27

No

Question 28

What expect to see regarding vitality of root fracture?

Answer 28

Apical fragment usually remain vital if not displaced

Question 29

How to tx root fracture if lose vitality coronal fragment?

Answer 29

Extirpate and root fill to fracture line

Question 30

Should root fractures be splinted if no-displaced fragments?

Answer 30

No

Question 31

Is displacement and root fracture how manage?

Answer 31

Reposition and splint for 4 weeks

Question 32

How to manage cervical root fracture?

Answer 32

Splint4 months | Poor prognosis

Question 33

What might see in alveolar fracture?

Answer 33

Fracture of segment - several teeth move as one block | Gingival laceration

Question 34

Tx of alveolar fracture?

Answer 34

Reposition | Splint 4 weeks

Question 35

Issue w/ non-vital immature teeth?

Answer 35

``` Open apex Thin dentine walls Short roots Prone fracture No apical barrier ```

Question 36

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

Answer 36

Provide apexification - chemically induced hard tissue barrier formmation

Question 37

How is apexification carried out?

Answer 37

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

Question 38

Step by step of apexification?

Answer 38

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

Question 39

How test if apical barrier formed when carrying out apexification?

Answer 39

Test w/ paper points

Question 40

Disadv of apexification with CaOH?

Answer 40

Multiple visits | Dehydration of dentine

Question 41

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

Answer 41

MTA - tricalcium silicate | Sets in 12 minutes

Question 42

Management of infraoccluded incisor?

Answer 42

Incisal edge build up Surgical luxation and ortho reposition XLA Decorination

Question 43

What is decoration?

Answer 43

Removal of crown of tooth

Question 44

When is decorination considered?

Answer 44

Infraocclused teeth | Anklyosed teeth

Question 45

Adv of decoronation of infra-occluded teeth?

Answer 45

Help maintain bone width | Promote vertical bone growth over root surface

Question 46

What is tooth auto-transplantation?

Answer 46

Moving one tooth another site in mouth

Question 47

When is tooth auto-transplantation used?

Answer 47

Traumatic loss anterior teeth Premolar apliasia Ectopic development of teeth

Question 48

Which teeth are ideal for auto-transplant?

Answer 48

Mandibular premolars

Question 49

Which teeth are not good for auto-transplant?

Answer 49

Maxillary first premolar