Trauma of Young Permanent Teeth Flashcards
What are the 3 main principles of luxation injury management?
- Reduction
- Reposition teeth and tissues to their original position - Fixation – via splinting
- Endodontic monitoring
- Pulpal status
- Periodontal healing/non-healing
What are the aims of fixation?
Aims to stabilise and maintain teeth position to
- Optimise healing outcomes for pulp and PDL
- Improve function and provide comfort
What must be done before splinting and after repositioning?
Post-positioning x-ray to verify position
What must be taken note of when suturing gingiva as part of the reduction step?
Gingiva must be sutured back in correct position if not there will be tissue healing by secondary intention => ugly
How long are permanent teeth splinted for and what are the recommended follow up timingss?
Splint for 4 weeks
Follow up intervals (post-trauma)
- 2 weeks
- 4 weeks (remove splint)
- 8 weeks
- 12 weeks
- 6 months
- 1 year
- yearly for at least 5 years
Describe the process of splinting
After post-positioning x-ray
- Bend wire to sit passively on teeth
- Attach flexible wire splint to teeth with CR
For lateral luxation injury, what is the recommended definitive treatment?
- For teeth with complete root formation, pulp will likely become necrotic.
- At 2 week post injury, should commence RCT.
- Remove pulp and place corticosteroid-AB or Ca(OH)2 as intracanal medicament – prevent inflammatory external resorption
- Complete obturation at 4 week post injury recall (remove splint after obturation completed)
What are possible sequelae of trauma in permanent dentition?
- Loss of vitality
- Internal/external root resorption
- Pulpal calcification/obliteration
- Ankylosis/replacement resorption
Rank the types of traumatic injuries by their chance of pulp necrosis
- Intrusion
- Lateral luxation/Extrusion
- Concussion/Subluxation
What is the pathogenesis of inflammatory resorption?
Occurs due to pulp necrosis:
- Stimulus from infected pulp space will transverse the root and sustain inflammation around the root
- Inflammatory resorption will continue til the whole root is resorbed
Why is there a need for endodontic monitoring post-trauma?
- Protective layer of pre-cementum is damaged during trauma
- Inflammation due to injury occurs which can cause 3 kinds of resorption
1. Inflammatory resorption
2. Surface resorption
3. Replacement resorption
What is the pathogenesis of surface resorption?
Occurs when PDL cells are still viable
- Cementum healing can occur – only surface resorption
What is the pathogenesis of replacement resorption?
Occurs when large surface of PDL has been damaged
- Replacement resorption will take over inflammatory resorption (bone fills space) => ankylosis
- Occurs in severe injuries: intrusion, avulsion, lateral luxation
What may be a presentation of ankylosis?
Ankylosed tooth is infraoccluded – adjacent teeth have grown with alveolus
What should be noted about teeth with pulp canal obliteration?
pulp canal obliteration => slender neurovascular bundle => ortho movement will ↑ risk of tooth becoming non-vital
What should be included in a diagnosis of root fracture?
- Single/multiple
- Horizontal/vertical
- Level: apical/middle/coronal ⅓
- Degree of separation between fragments (radiographically)
What is the treatment for root fracture?
- Reduce fracture & splint
- Pulp protection: Cvek pulpotomy (1-2mm) then
- Ca(OH)2
- MTA (causes discolouration)
- Biodentine - Seal off access cavity with CR
- 4 week review: splint removal &
restore aesthetics
- If fracture is located cervically, stabilisation for a longer period of time (up to 4 months) may be needed
What are the possible healing outcomes for root fractures?
- Hard tissue union
- Interposition of CT
- Interposition of bone & CT
- Granulation tissue (coronal pulp necrosis)
=> worst outcome – appears as RL at fracture radiographically
Describe transient apical breakdown
- Occurs after luxation injuries
- Injured tissues undergo spontaneous repair in pulp & periapical area
- Followed by surface resorption &/or obliteration of pulp canal
- No permanent damage to pulp
How do teeth with transient apical breakdown present?
- PARL
- No response to vitality tests
- Grey discoloration
- No other symptoms
What is the treatment for intrusion injuries for permanent teeth with complete root formation?
If tooth intruded <3mm: allow re-eruption without intervention
If no re-eruption within 8 weeks
- Reposition surgically and splint for 4 weeks
- Reposition orthodontically before ankylosis develops
If tooth intruded 3mm or more: reposition surgically
Pulp will almost always become necrotic – pulpect should be done at 2 weeks
