Trauma - PDL injuries + Splinting Flashcards
List examples of PDL injuries
- Concussion
- Subluxation
- Extrusion
- Lateral luxation
- Intrusion
Avulsion
Define concussion injury
Concussion injury to tooth supporting structures
No increased mobility/displacement/gingival bleeding
TTP
Sensibility testing - likely to respond may be negative on initial assessment
Radiographic assessment of concussion injury
1 PA
Additional if associated injury
Tx for concussion
No tx
Monitor 4wks then 1yr
Follow up for concussion
4wk
1yr
Define subluxation injury
Traumatic injury to PDL tissues
Increased mobility
No displacement
Gingival bleeding
Radiographic assessment of subluxation (3)
1 PA
2 additional radiographs of the tooth taken with different vertical and/or horizontal angulations
Occlusal radiograph
Tx for subluxation
None usually
If excessive mobility or pain when biting 2wk passive + flexible splint to stabilise tooth
Review for subluxation
after 2 wk S+
after 12 wk
after 6 mo
after 1 yr
Monitoring of concussion/subluxation
Clinical - Trauma stamp
Sensibility testing: thermal + electric
- At time of injury
- Transient lack of sensibility can occur (can relate to future pulp necrosis)
Radiographs
- Root development - width of canal + length
- Comparison to other side
- Internal + external inflammatory resorption
Features of trauma stamp
- Mobility
- Displacement
- TTP
- Colour
- Sinus
- ECL
- EPT
- Radiographs
5 year resorption for concussion/subluxation
Open - 1%
Closed - 3%
Define an extrusive luxation injury
Tooth injury characterised by partial or total separation of PDL
Displacement of tooth out of socket
Increased mobility
Alveolar socket intact
Tearing injury within PDL
Tx of extruded tooth (2)
- Reposition with digital under LA (buccal + palatal)
-Stabilize the tooth for 2 wk using a passive and flexible splint.
Monitor pulp if it becomes necrotic = endo
Review of extrusive luxation injury
after 2 wk S+
after 4 wk
after 8 wk
after 12 wk
after 6 mo
after 1 y
then yearly for at least 5 y
Patients (and parents, where relevant) should be informed to watch for any unfavorable outcomes and the need to return to clinic if they observe any
General instruction with all PDL injuries
- OHI (clean affected area with soft brush gently to prevent plaque accumulation)
- Alcohol free 0.2% CHX glauconite MW rinse 2x day for 1wk
- Soft diet
- Avoid contact sports
High ankylotic sound is associated with what 2 PDL injuries?
Intrusive + lateral luxation
Define a lateral luxation injury
Displacement of tooth other than axially
Associated with a fracture or compression of labial/lingual bone or alveolar bone
Radiographic assessment for extrusive luxation injury
1 parallel PA
1 occlusal
2 additional radiographs taken at diff vertical and/or horizontal angulations
Radiographic assessment for lateral luxation injury
1 parallel PA
1 occlusal
2 additional radiographs taken at diff vertical and/or horizontal angulations
Tx of lateral luxation injury (2)
Reposition under LA
4wks flexible splint
Follow up for lateral luxation injury
2wks
4wks S+
8wks
12wks
6mths
1yr
yearly for 5 yrs
Define an intrusive luxation injury
Tooth driven into the alveolar process due to an axially directed impact
Most severe form of displacement injury in permanent teeth
Crushing injury to PDL
No mobility
No pulp response
Radiographic assessment for intrusive luxation injury
1 parallel PA
1 occlusal
2 additional radiographs with different vertical and/or horizontal angulations
Tx for intrusive luxation injury
Immature
- Spontaneous repositioning
- Ortho repositioning if no re-eruption within 4wks
- Monitor pulp
Mature
- Spontaneous repositioning if >3mm
(Surgical repositioning if no re-eruption within 8wks + flexible and passive splint for 4wks)
- 3-7+mm = surgical repositioning
What injuries require a flexible 2 wk splint?
Subluxation (possibly)
Extrusive luxation
Avulsion open + closed apex
What injuries require a flexible 4wk splint?
Intrusive luxation (if spontaneous repositioning fails)
Lateral luxation
Alveolar fracture
Apical/middle 3rd root fracture
What injury requires a 4mth splint?
Cervical fracture
How to monitor spontaneous tooth repositioning
Advice regarding diet + OH
Review monthly to observe re-eruption
Measure progress against fixed point (incisal edge of fully erupted non displaced adjacent incisor)
What injury has a high risk of resorption?
Intrusive luxation
When to commence RCT in mature tooth with intrusion injury
No more than 2wks post trauma using CAOH as an intracranal medicament (prevents external resorption)
