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Paeds for FINALS > Trauma to the permanent dentition: hard tissue injuries and management of sequelae > Flashcards

Trauma to the permanent dentition: hard tissue injuries and management of sequelae Flashcards

1
Q

What is a Cvek pulpotomy? (1)

A

Partial pulpotomy

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2
Q

How to perform a Cvek pulpotomy (6)

A

Amputate pulp to gingival level
Arrest haemorrhage with saline soaked pledget
Calcium hydroxide onto pulp (powder or non-setting)
Setting calcium hydroxide
Restore with composite
Follow up radiographically for continued root growth

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3
Q

Success of Cvek pulpotomy (2)

A

79% 1-14 years
(Gelbier et al 1988)
Prone to pulp canal obliteration

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4
Q

Why do we want to avoid doing a pulpectomy in the immature tooth and how do we get round this problem? (2)

A

Open apex, wide pulp canal which can lead to fracture
Will need to use procedures to artificially create an apical barrier
-Biodentine
-MTA
-calcium hydroxide

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5
Q

Types of crown-root fractures (2)

A

Complicated

Uncomplicated

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6
Q

Treatment 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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7
Q

Classification of root fractures (3)

A

Apical third
Middle third
Cervical third

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8
Q

Radiographs for root fractures (3)

A

2 different angles

  • usually PA with central beam through tooth
  • occlusal helpful for diagonal fractures
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9
Q

Prognosis of root fracture depends on (4)

A

Concomitant crown fracture
Maturity of tooth
Location of fracture
Degree of displacement

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10
Q

Healing of root fracture is dependent on (3)

A

Approximation of two fragments at time of injury
Stabilisation
Absence of infection

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11
Q

Pathway: healing of root fracture (5)

A 
Hard tissue union
Interposition of connective tissue
Interposition of bone and CT
Granulation tissue
Coronal pulp necrosis  --> coronal segment pulp extirpation --> healing
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12
Q

Root fractures and vitality (3)

A

Apical fragment usually remains vital (if not displaced)
If loss of vitality occurs to coronal portion, extirpate and root fill to fracture line
-possibly preceded by calcium hydroxide dressings, then MTA and biodentine, and thermoplastic GP

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13
Q

IADT guidelines about root fracture treatment (3)

A

Do not dplint non-displaced root fractures
Reposition, if displaced, the coronal segment of tooth as soon as possible
Stabilise tooth with flexible splint for 4 weeks

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14
Q

Cervical third fractures - stabilisation

A

Beneficial for a longer period of time (4 months)

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15
Q

What are alveolar fractures ? (3)

A

Fracture of segment
Several teeth move as one block
Gingival lacerations

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16
Q

Treatment of alveolar fractures (3)

A

Reposition
Can be difficult due to bony lock
Splint for 4 weeks

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17
Q

Non-vital immature teeth root development (6)

A

Incomplete

  • open apex
  • thin dentine walls
  • short roots
  • prone to fracture
  • need to create barrier to obturate
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18
Q

What is apexification used for? (1)

A

Treatment of non-vital immature teeth

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19
Q

What is apexification? (4)

A

Chemically induced hard tissue barrier formation
Created by placement of non-setting calcium hydroxide dressing to apex
Dressings replaced at 3 month intervals
Can take 12-18 months

20
Q

Apexification procedure (11)

A

Extirpation of pulp with or without LA
Rubber dam
Extirpation of pulp
Usually no mechanical prep required due to wide canal
Irrigation with sodium hypochlorite or chlorhexidine
Non-setting calcium hydroxide placed with syringe
Small file (size 25) placed to working length to ensure no air bubbles
Cotton wool placed in access cavity and CaOH compressed to be in contact with apical tissues
Dressed with IRM
Replaced every 3 months
Test for barrier with paper points

21
Q

Disadvantages with apexification (3)

A 
Multiple visits
Dehydration of dentine
Cervical fractures
-apex open, <2/3 root length complete is 75% risk
-root length complete - 25% risk
22
Q

Why is MTA better than CaOH? (2)

A

Only 2 or 3 visits needed

23
Q

Disadvantages of MTA (2)

A

MTA can cause tooth discolouration

Its alkilinity is similar to calcium hydroxide

24
Q

Why is Biodentine used more in hospitals? (5)

A 
Bioactive dentine substitute
Tricalcium silicate powder and calcium chloride solution
Sets in 12 minutes
Radiopaque: zirconium oxide
Slightly less alkaline than MTA
25
Q

Management options of infraoccluded incisors (5)

A 
Incisal edge build up
Surgical luxation and ortho repositioning
Distraction osteogenesis
Extraction
Decoronation
26
Q

Decoronation - indications (2)

A

Infraocclusion

Ankylosis in growing patients

27
Q

Decoronation - why interfere? (3)

A

To prevent defect in alveolar ridge
To prevent tilting of adjacent
Aesthetics

28
Q

Disadvantages of infraocclusion and decoronation (1)

A

Potential for infection

29
Q

advantages of infraocclusion and decoronation (2)

A

Helps to maintain bone width

Promotes vertical bone growth over root surface

30
Q

Indications for tooth autotransplantation (4)

A

Traumatic loss of anterior teeth
Premolar aplasia
Ectopic development of teeth
Replacement of misshapen teeth

31
Q

Ideal transplant tooth (3)

A

Mandibular first and second premolars are particularly suitable due to root anatomy
Maxillary first premolar NOT optimal as a graft because of divergent root anatomy

32
Q

Success rate of autotransplatation (2)

A

74-100% at 5 years

33
Q

Monitoring of tranaplanted teeth (5)

A 
4 weeks
3 months
6 months
1 year
2 years
34
Q

Different types of hard tissue injuries to the permanent dentition (5)

A 
Enamel
Enamel-dentine (comp/ uncomp)
Crown-root (comp/ uncomp)
Root
Alveolar fracture
35
Q

Which radiographs are used for hard tissue injuries to aid diagnosis? (4)

A 
PA
-central beam through injured tooth
-mesial or distal to injured tooth
Occlusal
Soft tissue view if lacerations
36
Q

Foreign bodies (1)

A

Always suspect, until proven otherwise if there is a soft tissue laceration and a piece of missing tooth

37
Q

Enamel infractions - what are they? (3)

A

A disruption of the enamel prisms
Extends from surface to ADJ
Usually seen when light is parallel to long axis of tooth

38
Q

What are enamel fractures? (2)

A

Loss of enamel only

Generally requires only smoothing (or possibly sealing)

39
Q

What are uncomplicated enamel-dentine fractures (2)

A

Not involving the pulp

Most common injury (of permanent incisors)

40
Q

Prevalence of pulp necrosis after extensive proximal fracture (2)

A

No treatment - 54%

Dentine coverage - 8%

41
Q

Quality of care for children with TDIs in UK

A

40% of children had received inappropriate or no treatment for their TDI at their emergency presentation

42
Q

What to use for emergency treatment for uncomplicated enamel-dentine fractures? (2)

A

Ideally composite - flowable easy and quick to apply

If excessive bleeding RMGIC may be used as ‘emergency’ option

43
Q

Prognosis (of appropriately treated uncomplicated crown fractures)

A

Almost 100% maintain vitality

Resorption rare

44
Q

Complicated enamel-dentine fracture (4)

A 
Involve pulp
Different treatment options exist depending on
-extent
-time of exposure
-developmental stage
45
Q

Treatment options for complicated enamel-dentine fracture (3)

A

Pulp cap
-pin-point exposures
-minimal exposure time (<24 hours)
Pulpotomy (partial removal of coronal pulp)
-usually where incomplete apex
Pulpectomy (complete removal of coronal and radicular pulp)
-non-vital tooth (or symptoms or irreversible pulpitis)
-prolonged exposure time, compelte apical development, large exposure

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