Trauma vocab Flashcards
concussion
an injury to supporting tooth structures without increased mobility or displacement of the tooth, but with pain to percussion
subluxation
an injury to the tooth or supporting structures with increased mobility, but without displacement of the tooth in acute trauma, bleeding from gingival sulcus confirms diagnosis
extrusion
partial displacement of the tooth out of its alveolar socket an injury to the tooth characterised by partial or total separation of the PDL resulting in loosening and displacement of the tooth the alveolar socket bone is intact in an extrusion injury as opposed to lateral luxation injury apart from axial displacement, tooth will usually have an element of protrusion or retrusion - severe extrusion injuries the retrusion/protrusion element can be very pronounced - some cases can be more pronounced than the extrusive element
lateral luxation
displacement of the tooth other than axially displacement accompanied by communication or fracture of either the labial or the palatal/lingual alveolar bone are characterised by partial or total separation of PDL (similar to extrusion injuries)
intrusion
displacement of the tooth into the alveolar bone accompanied by a communication or fracture of the alveolar socket
avulsion
complete displacement of the tooth out of its socket
enamel infraction
an incomplete fracture (crack) of the enamel without loss of tooth structure
enamel fracture
a fracture confined to the enamel with loss of tooth structure
uncomplicated crown fracture (enamel-dentine pulp fracture)
fracture confined to enamel and dentine with loss of tooth structure, but not involving the pulp
complicated crown fracture (enamel-dentine pulp fracture)
fracture involving enamel, dentine and cementum with loss of tooth structure and exposing the pulp
uncomplicated crown root fracture
fracture involving enamel, dentine and cementum with loss of tooth structure but not involving the pulp
complicated crown root fracture
fracture involving enamel, dentine and cementum with loss of tooth structure and involving the pulp
root fracture
fracture involving cementum, dentine and pulp can be further classified by whether the coronal fragment is displaced (see luxation)
alveolar fracture
fracture of the alveolar process may or may not involve the alveolar socket teeth with alveolar fractured are characterised by mobility of the alveolar process - several teeth typically will move as a unit when mobility checked
laceration of gingiva or oral mucosa
shallow or deep wound in the mucosa resulting from a tear, usually produced by a sharp object
contusion of gingiva or oral mucosa
bruise usually produced by impact with a blunt object and not accompanied by a break in the mucosa, usually resulting in submucosal haemorrhage injury may be associated with an underlying bone fracture
abrasion of gingiva or oral mucosa
superficial wound produced by rubbing or scarping of the mucosa leaving a raw, bleeding surface
pulp necorsis (PN)
necrosis of the pulp tissue
can be coagulation/ischaemic necrosis (uninfected) or infection related (liquefaction) necrosis
pathogenesis of pulpal necrosis
In traumatic dental injuries where the neurovascular supply to the pulp has been totally severed, mechanisms for revascularization and re-innervation are present.
- The probability of successful revascularization is determined primarily by the size of the apical foramen (stage of root development), the length of the pulp space and whether bacteria infect the revascularization site.
- In teeth where revascularization fails, the pulp tissue will undergo sterile necrosis. Although this avascular pulp usually becomes infected, in rare cases it may remain sterile indefinitely.
diagnostic signs of pulpal necrosis
- Periapical radiolucency
- Grey discoloration of the tooth crown
- Infection-related external root resorption
- No response to pulp sensitivity test
- Tenderness to percussion and palpation in the vestibule develops after an asymptomatic period
- Presence of a fistula (sinus tract)
- Unchanged thickness of dentinal walls (arrested root development)
pink tooth colour
An almost immediate pinkish discoloration indicates intrapulpal bleeding caused by the trauma
- Following weeks the red colour may turn grey but in case of pulp healing, the discoloration will gradually fade away.
red tooth may turn what colour
Following weeks the red colour may turn grey but in case of pulp healing, the discoloration will gradually fade away.
tooth turns grey gradually
necorsis suspected
tooth grey for first time several weeks/months after trauma
s regarded as a sign of necrosis.
- In this case, the grey colour signifies decomposition of necrotic pulp tissue.
yellow tooth
pulpal canal obliteration
pulp sensibility test options
electric pulp test
cold test (ethyl chloride, endoICE)
blowing air on exposed dentine
sensibility tests
test
sensory nerve activity and not a measure of the vitality of the pulp.
revascularisation after severage of pulp
regeneration of the sensory nerves takes longer than the ingrowth of new blood vessels.
- The tooth may therefore not respond to sensibility test until 2-12 months after injury.
should sensibility tests be used in isolation
no
negative test alone should not be regarded as proof of necrosis
need one other clinical and/or radiographic sign of necrosis before endo tx
immature teeth response to sensibility tests
teeth with immature root development may have a higher threshold for reaction to sensibility test because the sensory nerves are not yet fully developed.
inc width of PDL and loss of lamina dura sign of
pulp healing in relation to revascularisation of pulp
However increasing size of the defect and development of a persistent apical radiolucency indicate periapical inflammation in response to bacteria in the root canal.
development of persistent apical radiolucency and increaing size of PDL widening
indicate periapical inflammation in response to bacteria in the root canal.
infection related external resorption linked to
pulp necrosis by biologic mechanisms
thus presence of infection-related resorption is, therefore, a clear sign of an infected pulp necrosis.
Development of a fistula (sinus tract) in the oral mucosa or gingiva,
or subsequent pain/tenderness in a tooth which has been asymptomatic the first weeks after trauma
signs of
pulp necrosis
unchanged thickness of dentinal walls (arrested root development) indicates
pulp of yound tooth not survived
neighbouring tooth act as comparison
increased thickness of dentinal walls after revascularisation
sign pulp has survived
(pulp canal obliteration)
pulp canal obliteration
condition where hard tissue is depostied along the wall of the root canal and fills most of the pulp canal
pathogenesis of pulp canal obliteration
traumatic dental injuries where the neurovascular supply to the pulp has been severed, mechanisms for revascularization and reinnervation are present.
- When revascularization is successful, these teeth will show an accelerated deposition of hard tissue along the pulp canal walls.
- common sequela in all types of luxation injuries that include displacement
Within a year most teeth show a partial or totally obliterated pulp canal.
However, even in these teeth a small diameter pulp canal still exists.
- restricted pulp canals have been found, often after some years, to have a small risk of developing infection-related pulp necrosis.
- The exact cause of this pathologic change is unknown, but new trauma and extensive crown preparation appear to be probable risks.
external repair-related resorption (surface resorption)
pathogenesis
represents the result of removal of injured periodontal ligament tissue next to the root surface by macrophages and osteoclasts.
- It results in a saucer-shaped cavity on the root surface mostly involving cementum.
first part of a healing process.
- The resorption cavity will subsequently be fully or partially repaired by new cementum with insertion of new Sharpey’s fibers.
external repair related resorption
deep - comes into contact with denitnal tubules
if tubules communicate with an infected pulp
- risk of developing an infection-related resorption
common trauma to lead to surface resorption
all luxation injuries (in particular lateral luxation and extrusions)
root fractues - common near fracture site
diagnostic issue of repair related resorption
must be distinguished from early stages of infection-related resorption.
external ankylosis-related resorption (osseous replacement resorption)
‘an ankylosed tooth’ is a tooth partially or totally anchored to the alveolar socket by a bridge or bridges of bone extending from the root dentine to the socket wall
pathogenesis of osseous replacement resorption
Ankylosis is a progressive resorptive process seen in traumas where the tooth has received extensive damage to the innermost layer of the periodontal ligament and sometimes also the cementum.
competitive healing events between bone formation and regeneration f new periodontal ligament tissue
- From the socket wall, bone will be formed by bone marrow derived cells.
- From the intact PDL, new cementum and Sharpey’s fibers will be formed.
injury site 1-4mm2 in size
osseous replacement resorption
transient ankylosis can result in which the initial ankylosis subsequently is resorbed and replaced with new cementum and PDL.
- may be hampered if the tooth is rigidly splinted.
In contrast, if the tooth is splinted with a flexible splint or not splinted, small movements of the tooth during the healing period may lead to a break-up of the initially formed, small ankylotic sites.
injury site 4mm2+ in size
osseous replacement resorption
healing with new periodontal ligament is unlikely.
- In these areas ankylosis with progressive resorption of root dentin and replacement with osseous tissue occurs.
In effect, the root becomes an integral part of the bone remodelling system.
ankylosis leads to
loss of tooth (serious complication)
- children 8-16 years, tooth loss occurs rapidly (expected in 1-5 years)
- contrast - adults with ankylosed tooth may remain functional for many years
external infection related resorption (inflammatory resorption)
resorption involving the root and the adjacent alveolar bone
pathogenesis
external infection related resorption (inflammatory resorption)
progressive resorption that leads to tooth loss, unless endodontic therapy is initiated to eliminate the etiological agents (bacteria and necrotic tissue) responsible for the resorption process.
may occur after an initial surface resorption has penetrated through the cementum, exposing dentinal tubules in a tooth with infected pulp necrosis.
process of inflammatory resorption
osteoclastic process and the associated inflammation at the resorption site are fuelled by toxins created by bacteria located in the pulp and/or dentinal tubules.
- toxins travel by diffusion through the exposed dentinal tubules to the resorption site where they trigger osteoclastic activity and lead to resorption of the root surface and the adjacent socket bone.
will proceed as long as infection-related resorption can be arrested (if the infected pulp is removed and endodontic therapy performed)
- when arrested, a healing process will be initiated in which new cementum, bone and periodontal ligament will be formed.
inflammatory resorption affecting a large site
healing with normal periodontal ligament may not occur.
- Instead ankylosis may occur
internal infection related resorption (internal inflammatorty resorption)
This even takes place when revascularisation front meets an area of infected tissue located coronally (infected necrotic pulp tissue and/or infected dentinal tubules)
internal repair related resorption (internal surface resorption)
An event takes place when a revascularisation front meets an area of ischemia (sterile) pulp tissue
- This event may be seen in the apical area or at a root fracture site
internal ankylosis (internal osseous replacement related resorption)
A condition seen when pulp metaplasia has occurred
- When bone tissue is formed inside the pulp canal, a progressive replacement of dentine, cementum and sometimes enamel with bone may occur
cervical invasive resorption
An invasive resorption process which usually starts in the cervical area and later spreads in a coronal and/or apical direction
A possible aetiology is that the cementoblast later (for a unknown reason) does not protect the root from osteoblastic activity
Cervical invasive resorption can sometime be caused by trauma
traumatic loss of marginal bone
Loss of crestal bone around a traumatised tooth
When an area of periodontal ligament (PDL) tissue and alveolar socket bone are injured, resorption occurs as part of a repair process.
- Sometimes this causes permanent loss of tooth supporting bone and gingival attachment.
- Alternately, the bone loss may be transient as the periodontium may recover by forming new alveolar bone tissue and PDL over a period of 2-3 months.
transient apical breakdown
In teeth where revascularisation takes place in a narrow root canal, the initial phase of a series of events can be the apical breakdown radiographically of the lamina dura by the revascularization front.
- When this process moves in a coronal direction, the apical lamina dura is gradually reformed.
Although rare, it especially affects extruded and laterally luxated teeth with complete root formation.
pulp metaplasia
Term used to describe the condition in which normal pulp tissue has been replaced with other tissue types such as loose or dense fibrous connective tissue, bone, cementum or PDL
gingival reattachment
A healing process in which lacerated, displaced or lost gingiva is regenerated with a normal sulcular attachment and new gingival collagenous fibres
periodontal ligament regeneration
ruptures of the PDL are typically seen in luxation injuries
They usually heal by a regenerative process where newly formed Sharpey’s fibres and fibroblasts splice the ruptured PDL
This process if far advanced as soon as 2 weeks after injury
dentine coverage
Covering of exposed dentinal tubules with a suitable filling material e.g. glass ionomer, composite or CaOH containing cement
to prevent bacteria from entering the tubules and subsequently the pulp.
pulp capping
A covering over an exposed pulp to encourage the formation of new dentine to wall off the exposure
Commonly used materials are calcium hydroxide, CaOH containing cement or a calcium silicate based bioceramic e.g. MTA
partial pulpotomy (cvek pulpotomy)
Partial pulpotomy is a surgical removal of the coronal portion (2mm) of an exposed vital pulp as a means of preserving the vitality of the remaining pulp in the crown and root
- The exposed pulp is then covered by a material that induced formation of hard tissue barrier
- Calcium hydroxide or a calcium silicate bioceramic (MTA) are often used
In some cases the amputation site is placed in the cervical region when the vascular supply to the most coronal portion of the pulp is compromised by inflammation or lack of vascularity
decoronation
intentional removal of the crown, leaving the root portion of the tooth intact in order to preserve the alveolar bone structure.
- The root canal filling is removed and the canal allowed to fill with blood.
The remaining root portion usually undergoes ankylosis, but may retain a normal periodontal ligament in some areas.
- In both events the remaining root portion appears to maintain not only the labial-lingual/palatal dimension of the alveolar process, but also partially allow the development of the vertical height of the alveolar process.
Preservation of the ridge is crucial in treatment planning for children and adolescents.
An intact alveolar process is a precondition for aesthetic tooth replacement procedures.
apexification
An apical healing event in which an open apex is closed with newly formed hard tissue.
- Traditionally calcium hydroxide has been used to induce the barrier which usually consists of an irregular cementum-like tissue.
- Presently a calcium silicate based bioceramic material such as MTA is recommended for apexification in teeth with immature root development.
In rare cases a new apex is formed (apexogenesis), a finding related to the presence of a viable Hertwig’s epithelial root sheath.
regenerative endodontics (revitalisation)
Treatment aiming at ingrowth on new vital tissue after removal of necrotic pulp in teeth with immature root development.
osseous integration
A term used in connection with implants.
It describes the condition where new bone forms directly against the implant material and fuses to the surface of the alveolar socket.
- A similar healing event takes place in cases of tooth replantation where some or all of the PDL is damaged.
- In this situation the term is ankylosis or osseous replacement resorption.
splinting
Stabilization of loosened teeth, bone fractures or a combination of both with various splinting materials such as sutures, acid-etch flexible acrylic splints, flexible acid-etch-wire composite splints with diameter up to 0.016″ 0r 0.4 mm, acid-etch composite nylon line splints, titanium trauma splints, orthodontic power chain.
Splints which allows micromovement of the teeth during the healing phase is recommended - flexible
manual repositioning
Repositioning of displaced tooth, alveolar fracture, root fracture or jaw fracture with finger or hand pressure
surgical repositioning
Repositioning of displaced tooth, alveolar fracture, root fracture or jaw fracture with forceps or by surgical exposure of fracture site
orthodontic repositioning
Repositioning of displaced tooth, alveolar fracture, root fracture or jaw fracture with orthodontic appliances
partial repositioning
reposition of a displaced tooth into a non-optimal position in the socket
total repositioning
reposition of a displaced tooth into its anatomically correct position in the alveolar socket
pulp extirpation (pulpectomy)
complete removal of pulp
pulp testing
aim of pulp testing is to assess the circulatory or sensory status of a traumatized tooth.
- Several methods have been developed including thermal, electrometric and Laser Doppler Flowmetry (LDF) techniques.
- thermal and the electrometric test results are based upon the sensory competency of the pulp rather than the circulatory status.
- vascular and sensory status of the teeth are closely related.
A positive sensibility test is an indirect but good indication of satisfactory vascularisation of the pulp.
- Without an adequate vascular supply, the sensory nerves of the pulp will soon cease to function and become necrotic.
An immediate negative response after trauma should not be considered pathognomonic for pulp necrosis as initial rupture of the neurovascular supply in many cases can be repaired.
LDF method is based directly on the circulation of blood in the pulp.
- can measure the vascular status directly.
Comparisons between thermal, electrometric and LDF methods have shown that LDF is the most reliable test for circulatory status.
regeneration
healing modality where tissue (e.g. pulp, PDL, alveolar bone, gingival or oral mucosa) is replaced with an identical tissue. The new tissue is identical to the original tissue in both anatomy and function
repair
healing modality where damaged tissue (e.g. pulp, PDL, alveolar bone, gingiva or oral mucosa) is replaced with fibrous connective (scar) tissue.
The new tissue differs from the original tissue in both anatomy and function
revascularisation
process of healing in which ischemic pulp tissue, (resulting from the rupture of the apical neurovascular supply) becomes gradually replaced with new tissue.
This process can take place in 2 modalities:
- Gradual replacement of the ischemic pulp tissue by migration of new tissue from the apical area (the most common).
- Under optimal conditions this will result in the replacement of the injured ischemic pulp tissue with new pulp tissue possessing some of the characteristics of normal pulp tissue, including the ability to form a new odontoblastic layer lining the root canal.
- Immediate revascularization when optimal repositioning allows an end-to-end anastomosis in the apical area between ruptured blood vessels.
- implies that the vascular supply is re-established after a few days and existing odontoblasts survive.
In some cases the pulp tissue specificity is lost when fibrous tissue replaces the original pulp or, in rare cases, a pulp metaplasia occurs (where bone, periodontal ligament and cementum are formed inside the root canal)
A partial revascularization may occur if bacteria gain access to the coronal part of the ischemic pulp.
white or yellow brown opacity in permanent tooth after trauma to primary
Area with incomplete mineralisation below the enamel surface which is intact at time of eruption
- frequently appear as sharply demarcated, enamel opacities, most often located on the facial surface of the crown;
- extent varies from small spots to large areas.
- some may appear as diffuse opacities.
In this context, it should be mentioned that white enamel discolorations with a diameter of less than 0.5 mm are frequent in teeth without a history of trauma to their predecessors.
enamel hypoplasia in permanent tooth after trauma
Area with deficient enamel matrix formation. Opacities are frequently present in association with hypoplastic lesions
crown dilaceration in permanent tooth after trauma
Dilaceration malformation of the tooth crown are due to traumatic non-axial displacement of already formed hard tissue in relation to the developing soft tissues.
- Due to their close contact to the primary incisors, crown dilacerated teeth are usually maxillary or mandibular central incisors.
Approx. half of these teeth become impacted, whereas the remaining half erupt normally or in facio- or linguo- version
odontoma-like malformation in permanent teeth after trauma
Rare sequelae to injuries in the primary dentition
- Reported cases are confined primarily to maxillary incisors
histology and radiology of these cases show a conglomerate of hard tissue, having the morphology of a complex odontoma or separate tooth elements
Experimental evidence supports the theory that these malformations occur during early phases of odontogenesis and affect the morphogenetic stages of ameloblastic development
root duplication of permanent teeth after trauma
rare occurrence seen following intrusive luxation of primary teeth.
usually the result of an injury at the time when half or less than half of the crown is formed.
- pathology of these cases indicates that a traumatic division of the cervical loop occurs at the time of injury, resulting in the formation of two separate roots
- Radiographically, a mesial and distal root can be demonstrated, which extends from a partially formed crown.
vestibular rot angulation or dilaceration
of permanent teeth after trauma
developmental disturbance which appears as a marked curvature confined to the root as a result of an injury sustained between ages 2 to 5 years.
- The malformed tooth is usually impacted and the crown palpable in the labial sulcus.
- The only teeth demonstrating this malformation are maxillary central incisors.
lateral root angulation or dilaceration
appear as a mesial or distal bending confined to the root of the tooth.
- appears to be the result of an acute displacement of the tooth germ.
The root angulation is possibly created when the erupting tooth meets an obstacle such as scar tissue during eruption.
partial or complete arrest of root formation of permanents
rare complication.
This disturbance reflects a primary tooth injury that displaces a developing successor in such a way that Hertwig’s epithelial root sheath has been partly or totally destroyed
sequestrian of perment root germ of permenent after trauma
exceedingly rare after injuries to the primary dentition.
swelling, suppuration and fistula formation are typical clinical features that sometimes lead to spontaneous sequestration of the involved tooth germ.
Radiographic examination discloses osteolytic changes around the tooth germ, including disappearance of the outline of the dental crypt and expanded cortical alveolar bone.
disturbance in eruption after trauma
may occur after trauma to the primary dentition.
- suggested that this is related to abnormal changes in the connective tissue overlying the tooth germ.
- The eruption of succeeding permanent incisors is generally delayed for about 1 year after premature loss of primary incisors, whereas premature eruption of permanent successors is rare.*
- Early loss of primary incisors (avulsion or extraction) leads to space loss only in rare instances.
However, ectopic eruption of permanent successors can occur,
- possibly due to lack of eruption guidance otherwise provided by the primary teeth.
These succedaneous teeth often erupt labially to their normal position.
Impaction is very common among teeth with malformations confined to either the crown or the root.
When the permanent tooth does erupt, it is often in facio- or linguo-version.
