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Endodontics > Traumatic injuries > Flashcards

Traumatic injuries Flashcards

1
Q

Who are the victim of 1/2 of all dental trauma

A

Children

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2
Q

What is the cause of most dental trauma for kids under 1

A

Fall injuries

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3
Q

Possible cause of dental trauma for kids under 3

A

Battered child syndrome

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4
Q

Which age has the most dental injuries

A

8-12 Play/athletics

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5
Q

Why might teens have dental injuries

A

Fights

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6
Q

What are two common reasons for all ages of dental trauma

A

Auto injuries and fights

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7
Q

Which teeth are most commonly injured

A

Max anteriors

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8
Q

What are the most common types of injuries to primary teeth

A

Luxations/avulsions

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9
Q

What is the type of injury most common to the permanent dentition

A

Crown fractures

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10
Q

Steps of pt evaluation

A

History and Chief Complaint

Neurologic Assessment

Extraoral to Intraoral Soft / Hard Tissue injuries

Radiologic Evaluation

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11
Q

What are the classification of crown fractures

A

Complicated (involving the pulp)and uncomplicated (no plural involvement)

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12
Q

What radiographs are needed.

A

Multiple angulations recommended

  • Standard periapical
  • Occlusal Periapical with lateral angulations
  • Mesial & Distal
  • Consider soft tissue radiograph If lip or cheek laceration To search for tooth fragments
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13
Q

How should percussion be tested in a traumatic case

A

with finger as a mirror handle is likely to much for a pt in pain

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14
Q

Why is vitality testing important?

A

To have a baseline

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15
Q

Emergency Management of Uncomplicated Crown Fracture

A
  • Seal exposed dentin
  • Bond tooth fragment If available
  • Composite Resin
  • Glass ionomer (Vitrebond)
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16
Q

What is the incidence of Pulp necrosis in Uncomplicated Crown Fx only in enamel

A

.2-1%

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17
Q

What is the incidence of pulp canal obliteration in uncomplicated crown fx only in enamel

A

.5%

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18
Q

What is the incidence of root resorption in uncomplicated crown fx only in enamel

A

.2%

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19
Q

What is the incidence of Pulp necrosis in Uncomplicated Crown Fx into dentin

A

1-6%

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20
Q

What is the incidence of pulp canal obliteration in uncomplicated crown fx into dentin

A

0

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21
Q

What is the incidence of root resorption in uncomplicated crown fx into dentin

A

0

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22
Q

Assessing either type of crown fx

A
  • Assessment Radiographs
  • Percussion/mobility testing
  • Baseline vitality testing
  • Visualize Adjacent teeth
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23
Q

Treatment options for complicated crown fas

A
  1. Pulp Capping
  2. Pulpotomy
  3. Pulpectomy
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24
Q

Whats the main factor for tx of complicated crown fracture

A

Stage of Root Maturation

Mature root -Pulpectomy

Immature root -Pulpotomy -Pulp capping

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25
Q

Pulp healing prognosis of pulp capping

A

71-88%

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26
Q

Pulp healing prognosis of partial pulpotomy

A

94-96%

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27
Q

Pulp healing prognosis of Cervical pulpotomy

A

72-79%

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28
Q

Preffered tx for an immature root

A

Partial pulpotomy (apexogenesis)

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29
Q

Average depth of inflammatory change in partial pulpotomy

A

less than 2 mmm

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30
Q

Types of crown-root fx

A

Uncomplicated and complicated

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31
Q

Emergency management of Crown to Root Fx

A

Radiographs

Splint fragments temporarily to alleviate pain from mastication

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32
Q

What determines the definitive tx of crown to root fx

A

Level of the fracture

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33
Q

Treatment modalities of uncomplicated crown to root fx

A

1 Fragment rem

2 restoration

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34
Q

Tx of complicated crown to root fx (restorable)

A
  • Fragment removal
  • Gingivectomy/ostectomy*
  • Endodontic therapy Post-retained crown

*(can use orthodox extrusion/surgical extrusion instead of periodontal surgery)

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35
Q

Clinical presentation of Root Fractures

A

Tooth usually slightly extruded

Tooth frequently displaced lingually

Diagnosis entirely dependent upon radiographic examination

36
Q

Radiographs for root fas

A

Periapical radiographs

  • Standard XCP radiograph
  • Increased vertical angulation
37
Q

Emergency Management of root fx

A
  • Reposition coronal fragment
  • Flexible Splint
    • -4 Weeks
    • -If Fx near the cervical area - longer splinting time is beneficial Up to 4 months
38
Q

What are the 4 types of root fx healing

A
  1. Hard tissue 2. Conenctive tissue 3. Interposition of Bone and Connective tissue 4. Interposition of granulation tissue
39
Q

What is the incidence of pulpal necrosis after root fx for both segments

A

Coronal segment - 20 to 44%

Apical segment - 0%

40
Q

What is the incidence of pulpal obliteration after root fx for both segments

A

69%

41
Q

What is the incidence of root resorption after root fx

A

60%

42
Q

What is the determinant of prognosis of root fracture

A

Fracture location

43
Q

Prognosis of root fx in cervical 3rd

A

poorer

44
Q

Prognosis of root fx in middle and apical 3rd

A

better

45
Q

Classifications of luxation injuries

A
  1. Concussion
  2. Subluxation
  3. Extrusive Luxation
  4. Lateral Luxation
  5. Intrusive Luxation
46
Q

Lunation injury complications

A
  • Pulp necrosis
  • Pulp canal obliteration
  • Root resorption
    • External
    • Internal
  • Loss of marginal bone support
47
Q

Types of Ext root resorption

A
  1. Surface resorption
  2. Replacement resorption (Ankylosis)
  3. Inflammatory resorption
48
Q

Surface resorption

A

Superficial resorption cavities

Mainly in cementum

Complete repair of PDL

49
Q

Replacement resorption

A

Direct union of bone and root

Resorption of root - replacement with bone

Direct result of loss of vital PDL

50
Q

Inflammatory resorption

A

Resorption of cementum and dentin

Inflammatory reaction in the periodontal ligament

Surface resorption of cementum exposing dentinal tubules

Pulp necrosis

Toxic products from the pulp provoke an inflammatory response in the PDL

51
Q

Internal root resorption types

A
  1. Internal surface resorption
  2. Internal replacement resorption
  3. Internal inflammatory resorption
52
Q

Internal inflammatory resorption incidence in lunated permanent teeth

A

2%

53
Q

Concussion injury description

A

No abnormal loosening No displacement

54
Q

Subluxation description

A

Abnormal Loosening No displacement

55
Q

Emergency management of concussion and subluxation injuries

A
  • Radiograph
  • Baseline vitality testing
  • Usually no splinting required 7-10 days for comfort
  • Trauma Dx adjacent teeth Occlusal adjustment, if needed
  • Recall
56
Q

Pulpal necrosis incidence after concussion

A

3%

57
Q

Pulp canal obliteration incidence after concussion

A

5%

58
Q

Root resorption incidence after concussion

A

5%

59
Q

Pulpal necrosis incidence after subluxation

A

6%

60
Q

Pulp canal obliteration after subluxation

A

10%

61
Q

Root resorption incidence after subluxation

A

2%

62
Q

Extrusive luxation description

A

Partial displacement of tooth out of socket

Tooth appears elongated

Lingual deviation of crown typically

Excessively mobile

63
Q

Emergency management of extrusive luxation

A
  1. Radiographs
  2. Baseline vitality testing
  3. Anesthesia
  4. Reposition tooth
  5. Flexible splint 2 weeks
  6. Follow-up
    • 2, 4 weeks 6-8 weeks 6 months 1 year Every year for 5 years
64
Q

Pulpal necrosis incidence after extrusive luxation

A

26%

65
Q

Pulp canal obliteration incidence after extrusive luxation

A

45%

66
Q

Root resorption incidence after extrusive luxation

A

9%

67
Q

Lateral luxation description

A

Eccentric displacement of tooth

Crown usually displaced lingually

Fracture of socket wall

Tooth immobile

Percussion may have ankylotic sound

68
Q

Emergency management of lateral luxation

A
  • Radiographs
    • PA
    • Lateral
    • CBCT
  • Baseline vitality testing
    • Usually negative results
  • Anesthesia
  • Reposition
  • Flexible splint 4 weeks
    • Add 3-4 weeks in case of marginal bone breakdown
  • Occlusal adjustment, if needed
69
Q

One week after lateral luxation

A
  • Start endo / Ca(OH)2
  • Complete within one month
  • Follow-up 2 weeks 4 weeks (splint removal) 6-8 weeks 6 months 1 year Every year for 5 years
70
Q

Incidence of pulp necrosis after lat luxation

A

58% (77 with closed apex)

71
Q

Incidence of pulp canal obliteration after lat luxation

A

28%

72
Q

Incidence of root resorption after lat luxation

A

27%

73
Q

Incidence of loss of marginal bone support after lat luxation

A

5%

74
Q

Intrusive luxation description

A

Displacement of the tooth into alveolar bone

Comminution or fracture of socket

Immobile with ankylotic percussion sound

75
Q

Emergency management of Intrusive lunation

A
  1. Radiographs
  2. Pulp vitality tests Usually negative
  3. Anesthesia
  4. “Slightly luxate the tooth with forceps”
76
Q

Emergency management of Intrusive lunation of teeth with incomplete root

A
  1. Allow eruption without intervention
  2. If no movement within a few weeks initiate orthodontic repositioning
  3. If tooth intruded >7mm reposition surgically or orthodontically
  4. Monitor pulp vitality -if becomes necrotic Pulp regeneration or apexification
77
Q

What may happen if deciduous tooth is intruded

A

May damage developing permanent tooth

78
Q

Emergency management of Intrusive lunation of teeth with complete root

A
  1. Allow eruption without intervention
  2. If tooth intruded <3mm If no movement within a few weeks initiate orthodontic repositioning
  3. If tooth intruded >7mm reposition surgically Pulp will be necrotic Pulpectomy 2 weeks after injury Ca(OH)2 for up to 4 weeks
79
Q

If intruded tooth is repositioned surgically or orthodontically

A

Flexible Splint 2 weeks 4 weeks if displacement is ‘extensive

80
Q

Intrusion follow up

A

Follow-up depends on treatment

81
Q

Pulp necrosis and intrusion

A

complete root 100% Overall 85%

82
Q

Pulp canal obliteration incidence in intrusion

A

10%

83
Q

Root resorption incidence in intrusion

A

66%

84
Q

Loss of marginal bone support incidence in intrusive injuries

A

24%

85
Q

Graph of open apex luxation injury complications

A
86
Q

Graph of closed apex luxation injury complcations

A

Endodontics (9 decks)

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