Treatment Of Trauma Injuries

Question 1

Infraction tx

Answer 1

• Take PA
• Etch and seal with resin to prevent discolouration of infraction lines
• No follow up required unless luxation present

Question 2

Enamel fracture tx

Answer 2

• take PA and occlusal rads to rule out root fracture or luxation chance
• soft tissue radiograph - fragments in lip/cheek/lacerations
• if tooth fragment available, bond back onto tooth. Contour + composite restoration

Question 3

Enamel dentine fracture tx

Answer 3

• take PA and occlusal rads to rule out root fracture or luxation chance
• soft tissue radiograph - fragments in lip/cheek/lacerations
• if tooth fragment available, bond back onto tooth. Contour + composite restoration
• if no tooth fragment, provisional treatment with GIC, or permanent restoration with composite
• if exposed dentine = 0.5mm away from pulp, place CaOH base and cover with restorative material

Question 4

Enamel dentine pulp fracture tx (open vs closed apex)

Answer 4

IMMATURE TOOTH:
- preserve pulp vitality: pulp cap/Cvek pulpotomy !!!

MATURE TOOTH:
- RCT (but can try cvek)
- future treatment for fractured crown may be restoration

Question 5

Primary tooth tx for EDP fractures

Answer 5

1. Partial pulpotomy (difficult)
2. XLA

Question 6

Crown-root fracture with NO pulp exposure tx vs WITH pulp exposure

Answer 6

1. WITH PULP
   - extract, PD then RRB (replacement of tooth?)
   - remove loose fragment, reassess remaining tooth structure and MTA (RCT), but often difficult to do, poor prognosis

• if the tooth is deemed restorable follow up is important
• those teeth needing XLA can have apical portion left in situ, often resorbs on it’s own

Question 7

Crown root fracture in primary tooth

Answer 7

1. Remove fragment and restore
2. XLA

Question 8

Horizontal root fracture tx

Answer 8

• PA to detect these horizontal fractures
• Occlusal to detect oblique fractures (more common in apical 1/3)
• Reposition the displaced coronal segment asap
  ne
  • Check position radiographically.

• Stabilise tooth with a flexible splint for 4 weeks (can do up to 4 months if fracture more coronal)

• Monitor healing for 1yr to determine pulp status

• If pulp necrosis, then do partial RCT up to the fracture line only, as apical portion remains vital
1) extirpate to fracture line 2) Ca(OH)2 dressing 3) GP or MTA/biodentine

• Remove splint after 4weeks

Question 9

Horizontal root fracture tx in primary teeth

Answer 9

1. No displacement = no treatment but follow up in 1 week, 8 weeks, then every year until exfoliation
2. Displacement = extract coronal portion and leave roots as they resorb over time

Question 10

Alveolar fracture treatment

Answer 10

• PA occlusal and DPT can be useful to see course and position of fracture line
• reposition displaced segment and then splint for 4 weeks
• suture any gingival lacerations
• remove splint after 4 weeks

Question 11

Concussion tx

Answer 11

• no Radiographic abnormalities
  No tx
  Monitor pulp conditions for a year

Question 12

Subluxation tx

Answer 12

No tx needed
May add flexible splint for 2 weeks for patient comfort

Question 13

Primary tooth subluxation treatment

Answer 13

1. No tx needed. Observe, brush with soft brush, 0.1% CHX topically to area 2x day for 1 week
2. Follow up X rays not needed
3. Review after 1 week, 8 weeks

Question 14

Extrusive luxation

Answer 14

• reposition tooth by gently re inserting into socket then stabilise with 2 week flexible splint
• if signs of pulp necrosis = RCT
• X ray at regular intervals for 5 years

Question 15

Extrusive luxation primary tooth

Answer 15

1. Minor extrusion less than 3mm = careful repositioning OR leave for spontaneous realignment
2. Severe extrusion = XLA

Question 16

Lateral luxation tx

Answer 16

• will see widened PDL on occlusal views
• Reposition tooth digitally or with forceps to disengage from bony lock and then reposition into original location.

• Stabilise with 4 week flexible splint.

• Monitor pulp conditions.

• If pulp necrosis, then RCT to prevent root resorption.

Question 17

Lateral luxation primary tooth tx

Answer 17

1. No occlusal interference = leave alone for spontaneous repositioning
2. If occlusal interference = reposition under LA or XLA

Question 18

Intrusive luxation tx (open vs closed apex)

Answer 18

TEETH WITH INCOMPLETE ROOT FORMATION: OPEN APEX
• Allow eruption without intervention
• If no movement, then do ortho repositioning.
• If intruded more than 7mm will need surgical or ortho repositioning.

TEETH WITH COMPLETE ROOT FORMATION: CLOSED APEX
• Allow eruption without intervention if tooth is intruded less than 3mm.
• If no movement after 2-4 weeks = reposition surgically or orthodontically before ankylosis can develop.
• If tooth intruded 3-7mm, then reposition surgically or orthodontically.
• If tooth extruded 7+mm then reposition surgically.

• Pulp is likely to become necrotic in teeth that have complete root formation -> Do RCT 2 weeks after repositioning.
Stabilise with 4 week flexible splint after surgical/orthodontic repositioning.

FOLLOW UPS - trauma stamp

Question 19

Intrusive luxation of primary tooth

Answer 19

In PRIMARY tooth:
1. If apical tip appears SHORTER = it has been displaced towards buccal plate = AWAY from tooth germ - therefore
leave to re-erupt spontaneously.

2. If apical tip looks ELONGATED = apex is displaced palatally
   TOWARDS the permanent tooth germ -> therefore XLA.
3. Complications = loss of vitality, discolouration, need for
   XLA, ankylosis, Turners hypoplasia