Treatment Of Trauma Injuries Flashcards
Infraction tx
- Take PA
- Etch and seal with resin to prevent discolouration of infraction lines
- No follow up required unless luxation present
Enamel fracture tx
- 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
Enamel dentine fracture tx
- 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
Enamel dentine pulp fracture tx (open vs closed apex)
IMMATURE TOOTH:
- preserve pulp vitality: pulp cap/Cvek pulpotomy !!!
MATURE TOOTH:
- RCT (but can try cvek)
- future treatment for fractured crown may be restoration
Primary tooth tx for EDP fractures
- Partial pulpotomy (difficult)
- XLA
Crown-root fracture with NO pulp exposure tx vs WITH pulp exposure
- 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
Crown root fracture in primary tooth
- Remove fragment and restore
- XLA
Horizontal root fracture tx
- 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
Horizontal root fracture tx in primary teeth
- No displacement = no treatment but follow up in 1 week, 8 weeks, then every year until exfoliation
- Displacement = extract coronal portion and leave roots as they resorb over time
Alveolar fracture treatment
- 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
Concussion tx
- no Radiographic abnormalities
No tx
Monitor pulp conditions for a year
Subluxation tx
No tx needed
May add flexible splint for 2 weeks for patient comfort
Primary tooth subluxation treatment
- No tx needed. Observe, brush with soft brush, 0.1% CHX topically to area 2x day for 1 week
- Follow up X rays not needed
- Review after 1 week, 8 weeks
Extrusive luxation
- 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
Extrusive luxation primary tooth
- Minor extrusion less than 3mm = careful repositioning OR leave for spontaneous realignment
- Severe extrusion = XLA
Lateral luxation tx
- 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.
Lateral luxation primary tooth tx
- No occlusal interference = leave alone for spontaneous repositioning
- If occlusal interference = reposition under LA or XLA
Intrusive luxation tx (open vs closed apex)
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
Intrusive luxation of primary tooth
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.
- If apical tip looks ELONGATED = apex is displaced palatally
TOWARDS the permanent tooth germ -> therefore XLA. - Complications = loss of vitality, discolouration, need for
XLA, ankylosis, Turners hypoplasia