W11 - Outcomes of Dental Trauma - Mistry Flashcards
What can outcome of trauma depend on (3)
Type and severity of injury
Stage of dental development
Type of treatment
How/what to assess the extent of trauma
(clinical and what to ask)
Ask pt - symptoms
Soft tissues
Visual assessment + position of tooth
Colour of tooth
Mobility
Perio
Percussion (sound + pain)
Sensibility test
Radiograph
Two significant diagnoses of periradicular bone that has become symptomatic
- Acute apical periodontitis
- Chronic apical periodontitis
How to differentiate the diagnosis of AAP vs CAP
AAP - symptomatic tooth (TTP) with no radiolucency, intact lamina dura
CAP - bone loss adjacent to apex
Possible outcomes relating to pulp (3)
- Discoloration
- Pulp obliteration
- Necrosis (arrested development, subsequent RR)
Outcomes relating to PDL/root resorption (4)
- Infection-related resorption (external/internal inflammatory root resorption)
- Ankylosis / replacement resorption
- Surface Reparative resorption
- Transient apical breakdown
3 reasons for tooth discoloration
Bruising
Pulp Canal obliteration
Pulp necrosis
How do you know if the pulp canal is obliterated
Colour change - dark yellow
Reduced response to sensibility test
Tx for pulp canal obliteration
Observation - No tx indicated if not infected
How to tell if pulp is necrotic
Discolouration
Negative cold test
TTP
Sinus
Apical abscess
Radiographic LEO
Treatment of necrotic pulp
RCT
What causes inflammatory root resorption
Tissue colonisation of multinuclear giant cells due to microbial products
Features of external root resorption
- Non vital teeth
- Damage to PDL (usually luxation injuries)
- Toxins from pulp space → dentine tubules → inflammation and resorption of root surface
How to diagnose external root resorption
Radiographs
Treatment of external root resorption
RCT
What is cervical resorption?
Damage to root surface in cervical area
caused by infected pulp or periodontium
How to diagnose cervical resorption (2)
Clinical - Pink area near cervical margin
Radiograph - resorption in cervical area
Treatment of cervical resorption
if vital - curettage and MTA/CaOH lining followed by resto
non vital - RCT and then as above
How to diagnose internal root resorption
Clinical: Pink discoloration of crown
Radiograph: resorption of pulp space, rounded symmetrical radiolucency
Treatment of internal RR
RCT
How does ankylosis / replacement resorption occur?
- Luxation injuries causes significant damage to PDL →
- PDL repair with bony replacement
- Rate of repair dictates rate of root replacement
Other name of ankylosis
Replacement resorption
- Damaged PDL is replaced with bone
How to diagnose ankylosis clinically (2)
Ankylotic sound - high pitched, solid sounding metallic tone
May appear to be submerging in growing child
How to diagnose ankylosis radiographically
May show signs of replacement resorption
- Loss of PDL
Treatment of ankylosis (3)
May leave to monitor and allow it to take over root
Decoronation
Non vital teeth: RCT and dressing - no GP
How can trauma to primaries affect the permanent dentition? (7)
- Enamel defects
- Dilaceration
- Malformation
- Odontoma-like formation
- Duplication
- Arrested development
- Eruption disturbances
Why dont you put GP in ankylosed teeth?
Tooth root will eventually be replaced by bone → only CaOH NO GP
What to do?
Tooth has completely intruded
- Allow time for tooth to spontaneously re-erupt
- Damage was already done to successor at time of trauma
If doesnt come down, GA and remove before it gets ankylosed
What do you do - tooth is mobile
Option 1: Do nothing - advise parents that tooth may fall out soon on its own
Option 2: Extraction but usually parents will want to keep front tooth for longer
What is happening?
Displacement and impaction of mx permanent incisors as a result of inflammation infection from primaries
what is this and what caused it
Enamel defect as a result of injured primaries
dilaceration
When should RCT be performed following luxation injury?
When tooth has been intruded or avulsed, neurovascular bundle is severed and PDL is affected
- If tooth has complete root development (apex intact) at time of injury, its assumed tooth will have pulpal necrosis → RCT to avoid external inflammatory root resorption
IF tooth is IMMATURE (ex. child 9, root tip not closed) → give it a chance. NO ENDO (exo after 3 weeks if problematic)
Potential outcomes related to root injury ** (4)
Transient apical breakdown
Transient Marginal breakdown
Gingival reattachment
PDL reattachment
Differenc between PDL healing/damage reaction vs pulpal
Pulpal a lot easier to manage → LEO can stay and not affect tooth
PDL radiolucencies → “alarm bells” needs endo asap to save inflammatory root resorption
External inflammatory root resorption
- Toxins from pulp space entered tubules causing inflammation and resorption of root surface
In this particular pic both bone and PDL are being resorbed // URGENT
Describe the urgency for LEO alone vs PDL resorption
LEO alone - not urgent / PDL intact
Luxation injuries causing PDL resorption = URGENT endo to save structure
What injuries cause PDL resorption (urgent care)? (3)
Lateral luxation
Intrusion
Avulsion
When to recall for PDL injuries
What to look out for
3-4 weeks
PDL resorption / inflammatory root resorption on lateral wall
What to do for immature perm tooth (apex not formed) with punched out lesions on PDL
Extirpate
- Once stability is achieved → reassess
- If compromised, unrestorable → Exo
- If OK → Apical barrier / MTA and dress
What to do for primary tooth with punched out lesions on PDL
Extract
How long after avulsion is the recall
one week
How long to splint teeth after avulsion? What kind of splint?
Up to 2 weeks (7-10 days)
Flexible splint
- rigid splints lead to ankylosis
How long to splint teeth following alveolar fracture
4 months
