Week 11- Outcomes of Dental Trauma Flashcards
What tooth trauma’s have high risk of damaging permanent successors?
- Intrusion
- Avulsion
- Lateral luxation
What type of traumas are likely with high vs low velocity impact?
High velocity: fracture
Low velocity: displacement
What do outcomes of trauma depend on?
- Type and severity of injury
- Stage of dental development
- Type of tx
When can outcomes of trauma occur?
Days, months or years after trauma has taken place
What should you assess on patient with trauma?
- Soft tissues
- Visual assessment of tooth position
- Colour of tooth
- Mobility
- Perio
- Percussion test (sound and ttp)
- Sensibility test
- Radiograph
What should you do if pt has lip laceration?
Soft tissue radiograph
What are possible outcomes following trauma?
- Nil
- Pulpal (discolouration, canal obliteration, necrosis)
- PDL (infection related resorption, ankylosis resorption, surface reparative resorption, transient apical breakdown )
What are the 2 types of infection related resorption?
- Internal inflammatory root resorption
- External inflammatory root resorption
What is external inflammatory root resorption?
Toxins from pulp space > dentine tubules > inflammation and resorption of root surface (punched out lesions on root surface and resorption of bone)
Why should you perform elective pulpectomy after avulsion in mature teeth?
Prevent infection related root resorption
Why should you perform elective pulpectomy after avulsion in mature teeth?
Prevent infection related root resorption
Are PDL or pulpal issues more concerning?
PDL- needs urgent intervention
Is surface reparative resorption significant?
Not very clinically significant. Small areas of resorption.
How should transient apical breakdown be managed?
More rare and can happen after trauma- will disappear in 6-12 months. If no other signs of pulpal necrosis, don’t do RCT.
9 year old with mild intrusion. How would you manage?
- 1 week: soft tissue
- 3-4 weeks: PDL (if you see resorption do pulp extirpation to halt resorptive process) Also see if tooth has started to erupt- if it hasn’t, do ortho traction
- 6-8 weeks: Pulp (if you see discolouration wait 3 months until you do something)
- 6 months
- 1 year
9 yr old child with avulsed immature permanent tooth that develops EIRR. How would you manage?
- Replanted tooth and splint for 7-10 days (flexible)
- 1 week: soft tissue and remove splint
- 3-4 weeks: IOPA. If EIRR, extirpate and dress
- 6-8 weeks: take another IOPA and monitor and change dressing
- Once resorption stable, maybe do obturation
What is protocol for mature tooth with severed PDL and pulpal injury?
RCT asap
What is protocol for immature tooth with severed PDL and pulpal injury?
Want root development to continue so don’t
intervene immediately. If you start seeing root resorption after 3-4 weeks, extirpate and dress with CaOH- don’t extrude through apex.
Can place MTA plug and obturate after if prognosis okay and walls aren’t too thin. Could alternatively do stem cell regenerative therapy at apex to see if it grows.
What is pulp discolouration often caused by?
- Bruising
- Pulp canal obliteration
- Pulp necrosis (grey)
How does pulp canal obliteration appear and how should it be treated?
- Yellow darkening
- Observe- no tx indicated if no signs of infection
- Reduced response to sensibility test
What are characteristics of inflammatory root resorption?
- Colonised by multinuclear giant cells due to microbial products
- Non vital teeth
- Damage to PDL
- Need radiographs
- Needs RCT
What is cervical resorption and how does it appear?
Damage to root surface in cervical area caused by infected pulp or periodontium.
- Clinically: pink near cervical margin
- Radiograph: resorption in cervical area
How is cervical resorption treated?
- Vital tooth- curettage and MTA/CaOH lining followed by resto (can apply TCA to lesion before restoring)
- Non-vital tooth- RCT and as per vital tooth
How is internal root resorption diagnosed and treated?
- Pulp necrosis
- Clinically: may have pink discolouration of crown
- Radiographic: resorption in pulp space of internal dentinal wall. Rounded symmetrical radiolucency
- Tx: RCT
