Permanent Trauma Flashcards
Enamel Infraction (no tooth structure lost, no tenderness or mobility)
X-rays: PA
Tx:None, unless severe craze lines –> etch + seal
F/U: None if certain
Enamel only fracture
X-rays: PA, soft tissue if missing fragments unaccounted for
Tx:
- Bond tooth fragment back on
- Smooth edges
- Restore with composite
F/U: clinical + x-ray
6-8 wk
1 y
Enamel dentin fracture
X-rays: PA, soft tissue if missing fragments unaccounted for
Tx:
- Bond tooth fragment back on after rehydrating in water/saline for 20 min
- Cover dentin w/ GI and restore w/ composite
- If pulpal blushing –> place CaOH, then GI, then composite
F/U: clinical + x-ray
6-8 wk
1 y
Enamel-dentin-pulp fracture
X-rays: PA, soft tissue if missing fragments unaccounted for
Tx:
- Immature root/open apex: partial pulpotomy or pulp capping to promote further root development
- Complete root development: partial pulp
- Place CaOH on pulp
- If post needed in mature tooth –> do RCT
- If tooth fragment available, rehydrate and bond after pulp tx
- Or restore w/ GI and composite
F/U: clinical + x-ray 6-8 wk 3 mo 6mo 1 y
Crown-root fracture (no pulp, involves enamel, dentin and cementum)
X-rays: 1 parallel PA, 2 additional at different vertical or horizontal angles, occlusal, CBCT can be helpful, soft tissue if missing fragments unaccounted for
Tx: 1. Temporarily stabilize loose fragment 2. Consider removing mobile fragment + restoring Future Tx Options: 3. Orthodontic or surgical extrusion of remaining tooth w/ restoration and gingival recontouring if needed 4. Ext and prosthetic 5. Root submergence 6. Autotransplantation
F/U: clinical + x-ray 1 wk 6-8 wk 3 mo 6mo 1 y yearly for 5 yrs
Crown-root fracture w/ pulp exposure
X-rays: 1 parallel PA, 2 additional at different vertical or horizontal angles, occlusal, CBCT can be helpful, soft tissue if missing fragments unaccounted for
Tx:
1. Temporarily stabilize loose fragment
2. Immature tooth: partial pulpotomy w/ CaOH + cover w/ GI and composite
3. Mature tooth: RCT + cover w/ GI and composite
Future Tx:
Orthodontic or surgical extrusion of remaining tooth w/ restoration and gingival recontouring if needed
Or Ext and prosthetic
Or Root submergence
Or Autotransplantation
F/U: clinical + x-ray 1 wk 6-8 wk 3 mo 6mo 1 y yearly for 5 yrs
Root Fracture (horizontal, oblique or combo, coronal segment can be mobile or displaced)
X-rays: 1 parallel PA, 2 additional at different vertical or horizontal angles, occlusal, CBCT can be helpful, soft tissue if missing fragments unaccounted for
Tx:
- Reposition displaced coronal segment ASAP + verify radiographically
- Splint 4 wks (up to 4 months if cervically located fracture)
- Monitor fracture healing at least 1 yr
- RCT may be needed in coronal segment only usually
- If fracture is above the alveolar crest in a mature tooth and VERY mobile may need to remove coronal fragment and do RCT, post and crown
- May need ortho/surgical extrusion, crown lengthening, or ext in future
F/U: clinical + x-ray
4 wk splint removal for midroot or apical fractures
6-8 wk
4 mo for splint removal for cervical fractures
6mo
1 y
yearly for 5 yrs
Alveolar Fracture (extends from buccal to palatal/lingual walls, segment mobility, occlusal disturbances)
X-rays: 1 parallel PA, 2 additional at different vertical or horizontal angles, occlusal, PAN or CBCT can be helpful, soft tissue if missing fragments unaccounted for
Tx:
- Reposition displaced segment + verify radiographically
- Splint 4 wks
- Suture lacs
- Monitor pulp of all teeth involved initially and at follow ups for need for RCT
F/U: clinical + x-ray 4 wk splint removal 6-8 wk 4 mo 6mo 1 y yearly for 5 yrs Monitor bone and soft tissue healing as well
Concussion (no mobility, tender)
X-rays: 1 parallel PA, only need additional if signs of other injuries
Tx:
- None
- Monitor pulp at least one year
F/U: clinical + x-ray
4 wk
1 y
Subluxation (loosening of surrounding tooth structures, no displacement, tender, increased mobility)
X-rays: 1 parallel PA, 2 additional at different vertical or horizontal angles, occlusal
Tx:
- Normally none
- Splint may be used for 2 wks if excessive mobility or tenderness when biting
- Monitor pulp at least one year
F/U: clinical + x-ray 2 wk splint removal 3 mo 6mo 1 y
Extrusion (increased mobility, out of socket, appears elongated)
X-rays: 1 parallel PA, 2 additional at different vertical or horizontal angles, occlusal
Tx:
- Reposition by pushing back in
- Splint 2 wks (4 wks if fracture of bone)
- Monitor pulp for need for RCT
F/U: clinical + x-ray 2 wk splint removal 4 wk 8 wk 3 mo 6mo 1 y yearly for 5 yrs Tell parents to monitor for unfavorable outcomes
Lateral Luxation (displacement of tooth in palatal or labial direction usually w/ fracture or compression of socket or bone, apex of tooth locked in by bone fracture)
X-rays: 1 parallel PA, 2 additional at different vertical or horizontal angles, occlusal
Tx:
- Reposition digitally by disengaging from locked position and into original location
- Splint 4 wks
- Monitor pulp at follow ups
- Endo eval at 2 wks
- Immature root: spont revasc can occur, do RCT for immature tooth as soon as necrosis and inflammatory external resorption seen
- Mature root: necrosis likely, start RCT w/ CaOH as intracanal medicament to prevent inflammatory resorption
F/U: clinical + x-ray 2 wk splint removal 4 wk 8 wk 3 mo 6mo 1 y yearly for 5 yrs Tell parents to monitor for unfavorable outcomes
Intrusion (immobile)
X-rays: 1 parallel PA, 2 additional at different vertical or horizontal angles, occlusal
Tx:
Immature root:
1. Allow spont re-eruption
2. If no eruption in 4 wks, ortho repositioning
3. Monitor pulp for need for RCT, spont revasc can occur but as soon as necrosis/infection/inflammatory resorption seen do appropriate RCT
Mature root:
1. Allow spont re-eruption if intruded <3mm
2. If no eruption in 8 wks, reposition surgically or orthodontically
3. Splint 4 weeks
4. If intruded 3-7mm reposition surg or ortho
5. If >7mm, reposition surgically
6. Almost always necrotic –> start RCT as soon as tooth position allows (Intracanal CaOH) to prevent inflamm resorption
F/U: clinical + x-ray 2 wk 4 wk splint removal 8 wk 3 mo 6mo 1 y yearly for 5 yrs Tell parents to monitor for unfavorable outcomes
Preferred abx after avulsion
Doxy if >=12
PenVK if <12
Decoronation if
Ankylosis –> infraposition >1mm
