3 - Dental trauma II Flashcards
What can be used to sensibility test teeth?
- thermal (ethyl chloride or hot GP)
- electrical (EPT)
What is a traumatic occlusion?
Can only bite on one displaced tooth
How do you manage enamel fractures?
- bond fragment or smooth edges
- 2 periapicals to rule out luxation and root fracture
- follow up 8 weeks, 6 months, 1 year
How do you manage enamel-dentine-pulp fractures?
- pulp cap (1mm exposure within 24hrs)
- partial pulpotomy (>1mm exposure or >24hrs)
- full coronal pulpotomy
How do you manage enamel-dentine fractures?
- bond fragment or place composite bandage
- 2 periapicals to rule out luxation and root fracture
- sensibility testing
- definitive restoration
- follow up 8 weeks, 6 months , 1 year
What do you assess on follow up radiographs of trauma?
- root development (width and length of canal)
- comparison with adjacent and contralateral teeth
- internal or external IRR
- periradicular pathology
How do you complete a pulp cap?
- radiographic assessment
- LA / rubber dam
- clean area with water and disinfect with sodium hypochlorite
- apply dycal or MTA white to exposure
- restore with composite
How do you complete a partial pulpotomy?
- radiographic assessment
- LA / rubber dam
- clean area with water and disinfect with sodium hypochlorite
- remove 2mm of pulp with hi-speed round diamond bur
- place saline soaked CW pellet to achieve haemostasis
- apply dycal or MTA white to exposure
- restore with composite
What is the next step if you don’t achieve haemostasis in a partial pulpotomy?
Continue to a full coronal pulpotomy
How do you complete a full coronal pulpotomy?
- begin with a partial pulpotomy
- if haemostasis not achieved or pulp necrotic proceed to full coronal
- remove all of coronal pulp
- place dycal in the chamber
- seal with GI liner and place composite restoration
What is the aim of pulpotomy?
Maintain vital pulp tissue within the root canal to allow normal root growth and apexogenesis
How are immature incisors root treated?
- no apical stop, therefore specialist treatment required
- MTA or BioDentine placed at apex of canal to form cement barrier (apical plugging)
- regenerative endodontic treatment to encourage hard tissue formation (encourage bleeding, not routine)
What are the treatment options for uncomplicated crown-root fractures?
- fragment removal and restore
- fragment removal and gingivectomy
- orthodontic extrusion of apical portion
- surgical extrusion
- decoration
- extraction
What are the treatment options for complicated crown-root fractures?
- temporise with composite
- fragment removal and gingivetcomy
- orthodontic/surgical extrusion of apical portion
- decoration
- XLA
