W4: Orthodontic first aid:

Question 1

First action:

Answer 1

1. Take a medical history
2. Take a full history of the problem
3. If the patient is the patient of another operator, then a history of the treatment should also be taken
4. Do a thorough examination
5. When in doubt, seek expert advice

Question 2

Fixed appliance:

Answer 2

Question 3

Removable appliance- Functional appliance:

Answer 3

Question 4

Functional appliance:

Answer 4

Question 5

Headgear:

Answer 5

Question 6

Miscellaneous: Management of missing appliance:

Answer 6

Question 7

Once incitent occurs:
Steps

Answer 7

Question 8

Orthodontic First aid in Dental Trauma-Permanent teeth:

Types:

Answer 8

Question 9

Orthodontic First aid in Dental Trauma-Permanent teeth:

Concussion:

Answer 9

• The tooth is tender to touch or tapping; it has not been displaced and does not have increased mobility.
• Sensibility tests are likely to give positive results.
• No treatment is needed.
• Monitor pulpal condition for at least one year.

Question 10

Orthodontic First aid in Dental Trauma-Permanent teeth:

Subluxation:

Answer 10

• The tooth is tender to touch or tapping and has increased mobility; it has not been displaced.
• Bleeding from gingival sulcus may be noted.
• Sensibility testing may be negative initially indicating transient pulpal damage.
• Monitor pulpal response until a definitive pulpal diagnosis can be made.
• Normally no treatment is needed, however a flexible splint to stabilize the tooth for patient comfort can be used for up to 2 weeks

Question 11

Orthodontic First aid in Dental Trauma-Permanent teeth:

Extrusion:

Answer 11

• The tooth appears elongated and is excessively mobile.
• Sensibility tests will likely give negative results.
• Increased periodontal ligament space apically.
• Reposition the tooth by gently re-inserting It into the tooth socket.
• Stabilize the tooth for 2 weeks using a flexible splint.
• In mature teeth where pulp necrosis is anticipated or if several signs and symptoms indicate that the pulp of mature or immature teeth became necrotic, root canal treatment is indicated.

Question 12

Orthodontic First aid in Dental Trauma-Permanent teeth:

Lateral luxation:

Answer 12

• The tooth is displaced, usually in a palatal/lingual or labial direction.
• It will be immobile and percussion usually gives a high, metallic (ankylotic) sound.
• Fracture of the alveolar process present.
• Sensibility tests will likely give negative results
• The widened periodontal ligament space is best seen on eccentric or occlusal exposures.

Question 13

Orthodontic First aid in Dental Trauma-Permanent teeth:

Lateral luxation:
Tx

Answer 13

• Reposition the tooth digitally or with forceps to disengage it from its bony lock and gently reposition it into its original ocation.
• Stabilize the tooth for 4 weeks using a flexible splint.
• Monitor the pulpal condition.
• If the pulp becomes necrotic, root canal treatment is indicated to prevent root resorption

Question 14

Orthodontic First aid in Dental Trauma-Permanent teeth:

Intrusion:

Answer 14

• The tooth is displaced axially into the alveolar bone.
• It is immobile and percussion may give a high, metallic (ankylotic) sound.
• Sensibility tests will likely give negative results.
• The periodontal ligament space may be absent from all or part of the root.
• The cemento-enamel junction is located more apically in the intruded tooth than in adjacent non-injured teeth, at times even apical to the marginal bone level.

Question 15

Orthodontic First aid in Dental Trauma-Permanent teeth:

Intrusion:

Answer 15

• The tooth is displaced axially into the alveolar bone.
• It is immobile and percussion may give a high, metallic (ankylotic) sound.
• Sensibility tests will likely give negative results.
• The periodontal ligament space may be absent from all or part of the root.
• The cemento-enamel junction is located more apically in the intruded tooth than in adjacent non-injured teeth, at times even apical to the marginal bone level.

Question 16

Orthodontic First aid in Dental Trauma-Permanent teeth:

Intrusion:
Tx
Teeth with incomplete root formation

Answer 16

• Allow eruption without intervention
• If no movement within few weeks, initiate orthodontic repositioning.
• If tooth is intruded more than 7mm, reposition surgically or orthodontically.

Question 17

Orthodontic First aid in Dental Trauma-Permanent teeth:

Intrusion:
Tx
Teeth with complete root formation

Answer 17

• Allow eruption without intervention if tooth intruded less than 3mm. If no movement after 2-4 weeks, reposition surgically or orthodontically before ankylosis can develop.
• If tooth is intruded 3-7 mm, reposition surgically or orthodontically.
• If tooth is intruded beyond 7mm, reposition surgically.
• The pulp will likely become necrotic in teeth with complete root formation.
• Root canal therapy using a temporary filling with calcium hydroxide is recommended and treatment should begin 2-3 weeks after repositioning.
• Once an intruded tooth has been repositioned surgically or orthodontically, stabilize with a flexible splint for 4 weeks

Question 18

Orthodontic First aid in Dental Trauma-Permanent teeth:

Avulsion:

Answer 18

Question 19

Orthodontic First aid in Dental Trauma-Permanent teeth:

Avulsion:
Tx

Answer 19

Choice of treatment is related to the maturity of the root (open or closed apex) and the condition of the periodontal ligament cells.

Question 20

Orthodontic First aid in Dental Trauma-Permanent teeth:

Avulsion:
Tx
Closed vs open apex

Answer 20

Closed apex

• Apply a flexible splint
• Treat according to guidelines(antibiotics, tetanus protection, root canal etc

Open apex

• Apply a flexible splint
• Treat according to guidelines(antibiotics, tetanus protection, root canal etc)
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