Trauma - PDL injuries + Splinting

Question 1

List examples of PDL injuries

Answer 1

• Concussion
• Subluxation
• Extrusion
• Lateral luxation
• Intrusion

Avulsion

Question 2

Define concussion injury

Answer 2

Concussion injury to tooth supporting structures
No increased mobility/displacement/gingival bleeding
TTP
Sensibility testing - likely to respond may be negative on initial assessment

Question 3

Radiographic assessment of concussion injury

Answer 3

1 PA
Additional if associated injury

Question 4

Tx for concussion

Answer 4

No tx
Monitor 4wks then 1yr

Question 5

Follow up for concussion

Answer 5

4wk
1yr

Question 6

Define subluxation injury

Answer 6

Traumatic injury to PDL tissues
Increased mobility
No displacement
Gingival bleeding

Question 7

Radiographic assessment of subluxation (3)

Answer 7

1 PA
2 additional radiographs of the tooth taken with different vertical and/or horizontal angulations
Occlusal radiograph

Question 8

Tx for subluxation

Answer 8

None usually
If excessive mobility or pain when biting 2wk passive + flexible splint to stabilise tooth

Question 9

Review for subluxation

Answer 9

after 2 wk S+
after 12 wk
after 6 mo
after 1 yr

Question 10

Monitoring of concussion/subluxation

Answer 10

Clinical - Trauma stamp

Sensibility testing: thermal + electric
- At time of injury
- Transient lack of sensibility can occur (can relate to future pulp necrosis)

Radiographs
- Root development - width of canal + length
- Comparison to other side
- Internal + external inflammatory resorption

Question 11

Features of trauma stamp

Answer 11

• Mobility
• Displacement
• TTP
• Colour
• Sinus
• ECL
• EPT
• Radiographs

Question 12

5 year resorption for concussion/subluxation

Answer 12

Open - 1%
Closed - 3%

Question 12

Define an extrusive luxation injury

Answer 12

Tooth injury characterised by partial or total separation of PDL
Displacement of tooth out of socket
Increased mobility
Alveolar socket intact
Tearing injury within PDL

Question 13

Tx of extruded tooth (2)

Answer 13

• Reposition with digital under LA (buccal + palatal)
  -Stabilize the tooth for 2 wk using a passive and flexible splint.

Monitor pulp if it becomes necrotic = endo

Question 14

Review of extrusive luxation injury

Answer 14

after 2 wk S+
after 4 wk
after 8 wk
after 12 wk
after 6 mo
after 1 y
then yearly for at least 5 y
Patients (and parents, where relevant) should be informed to watch for any unfavorable outcomes and the need to return to clinic if they observe any

Question 15

General instruction with all PDL injuries

Answer 15

• OHI (clean affected area with soft brush gently to prevent plaque accumulation)
• Alcohol free 0.2% CHX glauconite MW rinse 2x day for 1wk
• Soft diet
• Avoid contact sports

Question 16

High ankylotic sound is associated with what 2 PDL injuries?

Answer 16

Intrusive + lateral luxation

Question 17

Define a lateral luxation injury

Answer 17

Displacement of tooth other than axially
Associated with a fracture or compression of labial/lingual bone or alveolar bone

Question 18

Radiographic assessment for extrusive luxation injury

Answer 18

1 parallel PA
1 occlusal
2 additional radiographs taken at diff vertical and/or horizontal angulations

Question 19

Radiographic assessment for lateral luxation injury

Answer 19

1 parallel PA
1 occlusal
2 additional radiographs taken at diff vertical and/or horizontal angulations

Question 20

Tx of lateral luxation injury (2)

Answer 20

Reposition under LA
4wks flexible splint

Question 21

Follow up for lateral luxation injury

Answer 21

2wks
4wks S+
8wks
12wks
6mths
1yr
yearly for 5 yrs

Question 22

Define an intrusive luxation injury

Answer 22

Tooth driven into the alveolar process due to an axially directed impact
Most severe form of displacement injury in permanent teeth
Crushing injury to PDL
No mobility
No pulp response

Question 23

Radiographic assessment for intrusive luxation injury

Answer 23

1 parallel PA
1 occlusal
2 additional radiographs with different vertical and/or horizontal angulations

Question 24

Tx for intrusive luxation injury

Answer 24

Immature
- Spontaneous repositioning
- Ortho repositioning if no re-eruption within 4wks
- Monitor pulp

Mature
- Spontaneous repositioning if >3mm
(Surgical repositioning if no re-eruption within 8wks + flexible and passive splint for 4wks)
- 3-7+mm = surgical repositioning

Question 25

What injuries require a flexible 2 wk splint?

Answer 25

Subluxation (possibly)
Extrusive luxation
Avulsion open + closed apex

Question 26

What injuries require a flexible 4wk splint?

Answer 26

Intrusive luxation (if spontaneous repositioning fails)
Lateral luxation
Alveolar fracture
Apical/middle 3rd root fracture

Question 27

What injury requires a 4mth splint?

Answer 27

Cervical fracture

Question 28

How to monitor spontaneous tooth repositioning

Answer 28

Advice regarding diet + OH
Review monthly to observe re-eruption
Measure progress against fixed point (incisal edge of fully erupted non displaced adjacent incisor)

Question 29

What injury has a high risk of resorption?

Answer 29

Intrusive luxation

Question 30

When to commence RCT in mature tooth with intrusion injury

Answer 30

No more than 2wks post trauma using CAOH as an intracranal medicament (prevents external resorption)