Trauma 5 - aesthetic management

Question 1

list the causes of tooth discolouration

Answer 1

pulp necrosis
discolouration following RCT
localised discolouration of permanent tooth following primary tooth trauma
discolouration of restoration following trauma tx

Question 1

what is the legal age to receive tooth bleaching?

Answer 1

18 years old

Question 2

how do you treat discolouration due to necrotic pulp?

Answer 2

confirm its aetiology
ensure its not from pulp canal obliteration
commence RCT
(this may not resolve discolouration but it is essential to preserve the tooth)

Question 3

list the ways in which a tooth can experience discolouration following RCT

Answer 3

the pulp hasnt been fully removed from coronal aspect
blood has leached into dentinal tubules
GP hasnt been adequately reduced in the pulp chamber
dark material has been used to seal the access cavity (fuji pink)

Question 4

Following RCT, the pulp hasn’t been fully removed from the coronal aspect of the tooth. This has caused discolouration. How do you resolve this?

Answer 4

open the access cavity
clean out remnants
(be careful not to remove excessive tooth structure)

Question 5

Following RCT, blood has leached into dentinal tubules and has caused discolouration. How do you resolve this?

Answer 5

Best treated with internal bleaching
(removal of dentine will significantly reduce tooth structure making it more prone to fracture)

Question 6

Following RCT, GP has not been adequately reduced in the pulp chamber and has caused disolouration. How do you resolve this?

Answer 6

carefully open access cavity
reduce GP to level of CEJ
(be careful not to perforate)

Question 7

Following RCT, a dark material i.e., Fuji Pink has been used to seal the access cavity. This has caused discolouration. How do you resolve this?

Answer 7

replace with more aesthetic material
(be aware of aesthetic limitations)

Question 8

What is good practice following RCT to prevent discolouration?

Answer 8

GP trimmed to finish below gingival level
Canal sealed with a thin layer of RMGI
Well condensed and colour matched composite used to fill access cavity

Question 9

You have finished RCT, sealed it well, but the tooth is still discoloured. What do you do?

Answer 9

crown +/- post core
ceramic veneer
internal bleaching
external bleaching
composite camouflage

Question 10

Disadvantages of crown +/- post core for a discoloured tooth in a child?

Answer 10

pretty destructive
entering child into “restorative cycle”
all restorations have a finite life span
patient is still growing

Question 11

why do you not want to do a post in a child patient?

Answer 11

gingival margins are not established yet as mandible/ maxilla is still growing

Question 12

pros and cons of a ceramic veneer in child pt with discoloured tooth?

Answer 12

less destructive than crown
cooperation needed for prep, imps etc
need established gingival margins

Question 13

advantages of composite camouflage for a disocloured tooth in a child pt?

Answer 13

can easily be modified
atraumatic
does not usually require LA

Question 14

what is hypoplasia following trauma?

Answer 14

change in tooth form

Question 15

list ways to undertake a composite restoration on a tooth following trauma?

Answer 15

free hand
crown form
wax up and make matrix (using memosil putty)
lab made composite

Question 16

how can poor OH affect composite?

Answer 16

gingival inflammation
bleeding which leads to brown/ pink, poorly bonded composite

Question 17

what procedure can be done that may prevent the need for restorative intervention following avulsion?

Answer 17

space closure

Question 18

what can you do to maintain space until pt reaches skeletal maturity?

Answer 18

acrylic partial denture
retainer with denture tooth incorporated
resin retained bridge

Question 19

at what age can implants be considered and why?

Answer 19

20 years old
continued growth up until this age

Question 20

a patient attends with a mobile replanted avulsed tooth (4 months ago), what can cause this?

Answer 20

not replanted to full depth
something is pushing it through
external resorption