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Avulsion and Luxation Injuries Flashcards

(59 cards)

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1
Q

Types of injuries?

A

 Concussion (primary and permenant teeth) /Subluxation
 Lateral/Extrusive luxation
 Intrusive luxation
 Avulsion
 Injury to supporting bone

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2
Q

Concussion what is it? primary and permenant teeth

A

(1º and perm) No abnormal loosening, bleeding or displacement but TTP

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3
Q

How to assess concussion? primary and permenant teeth

A

 Check sensibility
 IOPA

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4
Q

Treatment concussion? primary and permenant teeth

A

 Reassure and analgesia advice
 1/52 soft diet
 Good OH ( +0.2%Chlorhex swab/mw
bd for 1/52)
 Monitor

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5
Q

What is subluxation? primary teeth

A

(1º) Abnormal loosening, but no displacement

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6
Q

subluxation results of tests? primary

A

 Mobile, TTP, +bleeding
 No abnormal radiological findings/slightly

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7
Q

Treatment of subluxation? primary

A

 Reassure and analgesia advice
 1-2/52 soft diet
 Good OH
 Monitor
 *Good OH consider Chlohexidene MW/swab

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8
Q

Subluxation permenant teeth? findings?

A

 Abnormal loosening, but no displacement
 Mobile, TTP, +bleeding
 No abnormal radiological findings

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9
Q

what to assess for permenant tooth subluxation?

A

 Check sensibility (informs prognosis)

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10
Q

Treatment of permenant tooth subluxation?

A

 Reassure and analgesia advice
 1-2/52 soft diet
 Good OH
 Consider flexible splint (2/52) if very
mobile/ tender or closed apex
 Monitor

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11
Q

Types of splinting?

A

Flexible/physiological
Rigid

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12
Q

Flexible/physiological splinting

A

1 tooth either side

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13
Q

Rigid splinting

A

More than 1 tooth either side

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14
Q

Direct restorations for splinting?

A

Composite and wire
Composite and titanium trauma splint
Orthodontic bracket and wire
Foil -cement
Composite/ acrylic

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15
Q

Indirect restorations for splinting?

A

Acrylic
Thermoplastic

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16
Q

When to check outcome of splinting?

A

2 days

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17
Q

Lateral luxation in primary teeth what is it

A

Displacement of the tooth in any lateral direction

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18
Q

Findings

A

No/minimal occlusal interference
Spontaneous repositioning

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19
Q

Treatment for lateral luxation in primary teeth?

A

Severe
Extraction
Reposition and splint
Risk (high)/benefit discussion pre treatment
Consider stability/ splint placement / R/O etc

10-14/7 soft diet
Good OH
Monitor

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20
Q

Extrusion what is it primary teeth

A

Partial displacement of tooth out of socket

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21
Q

What is treatment of extrusion in primary teeth based on?

A

Degree of displacement
Mobility
Interference with occlusion
Root formation
Splint options (co-op)

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22
Q

What is treatment of extrusion in primary teeth?

A

If no occlusal interference conservative
XS mobility or >3mm extract under LA
1-2/52 soft diet
Good OH, reassurance and analgesia advice, Monitor

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23
Q

Extrusive/ lateral luxation is what

A

displacement other than axially, with comminution or fracture of alveolar plate

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24
Q

Treatment of extrusive/lateral luxation in permenant teeth?

Study These Flashcards
A

Reposition (after cleansing of tooth surface)
+/- LA
Digital
Orthodontic appliances (if digital fails)
Splint
Flexible
Lateral 4/52
Extrusive 2/52
Pt instructions
+/- antibiotics
Monitor

25
Intruded teeth is what?
A large force is required to severely intrude teeth so be aware of the possibility of other injuries – adjacent teeth, head injury
26
What in intrusion important to assess?
degree of intrusion as informs treatment
27
What factors to assess in intrusion of teeth?
Age of patient History of previous position Other teeth Radiograph Compare cej, apices Previous dental treatment
28
Treatment of intrusion in primary teeth?
Monitor for reeruption Usually within 6 months-1year 10-14/7 soft diet Reassurance and analgesia advice Good OH Monitor
29
Aim in treatment of permenant teeth in intrusion cases?
To maintain the tooth if possible
30
Treatment options for intrusion of permenant teeth?
Treatment options Monitor only +/- orthodontics later Monitor for up to 4 weeks if no movement -» Ortho Immediate orthodontic extrusion Surgical repositioning Consider pulp therapy and timing
31
What techniques are there for repositioning?
Orthodontic Repositioning Surgical repositioning
32
Orthodontic repositioning?
A removable appliance with a self-supporting spring or elastic module to apply vertical extrusive force through a bracket bonded onto the labial or incisal surface. UFA (sectional)
33
Surgical repositioning?
LA (Sedation or GA may be required) Gentle movements with a flat plastic instrument/forceps If resistant, consider if a bony impaction is present and release this before repositioning the labial plate of bone and soft tissue closure and suturing. Splint 4/52
34
IADT- Dental Trauma Guide Open apex?
Monitor up to 4/52 Then ortho
35
IADT- Dental Trauma Guide closed apex?
Up to 3mm ? monitor /-ortho /surgical 3-7mm Ortho / surgical >7mm surgical
36
Follow up/management of incomplete apex?
Monitor If signs or symptoms of pulp death start RCT with apexification
37
Follow up/ management of closed apex?
Elective pulp extirpation will be necessary for all intrusive luxation injuries on closed apex teeth Within 2 weeks of the injury Keep dressed with calcium hydroxide paste until any inflammatory resorption has stopped Any being monitored close follow-up
38
Antiobiotics for intrusive luxation?
Indications Contamination Additional injury to soft tissues or other injuries Significant surgical intervention Medical condition rendering more prone to infections Always for reimplantation in permanent teeth Types First line amoxicillin or penicillin based unless CI/ allergy >12 yrs doxycycline based as alternative
39
Avulsion in permenant teeth management at the site of injury Plan A?
Offer advice over telephone Plan A Re-implant immediately Contaminated -rinse in milk or saline or saliva Avoiding handling of the root surface Hold tooth in place by biting on folded handkerchief or napkin Attend dental surgeon immediately ATTEND DENTIST IMMEDIATELY
40
Avulsion management at the site of injury plan B?
If re-implantation not possible store in suitable storage medium - in order of preference: Cold fresh milk Hank’s Balanced Salt Solution Saliva (buccal sulcus or spit in a cup) ATTEND DENTIST IMMEDIATELY
41
What about the history for avulsion?
Avoid unnecessary delay before re-implantation During examination place in suitable storage medium if not currently in one Thorough medical, dental and accident history
42
Treatment for avulsion
--LA if patient co-operation allows --Reimplant ASAP! Keep pt calm Prepare socket No unnecessary manipulation If clot present gently irrigate with saline in syringe and use suction to remove clot Avoid curettage Reposition any bone fragments --Handling Tooth Don’t touch root If contaminated wash in normal saline
43
Treatment 2 for avulsion
Push tooth gently into socket If obstructed by alveolar bone fragments gently use blunt instrument to reposition bone Check position Splint if already reimplanted start here (after History and Exam) Flexible splint for 2 weeks Check occlusion +/- sutures Advise soft diet, good oral hygiene (soft tooth brush and chlorhexidine mouth rinse), avoid contact sports Follow-up
44
What are the two schools of avulsion?
IADT and BSPD
45
IADT
For avulsion injuries follow teaching in IADT ‘Dental Trauma Guide’
46
Avulsion open apex teeth- If reimplanted prior to clinical attendance ?
Antibiotics +tetanus Splint 2 wks Flexible Avoid contact sports Avoid RCT unless signs
47
Avulsion Open Apex Teeth If extra oral dry time is less than 60 minutes
Reimplant Antibiotics +tetanus Splint 2 wks Flexible Avoid contact sports Avoid RCT unless signs
48
Avulsion Open Apex Teeth If extra oral dry time is more than 60 minutes (or non-physiologic media)
Reimplant Antibiotics +tetanus Splint 2 wks Flexible Avoid contact sports Avoid RCT unless signs
49
IADT Avulsion Closed Apex Teeth If reimplanted prior to Clinic attendance?
Antibiotics +tetanus Splint 2 wks Avoid contact sports RCT within 2 wks Calcium Hydroxide 1mth
50
IADT Avulsion Closed Apex Teeth
Reimplant Antibiotics +tetanus Splint 2 wks Avoid contact sports RCT within 2 wks Calcium Hydroxide 1mth
51
IADT Avulsion Closed Apex Teeth If extra oral dry time is more than 60 minutes
Reimplant Antibiotics +tetanus Splint 2 wks Avoid contact sports RCT within 2 wks Calcium Hydroxide 1mth
52
IADT Avulsion Closed Apex Teeth If extra oral dry time >60 mins (or non-physiologic media)
Reimplant Antibiotics +tetanus Splint 2 wks Avoid contact sports RCT within 2 wks Calcium Hydroxide 1mth
53
When Not To Reimplant (Almost Never!)
Primary teeth Other injuries Where other injures are severe and require preferential emergency treatment Medical history Depressed immunity eg. Acute lymphoblastic anaemia If in doubt liaise with physician
54
When Not To Reimplant (Almost Never!) cont...
Immature permanent tooth with short wide open apex and prolonged extra-oral time Replacement resorption is inevitable Gross contamination/ long time out Grossly carious tooth Severe periodontal disease Patient choice
55
Follow-up Management
Ideally review within 48 hrs Check splint and modify if necessary Reinforce OH and soft diet Review 2 weeks Radiograph prior to splint removal Commence RCT if indicated Remove splint
56
Avulsion outcome Summary
Periodontal ligament survival is critical factor Dry storage time is most important factor Wet time less critical Contamination of root adverse effect Handling root adverse effect Prompt RCT decreases inflammatory resorption Replacement resorption rate determines prognosis Short term space maintainer should be considered Long term survival questionable
57
Injuries to supporting bone
Comminution of alveolar socket wall Fracture of alveolar socket wall Fracture of mandibular or maxillary alveolar process Fracture of mandible or maxilla
58
Aveolar fracture primary and permenant
Mobility of several teeth ‘en bloc’ Displacement, Occlusal interference, TTP SI IOPA, Occlusal +/- OPT and/or CBCT
59
Treatment of alveolar fracture primary
Debridement LA/GA Reposition Soft tissue repair Flexible Splint 4/52 Soft diet Antibiotics Good OH Monitor

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