avulsion and luxation injuries Flashcards
(38 cards)
what is concussion to primary and permanent teeth?
> No abnormal loosening, bleeding or displacement but TTP
> oedema and haemorrhage in the PDL
> Quite often Primary tooth concussion injuries will not attend dentist
what is the management for concussion in primary and perm teeth?
> Check sensibility (unreliable in primary)
> IOPA
> Reassure, educate and analgesia advice
> soft diet for 1 week
> Good OH ( +0.2%Chlorhex swab/mw bd for 1 week)
> Monitor
what is subluxation in the primary/ perm dentition?
> Abnormal loosening, but no displacement
> Mobile, TTP, +/ - bleeding
> No abnormal radiological findings
what is the management of subluxation in a primary tooth ?
> Reassure and analgesia advice
> 1-2/52 soft diet
> Good OH
> Monitor
*Good OH consider Chlohexidene MW/swab
what is the management of subluxation in a perm tooth?
> Check sensibility (informs prognosis)
> Reassure and analgesia advice
> 1-2/52 soft diet
> Good OH
> Consider flexible splint (2/52) if very mobile/ tender or closed apex
> Monitor
when would you use a flexible/ physiological splint?
> if there is 1 tooth either side
when would you use a rigid splint?
> when there is over 1 tooth either side
what are example of direct splints?
> Composite and wire
> Composite and titanium trauma splint
> Orthodontic bracket and wire
> Foil -cement
> Composite/ acrylic
what are examples of indirect splints?
> Acrylic
> Thermoplastic
what is lateral luxation?
> displacement of the tooth in any lateral direction
what is the management of lateral luxation in primary teeth?
> No/minimal occlusal interference
- Spontaneous repositioning
> 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
what is extrusion in a primary tooth?
> partial displacement of tooth out of socket
what is treatment of exclusion based off?
> Degree of displacement
> Mobility
> Interference with occlusion
> Root formation
> Splint options (co-op)
what is the management of extrusion?
> If no occlusal interference conservative
> excess mobility or >3mm extract under LA
> 1-2/52 soft diet
> Good OH
> reassurance and analgesia advice
> Monitor
what is extrusive luxation?
> Lateral luxation-displacement other than axially, with comminution or fracture of alveolar plate
what is the treatment for extrusion and lateral luxation in a permeant tooth?
> 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
when a tooth has intruded what is important to assess?
> Important to assess degree of intrusion as informs treatment
> Age of patient
> History of previous position
> Other teeth
> Radiograph
- Compare cej, apices
> Previous dental treatment
> A large force is required to severely intrude teeth so be aware of the possibility of other injuries – adjacent teeth, head injury
what is the treatment of an intruded primary tooth?
> Monitor for reeruption
- Usually within 6 months-1year
> 10-14/7 soft diet
Reassurance and analgesia advice
Good OH
Monitor
what are the treatment aims and options for intrusion of a permanent tooth?
> Aims to maintain the tooth if possible
> 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
what are the 2 repositioning techniques?
> orthodontic
> surgical
what is 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)
what is 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
> benefits? = reduced number of visits, rapid access for RCT
what is the IADT - dental traumaa guide guidelines for open and closed apex intrusions?
> open apex =
- monitor up to 4/52
- then orthodontic
> closed apex
- up to 3mm = monitor +/- ortho/ surgery
- 3-7mm = ortho/ surgery
- over 7mm = surgery
what is the follow up management of intrusion in permanent teeth?
> Incomplete Apex
- Monitor
- If signs or symptoms of pulp death start RCT with apexification
> 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
