Dentoalveolar Injuries Flashcards by Ani Hsn

What are TDI’s?

Acute transmission of energy to tooth and supporting structures resulting in tissue damage

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Describe the incidence of TDI’s

More common in

males than females
prev history of TDI
class 2/1 incisor relationship

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Which teeth are most commonly affected by TDI?

Upper incisors

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What type of TDIs mainly affect primary teeth ?

Luxation

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What type of TDIs mainly affect adult teeth ?

Fractures

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What is the normal size of overjet?

3mm

>6mm there is a 3x risk of TDI

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What are the overall stages of managing TDIs?

Triage
Fact finding 
Clinical exam
Radiograph exam
Photographic
Acute management
Medium term management 
Long term managing

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What would form part of the Acute management of TDI?

Soft tissue trauma
Pain management
Reposition teeth

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What would form part of the medium term management of TDI?

Repairing fractures / RCT

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What would form part of the long term management of TDI?

Attempting to retain teeth esp children

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As part of the fact finding stage what would you ask in management of TDI?

When/where/ how
Patient details
History of trauma
If teerh / fragments broken avulsed are they accounted for

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What are you assessing during the clinical exam following TDI?

Soft tissue trauma
Occlusion
Broken/ missing teeth
Vitality tests

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What would signs of Diplopia mean?

Possible orbital fracture

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What aspects would you record as part of teeth assessment during trauma ?

Colour
Fracture
Mobility
TTP
Cold
EPT

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When would you consider a DPT in TDI?

Suspected condylar or mandibular fracture

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What are the traumatic dental injuries that exist ?

Enamel infraction
Crown fracture
Crown root fracture 
Root fracture 
Luxation

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What are the types of luxation injuries?

Concussion
Subluxation
Lateral luxation
Extrusive luxation
Intrusive luxation 
Avulsion

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Why do luxation injuries more commonly occur in primary teeth ?

Cancellous bone is more spongey

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What are the soft tissue injuries

Contusion
Abrasion
Laceration

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What are the alveolar injuries

Fracture of socket wall or process

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What are the features of enamel infraction ?

Crack in enamel with no loss of structure
No treatment needed
Normal pulp tests

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What are the features of complicated crown fracture ?

Pulp exposed

Exposed pulp sensitive to stimuli eg cold/probing

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What are the management principles of complicated crown fracture ?

Immature root -Cvek pulpotomy

Adult root : VPT or RCT

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Management for crown root fractures ?

Remove broken fragment
Immature teeth try to preserve pulp
Consider extrusion at later stage
RCT as required

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In root fractures pulp tests are usually?

Negative initially indicative of transient or permanent damage

What direction do root fractures tend to occur?

Transverse or oblique

If on the X-ray following root fracture you see a radiolucent line what may this indicate with regards to pulp vitality ?

The coronal portion may necrose

Where do you RCT in root fractures ?

To fracture line | Can place CaOH barrier

How long do you splint for in root fracture cases?

4 weeks to 4 months

What may indicate the presence of alveolar fracture ?

Occlusal disturbance | Misalignment of fracture portion

Teeth in the fracture alveolar bone are like to respond how to pulp tests ?

Negative

How long to splint in alveolar fractures ?

4 weeks

In concussion injuries which tissues are damaged ?

Neurovascular bundle PDL is unaffected

How would you manage a subluxation injury ?

Splint if required | Review and monitor pulp

How would you manage a lateral luxation injury ?

Reposition and splint 4 weeks

What are the risks of lateral luxation?

Resorption

What other injury is often associated with lateral luxation?-

Alveolar fracture

What junction exposure is indicative of extrusive luxation ?

CDJ visible

What sound would TTP be in an intrusive luxation?

Metallic

How would you define subluxation

Damage resulting in loosening but not displacements

How would you define concussion

TDI with no loosening or displacement but TTP

How long would you splint an extruded tooth for?

2 weeks

How would you manage an intruded tooth?

Immature tooth: allow to erupt if more than 8 weeks - ortho req Mature root: 3mm allow spontaneous 3-7mm ortho req and 7+mm surgucal reposition

At what timeframe would you carry out RCT in intruded cases?

2 weeks

What is transient apical breakdown?

Resorption what takes places in apical region to allow for new blood vessels to come in- mimics path. Seen more commonly in lateral and extrusion luxations

How long for transient apical breakdown to resolve ?

12 months

In extrusion what happens to PDL?

Severing

In subluxation what happens to PDL?

Stretched

In lateral luxation what happens to PDL?

Crushing causing death

The management and success of avulsed tooth heavily dependant upon?

Extra oral dry time (EOT) | Ideally less than 60 mins

If EOT is greater than 60 mins how do you manage this?

Soak in 2% sodium fluoride for 20 mins

How long do you splint an avulsed tooth?

EOT <60 mins 2 weeks EOT >60 mins 4 weeks

In what circumstances do you carry out RCT in avulsed cases?

Closed apex Open apex with EOT > 60 mins

When should you start RCT by in avulsion?

7-10 days

What are the main types of resorption likely to develop following avulsuon?

Replacement Inflammatory

Following avulsion patients also require what medication?

Antibiotics

What types of splint exist ?

Rigid | Physiological

What are the functions of splints ?

Allow for physiological tooth movement preventing anyklosis | Immobilises tooth into the correct position

What are some examples of splints?

TTS Wire Composite resin

What is the benefit with the TTS?

Allows for movement in vertical and horizontal plane

How far should splint extend?

One tooth either side of trauma

In which TDI cases are you more likely to see replacement resorption?

Excessive damage causing clastic cells to dominate

In which TDI cases are you more likely to see inflam resorption?

Damaged PDL + infection

Which two healing options exist following root fracture?

Regeneration of orginal tissue Repair of tissue with fibrous

What has occurred for regeneration during healing to be preferred over repair ?

Less trauma Ability to stimulated stem cells been greater

With regards to the apex what indicates the best outcome for TDI’s?

Open apex due to presence of thicker neurovascular bundle

Which injuries have worst outcomes?

Intrusion

What are the potential outcomes for pulp and apical tissues following trauma ?

Vital Obliteration Transient apical breakdown Necrosis

How will the occlusion be affected in intruded teeth?

Infraocclusion

When carrying out Cvek pulpotomy what should you avoid using?

Adrenaline in LA

What is the benefit of using MTA/Biodentine in complicated crown fractures ?

Odontoblast like cells are not innervated

In trauma cases what is the benefit of placing a MTA or putty if apically?

If surgery needed later easier to perform

How long does it take for odontblasts to lay down dentine bridge?

2-3 weeks

What are the management strategies for open apex RCT?

Apexification Regeneration by placing cocktail of AB and promotion stem cells Apexogenesis

What is another name for pulp canal obliteration? | McCabe and Dummer 2011

Calcific metamorphosis

Which traumatic events most commonly lead to obliteration? McCabe and Dummer 2011

Concussion Subluxation

Why does obliteration occur ? McCabe and Dummer 2011

Damage to neurovascular bundle

What colour do crowns of teeth go following obliteration? McCabe and Dummer 2011

Yellowish hue due to calcification of pulp

Obliteration can be partial or total? T/F McCabe and Dummer 2011

Dentoalveolar Injuries Flashcards

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