***Fractures, resorption and toothwear Flashcards
(25 cards)
Describe the need to take radiographs in a situation where trauma has occurred
• When a patient presents following trauma, clinical evidence alone does not indicate the damage that has occurred
Radiographs detect: • root fractures • fracture of the alveolar process • luxation injuries • post injury pathological change
Discuss the type of radiographs you would take for a fracture
- PA’s, BW’s, OPG’s & lateral cephs may not clearly show facial fractures
- Specialised techniques & scans such as CT may be necessary to detect many facial fractures
Briefly describe a cleft lip and palate
- Incomplete fusion of medial, lateral and maxillary nasal processes
- Presentation varies from mild cleft lip only to extensive bilateral complete cleft lip and palate
- Cause unknown
Describe concussions
Description
• Trauma to the supporting structures of the tooth
• No displacement or mobility
Radiographic appearance
• Normal
Describe root fractures
Radiographic appearance
• Radiolucent lines separate the fragments
• Apical portion remains in place while coronal portion is displaced
Describe alveolar fractures
Radiographic appearance
- Radiolucent line in bone
- Apex of the root is not attached to the bone
Describe subluxation
Description
• Tooth is mobile
• Tooth is NOT displaced
• There may be bleeding around the gumline and the tooth is sensitive to the touch
Radiographic appearance
• No abnormalities
• Pulp tests can indicate damage
Describe extrusive subluxation
Description
• Entire tooth is displaced, partially out of the socket
Radiographic appearance
• Apical portion of the socket is empty
Describe lateral luxation
Description
• Tooth displaced laterally
• Fracture of the alveolar bone plate
• Tooth is immobile
List the radiographic technique suited to straight fractures
Paralleling angle
List the radiographic technique suited to angled fractures
Bisecting angle
List the steps required when a concussion occurs
- PA via paralleling technique
- Radiographic review in 6 to 8 weeks - increased PLS, periapical radiolucency
- Monitor pulp vitality
- Refer to DO
List the steps required when a crown/root fracture occurs.
- 2 PA’s: 1 paralleling technique and 1 bisecting angle
- Radiographic review in 6 to 8 weeks - increased PLS, periapical radiolucency
- Monitor pulp vitality
- Root fractures: refer to DO for repositioning, immobilisation and RCT
List the steps required when an alveolar process fracture occurs.
- To distinguish from a tooth fracture, two radiographs will need to be taken with different vertical angulation
- If the bone is fractured, then the fracture will move in relation to the angulation. If it was the tooth only, then the fracture will not move
- Refer to DO for repositioning and immobilisation
- Radiographic review to ensure healing and to detect pathological changes
List the steps required when a subluxation fracture occurs.
- Initial PA
- Refer to DO for immobilisation (repositioning if extrusive)
- For intrusive luxation, orthodontic extrusion is required
- Radiographic review & connective tissue healing & detect pathological changes
List the steps required when an avulsion fracture occurs.
- Store tooth in saliva or milk
- PA & Occlusal films
- Refer to DO
- Reimplantation, immobilisation, antibiotic cover & tetanus prophylaxis
- Post radiographic &clinical review
List the effects of trauma to the primary dentition on permanent dentition
- Effects may involve hypomyelination
- Whitish or brownish defects
- Crown dilacerations
- Dilacerations of the root, incomplete root formation
- Malformation resembling an odontoma
- Ectopic eruption
Define resorption and list the types of resorption
Resorption: Tooth resorption is the removal of tooth structure by ‘clastic’ cells
Types:
Physiological resorption
Internal inflammatory resorption
External inflammatory resorption
Pressure resorption
Replacement resorption
Describe physiological resorption. List the impact of malpositioned permanent successors.
Causes:
• NOT pathological
• Resorption of the roots of primary teeth
Radiographic appearance:
• Starts at the apex of the root/s
• As the permanent tooth erupts the resorption progresses coronally
Impact of malpositioned permanent successors:
• Resorption may not occur normally and the primary tooth may be over-retained
Describe internal inflammatory resorption and its causes.
Causes • Dentine resorption due to pulpitis • Caries • Tooth surface loss • Trauma • Pulpal treatment
Radiographic appearance
• Radiolucency within the pulp chambers/ root canals
Describe external inflammatory resorption, and possible causes.
Causes:
Inflammation of the PDL due to:
• Trauma (ortho appliances)
• Periapical infection
Radiographic appearance
• Occurs outside of tooth (not in pulp, dentine or enamel)
• Apical loss of root, indicated by blunting
Describe pressure resorption
Surrounding structures may undergo resorption due to malposition of a unerupted or partially erupted tooth
Describe replacement resorption
- Replacement of the tooth by bone
- Occurs following extensive damage to the cementum
- Seen most often following reimplantation of an avulsed tooth
- Early replacement resorption is evident by the loss of the lamina dura, making it difficult to distinguish between tooth and bone
Describe the radiographic appearance of tooth wear
- Appear as radiolucent lesions superimposed on the teeth
- Attrition can result in shortened crowns or thin enamel on incisal edges and cusp tips
- Seen more clinically than radiographically
