long term follow up

Question 1

long term complications of of trauma to primary teeth 4

Answer 1

pulp necrosis
pulp obliteration
root resorption
damage to successors

Question 2

treatment for pulp necrosis in primary teeth

Answer 2

Extract or if close to exfoliation monitor till exfoliation

Question 3

what indicates pulp necrosis in primary teeth 4

Answer 3

Grey colour that does not fade

No reduction in pulp cavity radiographically

Periapical pathology

Clinical signs of infection

Question 4

treatment for pulp obliteration in primary teeth

Answer 4

Nothing if asymptomatic, extract if symptoms/infection/inflammation

Question 5

what indicated pulp obliteration in primary teeth 2

Answer 5

Yellow/opaque colour

Pulp chamber shrinks radiographically

Question 6

treatment for root resorption in primary teeth

Answer 6

Extract if signs of infection

Question 7

what indicates root resorption in primary teeth 2

Answer 7

Root resorption radiographically

Possible clinical mobility

Question 8

what can happen to the successors crown if its damaged

Answer 8

enamel hypomineralisation
enamel hypoplasia
crown dilaceration
odontoma-like malformation
sequestration of permanent tooth germ

Question 9

what is enamel hypomineralisation

Answer 9

reduced quality of enamel

Question 10

what is enamel hypoplasia

Answer 10

thin enamel

Question 11

what is odontoma-like malformation

Answer 11

□ masses of mineralized tissue resembling a tooth or a collection of small teeth, with enamel, dentin, and sometimes pulp-like tissue

Question 12

explain sequestration of permanent tooth germ

Answer 12

Heavy trauma stops tooth germ forming so don’t have tooth there

Question 13

remember damage to the successors root can stop the tooth erupting

Question 14

what can happen to the successors roots if damaged

Answer 14

root duplication
root dilaceration
arrest of root formation

Question 15

long term complications of trauma to permanent teeth

Answer 15

pulp necrosis
reactionary dentine
resorption
discolouration

Question 16

signs of pulp necrosis in permanent teeth 4

Answer 16

-ve sensibility testing

Greyish discolouration

Periradicular inflammation - radiographically and clinically

Immature teeth - no signs of further root development radiographically

Question 17

treatment of pulp necrosis in mature permanent teeth with closed apex

Answer 17

RCT

Question 18

treatment of pulp necrosis in mature permanent teeth with open apex

Answer 18

apexification
visit 1: extirpate pulp NaOCl, working length, place CaOH

visit 2: irrigate with NaOCl and citric acid. Final flush with sterile H2O to prevent discolouration. Dry and place 4-6mm MTA

visit 3: complete obturation with thermoplastic GP

Question 19

treatment of pulp necrosis in immature permanent teeth

Answer 19

extirpate pulp, fill with CaOH till specialist can do RCT for maximum 4 weeks

Question 20

what can reactionary dentine lead to?

Answer 20

pulp canal obliteration if the process doesn’t stop and the canal continues to narrow

Question 21

signs of reactionary dentine in permanent teeth 3

Answer 21

Pulp chamber and root canal shrink radiographically

Darken (yellowing) of tooth - as more dentine

Reduced response to sensibility tests

Question 22

treatment of reactionary dentine in permanent teeth

Answer 22

Monitor
RCT if signs of periapical inflammation/infection - difficult due to narrowed canal

Question 23

name 4 types of root resorption in permanent teeth

Answer 23

external inflammatory resorption

cervical inflammatory resorption

internal inflammatory resorption

replacement resorption and ankylosis

Question 24

what is external inflammatory resorption caused by?

Answer 24

PDL damage and propagated by infected necrotic pulpal products diffusing down the dentinal tubules into the PDL

Question 25

signs of external inflammatory resorption 2

Answer 25

Change in external contour of the root radiographically May have mobility

Question 26

treatment of external inflammatory resorption in permanent teeth

Answer 26

RCT - pulp extirpation, debridement, filling with CaOH until infection controlled then permanent root filling. Review radiographically

Question 27

what is cervical inflammatory resorption caused by

Answer 27

damage to cervical region

Question 28

treatment of cervical inflammatory resorption in permanent teeth

Answer 28

RCT if necrotic pulp

Question 29

what is internal inflammatory resorption caused by

Answer 29

Caused by chronic pulpal inflammation - necrotic, inflamed pulp

Question 30

signs of internal inflammatory resorption 2

Answer 30

Pink spot if occurs in coronal 1/3 of canal Round symmetrical radiolucency in the canal. Inside canal lines have changed

Question 31

treatment of internal inflammatory resorption in permanent teeth

Answer 31

RCT - dress with CaOH

Question 32

explain replacement resorption and ankylosis

Answer 32

Root structure is removed and replaced by investing bone structure and Fusion of the root to the surrounding bone

Question 33

how is replacement resorption and ankylosis different to inflammatory resorptions

Answer 33

no infection or inflammation

Question 34

what is replacement resorption and ankylosis caused by?

Answer 34

When more than 20% of the PDL is damaged before re-implantation/positioning bone cells colonise the root faster than the PDL. It undergoes the normal bone remodelling process so the root is slowly replaced by bone

Question 35

signs of replacement resorption and ankylosis 3

Answer 35

No biological mobility Metallic tone on percussion No distinct demarcation between bone and tooth

Question 36

treatment for replacement resorption and ankylosis in fully grown patient permanent tooth

Answer 36

Monitor in fully grown pt

Question 37

treatment for replacement resorption and ankylosis in growing pt permanent tooth

Answer 37

tooth may begin to appear infra-occluded and inhibit alveolar bone growth. If gingival margin discrepancy exceeds 1-2mm requires further treatment planning such as decoronate the tooth below alveolar bone level and remove root filling material to promote alveolar growth.

Question 38

what is transient apical breakdown

Answer 38

- Radiolucent cap around the root apex due to increased cellular activity from tooth revascularizing

Question 39

treatment for transient apical breakdown

Answer 39

Monitor if it’s the only sign of non-vitality

Question 40

how is endodontics carried out in apical/mid third root fractures

Answer 40

- Treat up until the root fracture, do not extend beyond the fracture in the apical portion - MTA may be used to create an apical stop

Question 41

how is endodontics carried out in coronal 1/3 fractures? 3

Answer 41

Splint the coronal segment Extract the coronal and apical portions Extract the coronal portion