Management of dentine and enamel fractures

Question 1

Enamel infraction what is it

Answer 1

Incomplete fracture of enamel without loss of tooth structure

Question 2

Treatment of enamel infraction?

Answer 2

 Monitor
 Occasionally etch and seal if sensitive

Question 3

What is an enamel fracture

Answer 3

 Minimal fracture
 Loss of tooth substance confined to enamel

Question 4

Treatment of enamel fracture

Answer 4

 Leave (smooth if necessary)
 Composite restoration
 Splint if any mobility
 Periodic review
 Radiographic
 Sensibility

Question 5

Treatment of primary teeth enamel fractures?

Answer 5

 Monitor
 Usually sufficient to smooth if possible to prevent soft tissue
damage

Question 6

What is enamel dentine fracture uncomplicated?

Answer 6

Loss of tooth substance confined to enamel and dentine
and not involving the pulp

Question 7

Treatment of enamel dentine fractures uncomplicated?

Answer 7

Loss of tooth substance confined to enamel and dentine
and not involving the pulp

Question 8

Emergency treatment of enamel dentine fractures uncomplicated? option1

Answer 8

 Dress exposed dentine with glass ionomer
 Composite bandage / composite crown build up

Question 9

Emergency treatment of enamel dentine fractures option 2? uncomp

Answer 9

Reattachment of fragment
 Immediately reattach fragment if possible
 If fracture close to pulp –indirect pulp cap
 Dress exposed dentine with glass ionomer
 Thin lining / cement over dentine, aim to maintain vitality
 Delay placement of fragment and store in milk / saline

Question 10

Technique of reattachment of fragments? first …. uncomp

Answer 10

Check vitality of tooth
 Check fit of fragment
 Keep fragment hydrated

Question 11

step by step technique of enamel dentine fractures? uncomp

Answer 11

Isolate tooth - rubber dam
Attach fragment to gutta percha for handling
Etch enamel on both fracture sites & 2mm margins
Wash, dry, apply primer
Bonding agent
Note - Do NOT dessicate fragments

Question 12

Once the fragment is rebonded? uncomp

Answer 12

 Place composite –remove excess
 Finish

Question 13

Follow up once the fragment is rebonded? for uncomp

Answer 13

Monitor vitality
 Monitor colour changes

Question 14

Consequence after rebond for uncpmplicated fracture?

Answer 14

Space loss

Question 15

Treatment of primary teeth enamel dentine fractures

Answer 15

 Glass ionomer dressing to protect dentine and decrease
sensitivity if sufficient cooperation
 Smooth if possible to prevent soft tissue trauma

Question 16

Complicated fractures- whats the idea?

Answer 16

the pulp is involved !

Question 17

what factors to consider with enamel dentine and pulp fractures? complicated f

Answer 17

*Time from pulp exposure
*Size of pulp exposure
*Stage of root development
*Age of child –cooperation

Question 18

What are your options for enamel dentine and pulp fracture treatment? complicated f

Answer 18

*Pulp cap
*Pulpotomy
*Pulpectomy

Question 19

When to pulp cap? (presentation?) complicated fractures

Answer 19

Short time, pin point exposure, poor co
- operation
Prognosis better if seen < 24 hrs

Question 20

Treatment - pulp cap (comp)

Answer 20

Layer of Ca OH2 placed directly over
exposed pulp
Bandage of GI or composite

Question 21

Aim of pulp capping- comp fractures

Answer 21

Preserve vital pulp, bridge of reparative
dentine

Question 22

Monitering vitality/ radiographs? post pupl capping treatment -complicated f

Answer 22

Exclude resorption /necrosis

Question 23

When to pulpotomy for complicated fractures? (presentation)

Answer 23

Incomplete apex / complete apex
Small exposure
Vital pulp, not infected
Patient co-operative

Question 24

Treatment pulpotomy for complicated fractures is done when

Answer 24

asap

Question 25

Aim of pulpotomy for complicated fractures?

Answer 25

Allow continued root growth –apexogenesis Avoid need for open apex RCT –apexification

Question 26

Success rate of pulpotomy for complicated fractures

Answer 26

80-96 percent 96 percent (Cvek 1978)

Question 27

Clinical procedure of vital pulpotomy - Cvek - complicated fractures

Answer 27

Local anaesthetic Isolation Remove non vital tissue (2-3mm) Non setting Calcium Hydroxide No pressure Glass ionomer dressing Other materials used –MTA or biodentine

Question 28

Follow up for pulpotomy

Answer 28

Review  Radiographs at 1 month, then 3-6 month  Check hard tissue barrier formation  Check continued root growth

Question 29

When to pulpectomy for complicated fractures> - presentation

Answer 29

Gross exposure / extrusion of pulp Complex crown / root fracture Necrotic pulp in open apex

Question 30

What is treatment ie. pulpectomy for complicated fractures ?

Answer 30

Closed apex –standard RCT Open apex –apexification

Question 31

Aim for pulpectomy after complicated fracture

Answer 31

Maintain tooth Weak tooth as no further development

Question 32

Note ... for pulpectomy - after complicated fracture

Answer 32

Endodontic management of immature non vital tooth covered in a later lecture

Question 33

Treatment of primary teeth for enamel/ dentine fracture with pulp exposure

Answer 33

Generally extraction due to limited cooperation for pulp treatment

Question 34

Classification of root fractures?

Answer 34

 Dentine, cementum and pulp -Apical - Middle - Coronal third  Displaced  Undisplaced

Question 35

Treatment of root fractures?

Answer 35

 Immediate repositioning  Splint 4 weeks or until stable  Soft diet and Chlorhexidine mouthwash  Review vitality of coronal fragment  Treat complications

Question 36

Diagnosis for root fractures

Answer 36

May require 2 views radiographically to position + displacement

Question 37

Treatment of root fractures at coronal 1/3 of root?

Answer 37

 Poorer prognosis  May require extraction of tooth  May require extraction of coronal fragment + extrusion of root  May require endodontic treatment to fracture line

Question 38

Repositioning after root fracture?

Answer 38

Reposition as early as possible  May require local anaesthetic  Digital manipulation  Forceps  Orthodontics

Question 39

Aim for splinting after root fracture?

Answer 39

to immobilise tooth in correct anatomical position preventing further trauma and allowing healing

Question 40

The type of splint depends on? (root fracture)

Answer 40

* Injury * Age of child / teeth present * Facilities

Question 41

What is a functional splint (root fracture)

Answer 41

 one that includes tooth either side of the traumatised tooth

Question 42

For a root fracture what splint treatment

Answer 42

 4 weeks of functional splint  Previously recommended rigid fixation (2 teeth either side of traumatised tooth)

Question 43

Assessing the position of the root fracture for treatment

Answer 43

 If coronal fragment is stable then it can be monitored  If coronal fragment is displaced / mobile then extraction may be required

Question 44

Displacement injuries

Answer 44

Luxation (see other lecture)

Question 45

Realistically the prognosis for traumatised teeth depends on accurate diagnosis and appropriate immediate management