Permanent Dentition Trauma 1 (HT)

Question 1

define

Infraction

Answer 1

An incomplete fracture (crack) of the
enamel without loss of tooth
structure.

Question 2

Visual= Visible crack
Mobility= None
Percussion= None
SensibilityTesting's=Unusualy positive
Radiographic Finding=No abnormalities

Answer 2

infraction

Question 3

treatment of infraction:

b) what follow up is there?

Answer 3

1. No treatment
2. Etch and Bond
   b) none

Question 4

Visual= Loss of tooth tissue
Mobility= None
Percussion= None
SensibilityTesting's=Unusualy positive (if negative may be transient)
Radiographic Finding=No abnormalities

Answer 4

Enamel/dentine fracture

Question 5

Enamel/dentine fracture- treatment:

b) follow up?

Answer 5

1.Composite bandage or definitive
composite restoration
2. Bonding fractured portion (use flowable composite)
b) 6-8w (rad), 1 yr (rad)

Question 6

Define enamel fracture

Answer 6

Fracture with the LOSS of tooth substance confined to the enamel

Question 7

Visual= Enamel/dentineloss and exposure of the pulp
MobilityNone
PercussionNone
Sensibility Testing’sUsually positive (ifnot delayed)
Radiographic
Findings Visible = piece of enamel/dentine and into pulp visible

Answer 7

enamel/dentine /pulp fracture

Question 8

tx for enamel/dentine /pulp fracture=
scenario 1: less than 24 hours and tiny exposure less than 2 mm
Scenario 2: MOre than 2 mm or more than 24 hours sicne
b) follow up

Answer 8

1. Maintain vitality
   scenario1 : Pulp capping with Ca(OG)2, and hermetic seal (composite)
   Scenario1L Partial pulpotomy or full coronal : both with Ca(OH)2 and hermetic seal (composite)
   3.. Extipation
   B) 6-8 week (rad), 3 m (rad), 6 m (rad), 1 year (rad)

Question 9

What does an uncomplicated Cr-root fracture involve?

Answer 9

enamel, dentine and cementum

Question 10

Visual: Crown fracture extending below gingival margin.
Mobility: Coronalfragment often mobile
Percussion: Tender
Sensibility Test: Usually positive for apical portion
Radiographic Findings: Apical extension of fracture usually not visible. CBCT may be helpful

Answer 10

uncomplicated Cr-Root fracture

Question 11

Treatment of CR-root fracture (uncomplicated):

B) Follow-up

Answer 11

Removal of fractured  portion  then:
1.Restore with composite
2.Gingivectomy/ostectomy
3.Orthodontic  extrusion
4.Surgical extrusion
5.Decoronation
6.Extraction
B)6-8w (RAD);3m (RAD), 6m RAD, 1yr (RAD), Annually  till up to at least 5 years (RAD)

Question 12

What do you needs to asses in a root fracture

Answer 12

Classified by position of # lines radiographicallyAssess displacement of coronal fragmentAssess stage of root development: Mature or immature

Question 13

What is involved in a complicated Cr-Root fracture

Answer 13

cementum, dentine, enamel and pulpal exposure

Question 14

What is the follow up for complicated Cr-root fracture

Answer 14

6-8w;6m, 1yr

Question 15

What is the emergency tx for cr-root fracture (complicated_

Answer 15

Use flowable composite to sandwich together. Removal of fractured portion and pulpotomy or extirpation (as per EDP#)

Question 16

What is the longer term tx for Cr-root fracture (complicated_
(6)

Answer 16

manadge pulp then tx as you would if uncomplicated. remove # portion (and yes in an emergency you just sandwitch the 2 together), then tx pulp: pulpotomy or extirpation (as you would in complicated enamel–dentine-pulp #)Restore with composite2.Gingivectomy/ostectomy3.Orthodontic extrusion4.Surgical extrusion5.Decoronation6.Extraction

Question 17

define root fracture

Answer 17

a fracture confined to the root of the tooth involving cementum, dentin and the pulp

Question 18

Visual: The coronal segment may be mobile and in some cases displaced. Transient crown discoloration (red or grey) may occur. Bleeding from the gingival sulcus may be noted.
Mobility: Coronalfragment often mobile
Percussion: Tender
Sensibility Test: Initially negative (transient)
Radiographic Findings: The root fracture line is usually visible

Answer 18

root fracture (may be coronal, aprical or mid third) coronal =worse prognosis (up to 4 month flexible splint)

Question 19

follow up for a root fracture

Answer 19

4w (SPLINT (take off), RAD), 6-8w (RAD), 4m (SPLINT (if coronal third), RAD), 6m (RAD), 1yr (RAD), Annually till up to at least 5 years (RAD)

Question 20

treatment objectives for root fracutre

Answer 20

Repositionfracture portionApical/Mid –4 weeks flexible splint; Coronal –4 months flexibleRemove splint

Question 21

What must you do

pt C/O hit head now tooth wobbly:

Answer 21

1. Head injuries?
   - MH, SH, DH, EXamine, E/O, I/O (do we do it in the sam order)
2. manage pain
3. check tetanus status (have they had their boosters)
4. clean injury
5. maintain vitality of tooth
6. refer for specialist manadgement?
   (get a dental trauma sheat) (

Question 22

What MH can contraindicate certain manadgments for dental trauma?

Answer 22

allergies
cardiac
immunology (e.g. chemo and immuno suppressed)- don't go putting a detty tooth back in their
Haematology
Disability (will they cooperate with tx)

Question 23

What extra oral things are you looking for in dental trauma

Answer 23

examine face, lips, and orla muscles for E/O ST lesions
2) palapate facial skeleton (fracture, anaesthesia, parasthesia and dysaesthesia)
TMJ (mouth opening
CSF leakage (check ears and nose)
Sub-conjuctive haemorrhage (white of eye is red)

Question 24

What does gingival crevicular bleeding around damadge trauma tooth indicate?

Answer 24

subluxation injury
(+ TTP, but not mobility)
Tx- monitor , Soft toothbrush , CHX mouth wash, (+/- splint for 2 weeks)

Question 25

WWhat does gingival displacement around damadge trauma tooth indicate?

Answer 25

dento-alveolar fracture

Question 26

What radiographs will we be taking in dental trauma?

Answer 26

PA with 90 degree horizontal angle with central beam on tooth Occlusal view PA with lateral angulations from mesial and distal Soft tissue imaging (check nothing in ST) CMCT (if fracture subgingival)

Question 27

What dental history is relevant when seeing pt with dental trauma?

Answer 27

previous trauma (NAI? safe gaurding!) cooperation other pathology

Question 28

What can we do to help medico-legally for record in dental trauma?

Answer 28

photos diagrams radiographs dental trauma sheat

Question 29

what are we diagnosing in dental trauma? | possible cause +possible result

Answer 29

``` PDL damadge (cause displacement can result in resorption) Pulp damadge (cause Cr fracture of significant displacement may cause pulp necrosis) ```

Question 30

Manadgement of root fracture if pulp becomes necrotic? B) how frequently does this occur? c) different outcomes of distal fragment of root

Answer 30

extirpate to #line 2) dress non-setting CaOH then MTA/biodentine just coronal to # line obturate to # line b) 20% c) remain with PDL intact, resorption, may become infected monitor for this

Question 31

A pt had a root # that was non-vital. You treated is by dressing pulp with non-setting CaOH and MTA then obturated to # line then did a final restoration. THe pt is back with pain, swelling in area. What happened? b) tx

Answer 31

apical fragment of root didn't resorb , became infected | b) antibiotics and apicetomy

Question 32

what determines the prognosis of root fractures?

Answer 32

``` age of child (mature/immature teeth) degree of displacement associated injuries e.g. cr # time between injury adn tx presence of infection ```

Question 33

what determines prognosis of enamel-dentine pulp #?

Answer 33

Depends on:  Age of child; mature / immature tooth  Type of injury  Associated injuries; PDL injuries( e.g. subluxation injuries/)  Time between injury and treatment -Delays in accessing care  Presence of infection

Question 34

what is the success following in enamel, dentine, pulp fracture: A)partial pulpotomy b) coronal pulpotomy

Answer 34

Success:  Partial –97% success  Coronal –75% success

Question 35

what is the basic management of dental trauma?

Answer 35

Other injuries  Soft diet  Use of a soft toothbrush /Chlorhexidine rinse or gel?  Analgesics  Refer to GMP if Tetanus status uncertain  Explain long-term management plan, prognosis & potential complications