Permanent dentition trauma 2 (ST) Flashcards
(77 cards)
1
Q
define concussion
A
injury to the tooth supporting structures with abnormal loosening or displacement of the tooth (bruising)
2
Q
1.Visual None
2. Mobility None
3.Percussion= Tender to touch
4. Sensibility
Testing’s=
Usually positive (negative may be transient)
5. Radiographic
Findings=
No abnormalities
whats the problem?
A
consussion
3
Q
what treatment do you do for a concussion injury
A
follow up at 4 weeks and 1 year.
4
Q
Define Subluxation
A
an injury to the tooth suppporting structures with abnormal loosening but without displacement of tooth
5
Q
Visual None Mobility =increased mobility Percussion= Tender to touch Sensibility Testing's= Usually positive (negative may be transient) Radiographic Findings No abnormalities often noted whats the problem?
A
subluxation injury
6
Q
What is the tx and follow up intervals for a subluxation injury?
A
splint removal after 2 weeks
follow up= 2w, 12 w, 6m, 1yr
7
Q
Define extrusion@
A
partial displacement of the tooth out of its socket
8
Q
Visual Appears elongated Mobility Very mobile Percussion Tender to touch Sensibility Testing's Usually negative (mild displacement may be positive) Radiographi c Findings Increased PDL spacing, tooth displaced from socket
A
extrusion
9
Q
tx for extrusion
b) follow-up
(what are you monitoring for?)
A
a) LA; Digital repositioning, flexible splint, splint removal after 2 weeks
b) 2w, 4w, 8w, 12w, 6m, 1yr, annualy for 5
years
Monitoring pulpal healing and associated
root resorption
10
Q
Define lateral luxation
b) what is it accompanied by?
A
Displacement of tooth in a direction other than axially ( palatal better than buccal)
b) assompanied by communication or # of the alveolar socket
11
Q
Visual= Displaced in a palatal, lingual or labial direction Mobility =Very mobile or immobile (in a bony lock) Percussion= Tender to touch Sensibility Testing's= Usually negative (mild displacement may be positive) Radiographic Findings= Widened PDL spacing; tooth may appear shortened or elongated what is the problem?
A
lateral luxation
12
Q
Lateral luxation
treatment
follow up
A
1) LA
Reposition the tooth
Flexible Splint for 4 weeks
2)2w, 4w, 8w, 12w, 6m, 1yr, annualy for 5 years
Monitoring pulpal healing and associated root
resorption
13
Q
Define intrusion
2) When it comes to tx of intrusion it varies :
a) open apices less the 7 mm if intrusion
b) open apices more than 7mm
c) closed apices les than 3mm
d) 3-7mm
e) more then 7mm
Keep in mind teeth will lose vitality and require extirpation
A
the tooth has been driven into the alveolar process, PDL damadged severly, osteoclasts nible tooth away with replacement resorption foten
2) a) spontanous eruption
b) orthodonic reposition or surgically reposition the tooth (numb and forceps to move tooth then flexible splint)
c) spontanous repostioning
d) orthodontic or surgical
e) surgical
14
Q
Visual= Displaced axially into the alveolar bone Mobility= Usually immobile Percussion =Tender to touch Sensibility Testing's= Almost certainly negative Radiographic Findings= The periodontal ligament space may be absent from all or part of the root. CEJ more apically positioned.
whats the problem?
A
intrusion
15
Q
treatment of intrusion injuries
b) what is the objective of tx?
A
Treatment will depend on degree of intrusion* Flexible Splint Endodontic Treatment initiated within 10days if complete apex Splint removal after 4 weeks b) reposition and stabilise tooth for 4 weeks
16
Q
follow up of intrusion injuries?
A
2w, 4w, 8w, 12w, 6m, 1yr, annualy for 5
years
Monitoring pulpal healing and associated
root resorption
17
Q
define avulsion
A
complete displacement of the tooth out of its socket
18
Q
Visual The tooth is removed from its socket. Mobility n/a Percussion n/a Sensibility Testing's n/a Radiograph ic Findings n/a whats the problem?
A
avulsion
19
Q
you walk in a 111 call centre, pt phone tooth is removed from socket what do you advise?
A
• Hold by crown • Rinse under saline or milk • Replant • Bite on handkerchief and get to a dentist
20
Q
you walk in a 111 call centre, pt phone tooth is removed from socket what do you advise? it can’t be reimplanted
A
If it can’t be replanted store tooth in: • Saliva • Saline • Milk • Contact lens solution • Tooth rescue box
21
Q
What are the benefits of milk used to store a tooth?
A
• Nutrients maintain PDL cell viability, and with its
physiological pH of 6.5-7.2
• PDL cells can survive 2- 6 hours
easily availabel and a practical choice
22
Q
disadvantages of milk used to store a tooht?
A
• The antigens present in milk could interfere with
the process of reattachment of PDL cells
23
Q
can you use sour milk to store tooth?
is warm milk better?
is higher fat better?
A
Milk needs to be fresh and refrigerated
• Sour milk should not be used as it harmful to the
PDL cells
chilled milk and lower fat is best
24
Q
what determines the success of replantation of an avulsed tooth?
A
Extra-alveolar dry time (EADT)
Extra-alveolar time (EAT)
Storage medium
Medical history
25
when avulsion has occurred PDL cells are most likely viable if...
The tooth has been replanted immediately or within a very short time
(about 15 minutes)
26
when avulsion has occurred PDL cells may be viable but compromised if...
The tooth has been kept in a storage medium and the total extra‐oral
dry time has been <60 minutes).
27
when avulsion has occurred PDL cells are most likely non-viable if...
The total extra‐oral dry time has been more than 60 minutes,
| regardless of the tooth having been stored in a medium or not.
28
if the PDL cells are most likely viable what is done following reimplantation?
a) apices closed
b) open apices
```
Extirpate within 2 weeks post injury
Dress with Ca(OH)2 for up to 4 weeks
Obturate
Open apices
Leave to revascularize, only extirpate if signs of loss of
vitality and resorption
```
29
if the PDL cells are may be viable but complomised what is done following reimplantation?
a) apices closed
b) open apices
```
Extirpate within 2 weeks post injury
Dress with Ca(OH)2 for up to 4 weeks
Obturate
Open apices
Leave to revascularize, only extirpate if signs of loss of
vitality and resorption
```
30
what is the treament aim if a tooth is avulsed and the PDL cells are likely non-viable?
Replacement resorption will occur. Aim of treatment is to maintain
tooth until future loss with the benefit of maintaining space and bone
31
what is the treatment if a tooth with closed apices is avulsed and the PDL cells are likely non-viable?
closed vs open apices
Extirpate within 2 week post injury
Dress with Ca(OH)2 for up to 4 weeks
Obturate
Consider intracanal materials if root burial is to be considered
If open apices: consider the risk of inflammatory root resorption should be wieghed against the chances of obtaining pulp space revascularization. Leave to revascularize , only extirpate with signs of loose of vitality and resorption- very clsoe monitory needed.
32
what is the treatment if a tooth with open apicesis avulsed and the PDL cells are likely non-viable?
Consider the risk of inflammatory root resorption should be weighed against
the chances of obtaining pulp space revascularization.
Leave to revascularize, only extirpate if signs of loss of vitality and
resorption – very close monitoring is needed
33
if teeth are replanted what is the follow-up, what does it involve?
```
Replanted teeth should be monitored
clinically and radiographically at:
2 weeks (when the splint is removed),
4 weeks,
3 months,
6 months,
one year,
Annualy thereafter for at least five years
```
34
Post-op instructions for reimplanted teeth:
1.Avoid participation in contact sports.
2.Maintain a soft diet for up to 2 weeks,
according to the tolerance of the patient.65
3.Brush their teeth with a soft toothbrush after
each meal.
4.Use a chlorhexidine (0.12%) mouth rinse
twice a day for 2 weeks.
35
what is the prognosis of concussion in
a) open
b) closed apices
of pulp survival at 5 years
a) 100% b)96%
36
what is the prognosis of subluxation in
a) open
b) closed apices
of pulp survival at 5 years
a) 100
| b) 85%
37
what is the prognosis of extrusion in
a) open
b) closed apices
of pulp survival at 5 years
a) 95%
| b) 45%
38
what is the prognosis of lateral luxation in
a) open
b) closed apices
of pulp survival at 5 years
a) 95%
| b) 25%
39
what is the prognosis of intrusion in
a) open
b) closed apices
of pulp survival at 5 years
a) 40%
| b) 0
40
what is the prognosis of avulsion/replantation in
a) open
b) closed apices
of pulp survival at 5 years
there is also usually more resorption 100% closed apice that is replanted
a) 30%
| b) 0%
41
There are so many methods for splinting teeth name 5?
```
Lead Foil +sutures (this will overextend into gums and be help in place by suture)
Acrylic and wire
Composite and wire
Composite mesh
Gumshield
Mouthguard +perforations and cement
Arch bar
Ortho brackets and wire
Trauma Titanium Splint (looked like metal dna helix going over top of teeth)
```
42
what is the issue with a "gumshield" splint
oral hygiene is often very poor
43
what is the issue with an archbar splint?
too rigid
44
when is an acryllic URA type splint usefu:
when there are few abutment teeth
45
What is a foil temporary splint cemented with?
kalzinol
46
true of false
| Damage to PDL can cause resorption
true
47
true of false
Splints should be non-passive and rigid
false should be passive and flexible
48
true of false
PDL injuries be monitored for
pulp necrosis and resorption
true
49
true of false
Patients should be informed of prognosis at
an later stage in avulsion injuries
false should be informed at early stages.
50
Root surfaces indistinct
Tramlines of root canal intact
Treatment: Pulp extirpation. Mechanical and chemical irrigation, NS
CaOH.
diagnosis?
external inflammatory root resoption
51
treatment for external inflammatory root resorption?
Biomechanical preparation & N/S Ca(OH)2 until evidence of non
progression
Obturate (if doesn't progress)
52
Resorption -External Inflammatory
1) initiated by?
2) progessive?
1) damadge to PL initialy
2) yes- Maintained and propagated by necrotic pulp tissue via dentinal
tubules
53
Resorption -External surfaces
1) define?
2) progessive?
1) damadge to PL which subsequently heals
| 2) non-progressive
54
Diagnosis:
Tramlines of root canal indistinct
Root surfaces intact
resorption - internal inflammatory
55
treatment of resorption - internal inflammatory
Treatment: Extirpation
Mechanical and chemical preparation
Dress with NS Ca(OH)2
Obturate if signs of non progression
56
Resorption -internal inflammatory
1) initiated by?
2) progessive?
1) non-vital pulp
| 2) progressive yes
57
Reorption - replacement "ankylosis
1) initiated by?
2) disease process?
3) progessive?
1) initiated by severe damadge to pL e.g. evulsion/ intrusive injuries
2) normal repair doesn't occure, instead PDL is dead and osteoclasts access root surface producing bone that directly connects to dentine, the tooth is no part of bone remodelling so it gradually resorbed.
58
Diagnosis:
loss of PL and lamina dura
tone of percussion different , metallic sound
resoption - replacement ankylosis
59
tx for resoption - replacement ankylosis
nil
puberty growth face- decoronation ( gingival fibres grown over top of tooth, pulling on transceptal firbes promoting bone to grow over the top of the tooth)= lots of bone
autotransplantation- taking a tooth from a another place, 2/3 of root development moved into gap
resin-retained bridge
removable p/p
othodontic space closure
60
why can pulp canal obliteration be seen as a positive thing?
is a response for a vital pulp!
61
what is the process of pulp canal obliteration
Progressive hard tissue formation within pulp cavity
Gradual narrowing of pulp chamber and pulp canal -total or
partial obliteration
62
treatment for pulp canal obliteration?
conservatice (only 10% =PAP)
63
what is the missing step?
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. Check tetanus status.
14. Provide post‐operative instructions.
15. Arrange follow up
1. Do not touch the root
64
1. Do not touch the root
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. Check tetanus status.
14. Provide post‐operative instructions.
15. Arrange follow up
2. Rinse the root surface with a gentle stream of saline
65
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. ?
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. Check tetanus status.
14. Provide post‐operative instructions.
15. Arrange follow up
administer LA
66
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5.?
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. Check tetanus status.
14. Provide post‐operative instructions.
15. Arrange follow up
irrigate socket with sterile saline
67
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. ????
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. Check tetanus status.
14. Provide post‐operative instructions.
15. Arrange follow up
Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
68
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. ???
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. Check tetanus status.
14. Provide post‐operative instructions.
15. Arrange follow up
Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
69
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. ???
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. Check tetanus status.
14. Provide post‐operative instructions.
15. Arrange follow up
Replant the tooth slowly with slight digital pressure.
70
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. ????
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. Check tetanus status.
14. Provide post‐operative instructions.
15. Arrange follow up
Verify the correct position of the replanted tooth both clinically and radiographically.
71
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. ???
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. Check tetanus status.
14. Provide post‐operative instructions.
15. Arrange follow up
Stabilize the tooth for 2 weeks using a passive, flexible wire splint
72
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. ???
12. Administer systemic antibiotics.
13. Check tetanus status.
14. Provide post‐operative instructions.
15. Arrange follow up
Suture gingival lacerations, if present.
73
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12.????
13. Check tetanus status.
14. Provide post‐operative instructions.
15. Arrange follow up
Administer systemic antibiotics.
74
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. ???
14. Provide post‐operative instructions.
15. Arrange follow up
Check tetanus status.
75
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. Check tetanus status.
14. ???
15. Arrange follow up
Provide post‐operative instructions.
76
1. Do not touch the root
2. Rinse the root surface with a gentle stream of saline
3. Put or leave the tooth in a storage medium while taking a history, examining the
patient clinically
4. Administer local anaesthesia
5. Irrigate the socket with sterile saline.
6. Examine the alveolar socket. If there is a fracture of the socket wall, reposition the
fractured fragment into its original position with a suitable instrument.
7. Removal of the coagulum with a saline stream may allow better repositioning of the
tooth.
8. Replant the tooth slowly with slight digital pressure.
9. Verify the correct position of the replanted tooth both clinically and radiographically.
10. Stabilize the tooth for 2 weeks using a passive, flexible wire splint
11. Suture gingival lacerations, if present.
12. Administer systemic antibiotics.
13. Check tetanus status.
14. Provide post‐operative instructions.
15. ?
Arrange follow up
77
intrusion prognosis
```
pulp necrosis
root resorption
arrest root development
loss of marginal bone support
ankylosis
pulp canal obliterations ( in more mild case)
ginigival recessions
```
