question 6 Flashcards
(17 cards)
paeds - classification of fracture depends on
Prognosis depends upon – presence of infection, stage of root development, type of injury, time between injury and treatment, PDL damage
enamel fracture management
▪ Bond fragment to tooth/restore with composite/smooth sharp edges
▪ Take PA to rule out root fracture or luxation
▪ Follow-up – 6-8 weeks, 6 months, 1 year
● Trauma stamp, radiographs (root development, internal and
external inflammatory resorption, PA pathology)
enamel dentine fracture management
▪ Account for fragment
▪ Bond fragment or place composite ‘bandage’
▪ Take PA to rule out root fracture or luxation
▪ Radiograph any cheek or lip lacerations to rule out embedded
fragment
▪ Sensibility test and evaluate tooth maturity
● Immature teeth with short root length, thin dentinal walls and
wide open apexes have higher pulp survival rates
▪ Definitive restoration
▪ Follow-up – 6-8 weeks, 6 months, 1 year
enamel-dentine-pulp fracture management
▪ Trauma sticker and radiographic assessment
▪ LA and rubber dam
▪ Clean area with water then disinfect with sodium hypochlorite
▪ Evaluate exposure
● Exposure <1mm and <24 hours old – direct pulp cap:
o Apply CaOH or MTA white to pulp exposure
o Restore in composite
● Exposure >1mm or >24 hours old – partial pulpotomy:
o Remove 2mm of pulp with high speed round diamond
o Place saline soaked CW pellet over exposure until
haemostasis achieved
o Apply CaOH, GIC and restore in composite
● No bleeding (necrotic) or bleeding can’t be arrested
(hyperaemic) – full coronal pulpotomy:
o If indicated after partial pulpotomy, proceed to remove
all coronal pulp
o Place CaOH in pulp chamber
o Seal with GIC lining and restore in composite
▪ Follow-up – 6-8 weeks, 6 months, 1 year
▪ If tooth is non-vital a full pulpectomy is required – no apical stop in
immature incisors to obturate with GP
● CaOH placed in canal aiming to induce apexification, or
● MTA/BioDentine placed at apex to create cement barrier
root fracture management
▪ May require multiple radiographic views for diagnosis
▪ Apical or middle 1/3:
● Clean area with water/saline/CHX
● Reposition tooth
● Flexible splint for 4 weeks
● Review – 6-8 weeks, 6 months, 1 year and 5 years
▪ Coronal 1/3 (very poor prognosis – little PDL support):
● Require splinting for 4 months
▪ Soft diet for 1 week and good OH
concussion management
o Concussion – injury to the tooth supporting structures without increasing mobility, displacement of tooth or gingival bleeding
▪ Occlusal relief (can place GIC on posterior teeth)
▪ Follow-up – 4 weeks, 6-8 weeks, 1 year
subluxation management
o Subluxation – traumatic injury occurring to periodontal tissues leading to
increased mobility without displacement
▪ Gingival bleeding often seen
▪ Occlusal relief
▪ 2 week flexible splint may be necessary for comfort
▪ Follow-up – 2 weeks, 4 weeks, 6-8 weeks, 1 year
extrusion management
o Extrusion – partial or total separation of the PDL resulting in displacement of
the tooth out of the socket
▪ Reposition tooth under LA
▪ Flexible splint for 2 weeks
▪ Review – 4 weeks, 6-8 weeks, 6 months and yearly for 5 years
intrusion management
o Intrusion – tooth driven into alveolar process due to an axially directed
impact
▪ Determine severity by measuring against adjacent teeth
● Open apex:
o <7mm – spontaneous repositioning
o >7mm – orthodontic or surgical repositioning
● Closed apex:
o <3mm – spontaneous repositioning
o 3-7mm – orthodontic or surgical
o >7mm – surgical
▪ Spontaneous repositioning
● Allow tooth to erupt naturally and measure progress
● Diet and OH advice
● Review pt monthly to observe re-eruption
▪ Orthodontic repositioning
● Use of fixed or removable appliance
▪ Surgical repositioning
● Gently place forceps on tooth and bring down to level required
● Flexible splint for 4 weeks
▪ Endodontic treatment usually required for closed apex teeth
▪ Review – 2 weeks, 4 weeks, 6-8 weeks, 6 months, 1 year, yearly for 5
years
avulsion emergency advice
o Emergency advice:
▪ Hold tooth by crown only
▪ If obvious debris is present, wash in cold running water for up to 10s
▪ Replant tooth back into socket and ask child to bite on tissue
▪ If not possible, store tooth in cold fresh milk/saliva/saline
▪ Seek dentist immediately
avulsion management <60
Extra-alveolar time < 60mins:
▪ And stored in appropriate storage medium – chance of cemental/PDL
healing
▪ Replant tooth under LA
▪ Flexible splint for 14 days
▪ Consider antibiotics and check tetanus status
▪ Immature teeth (open apex):
● Closely monitor tooth - 2 weeks, 4 weeks, 2 months, 3
months, 6 months, yearly
● If tooth non-vital – extirpate pulp and refer to paeds specialist
(complex RCT – MTA for apexification)
▪ Mature teeth (closed apex):
● Carry out pulp extirpation at 0-10 days, disinfect and place
antibiotic-steroid paste as intra-canal medicament for 2 weeks
● At 2 weeks clean and replace intra-canal medicament with NS-
CaOH
● Obturation with GP within 4-6 weeks
avulsion management >60
▪ PDL unlikely to heal, aim for bony healing
▪ Closed apex:
● Carry out extra-oral endodontics
● Replant tooth under LA, 4 week flexible splint
● Consider antibiotic prescription
▪ Open apex:
● Don’t root treat unless signs of loss of vitality on follow-up
● Replant tooth under LA, 4 week flexible splint
● Consider antibiotic prescription, check tetanus
● Monitor closely for signs of necrosis vs root development
when not to reimplant
▪ Immunocompromised child
▪ Child has other serious injuries that take priority
dento-alveolar fracture management
o Use LA and reposition displaced segment
o Flexible splint for 4 weeks
o Cover with antibiotics
o Follow-up – 2 weeks, 4 weeks, 8 weeks, 4 months, 6 months, 1 year and
yearly
o Soft diet for 7 days, avoid contact sport whilst splint in place, OHI with use of
CHW MW
flexible splint placement
o Cut and bend 0.3mm stainless steel wire – adapt to teeth so that wire is
passive
o Apply composite resin to traumatised tooth and adjacent abutment teeth
o Sink contoured passive wire into composite, shape and cure
o Smooth any rough composite or wire ends
o May use vacuum formed splint – poor OH
primary tooth trauma
o Do not replant primary teeth – risk of damage to permanent successor
o Trauma classification the same as permanent teeth – management similar,
however risk of damage to permanent tooth avoided
o Soft diet 10-14 days, brush teeth with soft TB after every meal, topical CHX x2
daily for one week, review at intervals
long term complication trauma
o Primary teeth
▪ Discolouration and infection
● If non-vital with sinus or PAP – RCT or XLA
▪ Delayed exfoliation
● Extract to avoid permanent tooth erupting ectopically
o Permanent teeth
▪ Enamel defects
● Hypomineralisation – white/yellow spot (enamel soft)
o Leave, composite, external bleaching, micro-abrasion
● Hypoplasia – yellow/brown (reduced quantity of enamel)
o Composite, porcelain veneers when gingival levels
stable
▪ Abnormal morphology
● Crown or root dilaceration – surgical exposure, ortho
realignment
▪ Arrest of root development
● RCT or XLA
▪ Odontome
● Surgical removal
▪ Delayed eruption
● Palpate and take x-rays
● May require surgical exposure and ortho
