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Sequela trauma Flashcards

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1
Q

Discuss the complications which may arise from trauma to the permanent teeth

A

Loss of vitality
Periapical inflammation
Arrest of root development
Root resorption
Inflammatory (external/internal)
Replacement
Pulp canal obliteration

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2
Q

Loss of vitality clinically

A

History
(symptoms of irreversible pulpitis)
Sulcus-swelling, tenderness, sinus
Discoloured – often progressively grey
TTP
Mobile
Negative to sensibility tests
Majority are –ve immed after trauma
Most will respond within 3 months

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3
Q

Loss of vitality radiographically

A

Periapical radiolucency
Resorption (Int/ Ext)
Arrested root development

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4
Q

Loss of vitality treatment

A

Endodontic therapy
(At least 2 clinical signs before commencing RCT)

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5
Q

Periapical inflammation

A

Transient apical breakdown

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6
Q

Transient apical breakdown

A

> 4% of mature teeth following luxation injuries
Mimics apical resorption
Ambivalent clinical + radiographic signs - delay endodontic treatment
Monitor closely
May be present up to 2-3 months after trauma

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7
Q

Arrest of root development happens when

A

If necrosis affects root sheath before root development complete then no further growth

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8
Q

Arrest of root development- radiographically

A

majority- failure of pulp canal to mature and reduce in size

If sequential radiographs not available compare to root development of contra lateral tooth

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9
Q

Root resorption
Types

A

Inflammatory (surface/external/internal/cervical)
Replacement resorption (ankylosis)

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10
Q

Root resorption- external inflammatory -aetiology

A

non vital pulp
Mainly seen with avulsion and intrusion injuries (possible with lateral luxation, extrusion and subluxation)
Initiated by PDL damage and propagated by necrotic pulp/ pdl

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11
Q

Root resorption- external inflammatory- radiographically

A

Punched out areas of resorption
Loss of root surface, loss of adjacent bone, radiolucent area
Pdl expansion
May be evident from 3 weeks

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12
Q

Root resorption- external inflammatory- treatment-

A

Extirpation, debridement, non-setting Calcium hydroxide

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13
Q

Root resorption- internal inflammatory-Aetiology

A

– chronic pulpal inflammation

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14
Q

Internal root resorption radiographically

A

Ballooning of walls of root canal

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15
Q

Root resorption- internal inflammatory- progression –

A

rapid, may cause perforation of root surface

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16
Q

Root resorption- internal inflammatory- treatment-

A

extirpation, debridement,
Non-setting Calcium Hydroxide dressing

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17
Q

Cervical resorption

A

Damage to root surface in cervical region
Propagated by necrotic pulp or perio disease
Pink spot

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18
Q

Cervical resorption- treatment

A

Curette defect and
restore +/-RCT

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19
Q

Root resorption -Replacement (Ankylosis)- Aetiology –

A

– extensive damage to PDL and cementum (Intrusion/avulsion)
Results in bony union between alveolar socket and root surface

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20
Q

Root resorption -Replacement (Ankylosis)- radiographically

A

Loss of periodontal space, bone in direct contact with root
Usually evident within 2 mths -1 yr

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21
Q

Root resorption -Replacement (Ankylosis)- clinically

A

detected by distinctive high “metallic” note

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22
Q

Root resorption -Replacement (Ankylosis)-treatment

A

– No effective treatment
Extraction/root burial
Cannot be moved orthodontically

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23
Q

Replacement resorption- See px when?

A

6 weeks post injury, 18 months, 32 months,

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24
Q

Replacement resorption- radiographically

A

difference in incisal levels

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25
Pulp canal obliteration is the...
Progressive hard tissue formation within pulp cavity – narrowing of root canal Thin thread of pulp tissue remains More common in immature teeth and following luxation injuries
26
Pulp canal obliteration clinically-
Opaque/ yellow crown Reduced response to vitality testing
27
Pulp canal obliteration- treatment-
Conservative approach
28
Trauma follow up
Varies by injury in guidelines See IADT guidelines (essential reading) May increase if equivocal findings
29
Dental trauma review
Date and time
30
Trauma Colour
Grey/brown- pulp necrosis Yellow- pulp canal obliteration Pink- internal resorption, bleed into dentine
31
Trauma soft tissues clinically is shown by
Swelling Tenderness Erythema Sinus
32
Trauma review mobility
Assess between 2 ends of metal instrument One labial, one palatal Vertical
33
TTP/tone
Check TTP with metal instrument Vertical Tone Hi Replacement resorption intrusion Cracked cup root fracture
34
Trauma review Ethyl chloride
Cotton wool held in tweezers applied to centre of labial surface of tooth (Avoid gingivae) Newly erupted teeth may not respond May need repetitions for reliability in children After injury up to 3/12 for response
35
Trauma review electric pulp tester
Isolate teeth with cotton wool Lip electrode applied Tip dipped in toothpaste Raise hand on first sensation Avoid any restorations
36
Trauma review tests
ethyl chloride and electric pulp tester
37
Uncomplicated crown fracture
Fractures confined to enamel and dentine
38
Uncomplicated crown fracture prognosis
Pulp necrosis 54% if no dentinal coverage 8% if dentine protected
39
Complicated crown fracture Tx
Apexogenesis procedure - Vital/Cvek pulpotomy
40
Complicated crown fracture prognosis
Success rates 80 – 96% Better prognosis than direct pulp cap for immature permanent teeth exposed>24 hrs
41
5 year pulp survival and outcomes after intrusion
see tables
42
Root fractures- Healing influenced by-
Position of fracture line Degree of displacement of coronal fragment Necrosis of pulp usually only coronal fragment and coronal to #line Coronal fracture
43
Healing outcomes root fractures
Hard tissue formation Fibrous Bone and connective tissue Non-union-inflammatory/granulation Necrosis of coronal portion
44
Survival of a tooth with a fracture
Prognosis improves as distance from gingival margin increases
45
Avulsion Outcomes what is important and what is not
Extra – oral time is critical Storage medium important PDL survival is critical- resorption at 1year best predictor of survival Pulp death is less important
46
Avulsion Outcomes- what affects prognosis
Dry storage - decreases prognosis Contamination – decreases prognosis Prolonged splint time increases replacement resorption
47
Informed consent -Severe injuries – intrusions/avulsions
At least 8 – 12 visits Time off school / parents work Cost to NHS Unpredictable outcome Consider treatment options carefully Parents must be fully informed regarding nature of injuries, treatment, sequelae and long term prognosis
48
Complications of primary teeth
Pulpal necrosis – commonest complication Root resorption Pulpal canal obliteration Replacement resorption
49
Pulpal necrosis in the primary dentition- clinically
Grey colour/ sulcus/ history/ mobile/ TTP Transient - intrapulpal bleed, vital tooth, colour resolves persists, implies non vital (but may be uninfected)
50
Pulpal necrosis in the primary dentition- radiographically
Failure of pulp cavity to reduce Periapical area
51
Pulpal necrosis in the primary dentition- treatment
Extraction recommended Endodontic treatment occasionally- specialist Options discussed with parent Informed consent
52
Pulp Canal Obliteration in primary dentition- Clinically
yellow / opaque crown
53
Pulp Canal Obliteration in primary dentition-Radiography
Pulp canal narrowing
54
Pulp Canal Obliteration in primary dentition Treatment
Usually exfoliates If periapical inflammation - recommend extraction Discuss with parents – informed consent
55
Replacement resorption- ankylosis - Clinically
Below occlusal level Ensure no non-nutritive sucking
56
Replacement resorption- ankylosis -Radiographs are taken to...
Confirm presence of replacement resorption Assess position of permanent tooth
57
Replacement resorption- ankylosis Treatment
Monitor - may resorb Extraction If pathology, delayed eruption, displacement
58
Injuries to developing dentition following trauma to primary teeth studies...
Studies suggest 12 – 69% of primary trauma affect successor Depends on type and severity of injury, high with intrusions Most damage occurs before 3 yrs of age during its developmental stage
59
Injuries to developing dentition following trauma to primary teeth see all the photos of the labelled teeth
Hypomin/ hypoplasia of enamel Crown / root dilaceration Odontoma – like formation Root duplication Arrest of root development Disturbance in eruption Sequestration of tooth germ
60
Injuries to developing dentition following trauma to primary teeth
Avulsion Subluxation Lateral luxation Intrusion Alveolar/jaw fracture Periapical pathology
61
Follow up- Injuries to developing dentition following trauma to primary teeth- Avulsion Subluxation Lateral luxation Intrusion Alveolar/jaw fracture Periapical pathology
Monitor eruption pattern - delayed, ectopic Advice to parents

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