Soft Tissue Trauma Flashcards
What is a Concussion injury?
Mobility?
Treatment & Follow-up?
Injury to the tooth supporting structures without abnormal loosening or displacement of the tooth
Tooth has normal mobility and is retained in its normal position in the arch
Clinical Findings- there is no pain on percussion and no radiographic abnormalities
No treatment
Follow-up= 4 weeks post injury and 1 year
What is a Subluxation injury?
Mobility?
Treatment & Follow-up?
An injury to the tooth-supporting structures with abnormal loosening but without tooth displacement
Increased mobility but is not displaced
Radiographic appearance of tooth is usually normal, tooth is tender to percussion
Treatment is usually not required, a splint can be used if it is excessively mobile or tender when biting
Follow-up= 2 weeks (when splint can be removed), 12 weeks, 6 months and 1 year
What is an Extrusion injury?
Clinical Findings?
Treatment & Follow-up?
An injury in which the tooth suffers axial displacement partially out of the socket
Tooth appears elongated
Tooth is mobile
Usually the crown is displaced palatally
Radiographically an increased PDL space can be seen apically and laterally,
Tooth will not be seated in its socket
Treatment is to reposition the tooth by gently putting it back into the socket and placing a splint
Follow-up= 2 weeks (for splint removal), 12 weeks, 6 months and 1 year and annually for at least 5 years
What is a Lateral Luxation injury?
Clinical Findings?
Displacement of a tooth in a socket in a direction other than axially, accompanied by communication or fracture of alveolar bone plate
The tooth appears displaced in the socket
Tooth is immobile (locked into surrounding bone)
High ankylotic percussion tone (metallic sound)
Radiographs show a widened PDL
Treatment & Follow-up of a Lateral Luxation injury?
Reposition under LA
Splint for 4 weeks
Monitor and complete an endo evaluation 2 weeks after injury. If tooth becomes necrotic extirpate to prevent root resorption
more likely to become necrotic if the root has completely formed
Follow-up= 2 weeks (endodontic evaluation), 4 weeks (splint removal), 8 weeks, 12 weeks, 6 months, 1 year and annually for at least 5 years
What is an Intrusion injury?
Clinical Findings?
Tooth forced into socket in axial direction and locked into the alveolar bone
Crown appears shortened
ankylotic high, metallic percussion sound
After an intrusion injury, if the affected tooth has an open apex what is the treatment?
Spontaneous repositioning can occur
if no re-eruption within 4 weeks: orthodontic repositioning is advocated
Monitor the pulp condition- loss of vitality likely
Spontaneous pulp revascularisation may occur
If pulp becomes necrotic and infected or signs of inflammatory (infection-related) external resorption endodontic treatment should be performed
After an intrusion injury, if the affected tooth has a closed apex what is the treatment? <3mm of intrusion
Spontaneous repositioning
if no re-eruption in 8 weeks, reposition surgically and splint for 4 weeks or reposition orthodontically before ankylosis develops
After an intrusion injury, if the affected tooth has a closed apex what is the treatment? Between 3-7mm intrusion
Reposition surgically (preferably) or orthodontically
After an intrusion injury, if the affected tooth has a closed apex what is the treatment? >7mm intruded
Reposition surgically
Pulp almost always becomes necrotic
start endodontic treatment at 2 weeks or as soon as tooth position allows (aim to prevent the development of inflammatory infection related external resorption)
What is the Follow-up after a Lateral Luxation Injury?
at 2 weeks, 4 weeks (splint removal), 8 weeks, 12 weeks, 6 months and 1 year and annually for at least 5 years
Can measure spontaneous eruption of affected tooth by measuring distance from the incisal edge of a tooth adjacent to the intruded tooth to the incisal edge of the intruded tooth itself
What is an Avulsion injury?
Clinical Findings?
Critical Factors?
Tooth totally displaced from its socket
Socket is empty or filled with coagulum
Successful healing can occur if there is only minimal damage to the pulp and the PDL
Critical Factors:
Extra-Alveolar dry time (EADT), time the avulsed tooth is out the mouth and dry
Extra-Alveolar time (EAT), total time the avulsed tooth is out the mouth either dry or in a storage medium
Storage medium
What is the Emergency Advice for an avulsed tooth?
- Ensure it is a permanent tooth (avulsed primary teeth should not be replanted)
- Hold it by the crown (not by the roots)
- Encourage attempt to place tooth immediately into the socket
if the tooth is dirty, rinse it gently in milk, saline or in the patient’s saliva and replant - Bite on gauze/handkerchief to hold it in place once it has been replanted
- Seek immediate dental advice
What storage options are advised for an avulsed tooth?
Descending order of preference
1. Milk
2. HBSS- salt solution
3. Saliva
4. Saline
5. Water
What should commence 2 weeks after replantation of a tooth that has been avulsed and has a closed apex?
Endodontic treatment
