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MODULE 6 > Trauma 4 - long term follow up > Flashcards

Trauma 4 - long term follow up Flashcards

1
Q

list possible complications of trauma to primary teeth

A

pulpal necrosis (most common)
pulpal obliteration
root resorption
damage to the successors

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2
Q

what are general signs of pulpal necrosis?

A

persistent grey colour that does not fade

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3
Q

what are radiographic signs of pulpal necrosis?

A

no reduction in size of pulp cavity
periapical inflammation

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4
Q

what are clinical signs of pulpal necrosis?

A

tenderness
sinus
suppuration
swelling

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5
Q

what treatment to do with a primary tooth with pulpal necrosis?

A

xLA if signs of infection

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6
Q

what gives a tooth with pulpal necrosis its grey colour?

A

blood going into the tubules of the tooth - haemorrhage
disruption of blood supply

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7
Q

what is a sinus tract a sign of?

A

infection

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8
Q

what is pulpal obliteration?

A

a condition characterized by the pronounced deposition of hard tissue along the internal walls of the root canal that fills most of the pulp system leaving it narrowed and restricted

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9
Q

what are clinical signs of pulpal obliteration?

A

yellow/ opaque colour

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10
Q

what are radiographic signs of pulpal obliteration?

A

pulp chamber shrinks

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11
Q

what treatment do you do for a tooth with pulpal obliteration?

A

nothing is asymptomatic
xLA if signs of infection

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12
Q

what are radiographic signs of root resorption?

A

root resorption

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13
Q

what are clinical signs of root resorption?

A

possible mobility

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14
Q

what treatment to do for a tooth with root resorption?

A

xLA if signs of infection

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15
Q

what are the ways in which a successor tooth can be damaged following trauma?

A

primary tooth trauma (12-68% incidence)
jaw fracture (19-69% incidence)

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16
Q

at what age is the most damage produced to successor tooth? and why?

A

3 years old
tooth germ is still in developmental stage

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17
Q

what type of injury carries the most risk to successor teeth?

A

intrusive luxation

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18
Q

damage to successor tooth can result in?

A

delayed eruption or failure of eruption
ectopic eruption

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19
Q

damage to successor teeth at the age of 2-7 years can cause what appearance?

A

white/ yellow-brown enamel hypomineralisation
white/ yellow-brown enamel hypomineralisation and circular enamel hypoplasia

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20
Q

damage to successor teeth at age of 2 years can cause what appearance?

A

crown dilaceration

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21
Q

damage to successor teeth at age 1-3 years can cause what appearance?

A

odontoma-like malformation

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22
Q

what affect does damage to the successor tooth at age 2-5 years have on the root?

A

root duplication
root dilaceration

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23
Q

what affect does damage to the successor tooth at the age of 5-7 to the root?

A

arrest of root formation - partial/complete

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24
Q

what is root dilaceration?

A

deviation of root shape from the normal long axis formation (change in angulation)
has the potential to inhibit eruption

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25
how would you treat root dilaceration?
depends on its severity tx planning may involve paediatric/ orthodontic and oral surgery input or surgical/ orthodontic realignment or possible xLA
26
how may root dilaceration lead to resorption?
roots could be rubbing against other roots
27
list complications of trauma to permanent teeth
pulp necrosis resorption ankylosis replacement resorption external resorption internal resorption
28
what to look for clinically in a permanent tooth with pulpal necrosis?
no response to sensibility testing greyish discolouration patient symptoms
29
what to look for radiographically in a permanent tooth with pulpal necrosis?
periradicular inflammation/ infection
30
what does transient apical breakdown present as radiographically?
small radiolucent 'cap' around apex
31
what is transient apical breakdown?
in response to trauma, a repair process in the pulp and periapical area of teeth tooth may be discoloured and no response to sensibility testing resolves without treatment
32
questions you must ask yourself when deciding upon treatment of a permanent tooth with pulpal necrosis?
is there acute infection? does the tooth have a closed apex? how developed is the root?
33
what must you not do if you are starting RCT within 2 weeks of re-implanting an avulsed tooth? what should you do instead?
do not use calcium hydroxide as it may contribute to replacement resorption use ledermix and start RCT with a splint in situ if present
34
why should you only place calcium hydroxide in a root canal for 4 weeks?
it degrades collagen structure, weakening flexural strength of dentine over time
35
how do you treat a tooth with pulpal necrosis that has an open apex?
create apical stop or encourage root to continue to develop (regenerative endodontic technique)
36
what can be used to create an apical stop?
MTA apical barrier formation
37
what is completed in visit one for treatment of a tooth with an open apex and pulpal necrosis?
extripate pulp with NaCl establish working length place calcium hydroxide
38
what is completed in visit 2 for treatment of a tooth with an open apex and pulpal necrosis?
ensure no signs of infection irrigate with NaCl and citric acid flush with H2O (prevents discolouration) place MTA 4-6mm
39
what is completed in visit 3 for treatment of a tooth with open apex and pulpal necrosis?
complete obturation with thermoplastic GP
40
what depth of MTA should be dressed to create an apical plug?
4-6mm
41
why is calcium hydroxide not idea for apical barrier formation?
time consuming to get a result changes composition/ structure of dentine; higher incidence of cervical root fracture
42
what is regenerative endodontic technique?
activating stem cells to recreate dental pulp allows continues root growth
43
reactionary dentine forms in the root canal and pulp chamber, what does this look like radiographically?
pulp chamber and root canal shrinking
44
reactionary dentine forms in the root canal and pulp chamber, what does this look like clinically?
tooth may darken (yellowing) reduced response to sensibility tests
45
reactionary dentine forms in the root canal and pulp chamber, how do you treat this?
monitor can be very hard to access/ find canal only treat if signs of infection
46
how may you treat a darkened tooth?
internal bleaching on RCT veneer/ crown
47
why may reactionary dentine form in the root canal?
trauma triggers odontoblasts to lay down reactionary dentine
48
what does the process of reactionary dentine formation indicate?
tooth is still vital
49
what is pulp canal obliteration?
end point of root canal narrowing - whole canal becomes sclerosed
50
do you treat pulp canal obliteration?
no just monitor pt must be aware that tooth may darken however if pulp gets restricted at apical portion it becomes necrotic - endo tx
51
what are types of tooth resorption?
external inflammatory resorption cervical resorption internal resorption replacement resorption
52
what occurs as a result of replacement resorption?
ankylosis
53
what is inflammatory resorption caused by?
multi nuclear giant cells being stimulated and sustained
54
what teeth may external inflammatory resorption occur in?
necrotic pulps and associated infection associated by intrusions and re implantation (but may occur with all types of trauma)
55
describe the external inflammatory resorption process
initiated by PDL damage and propagated by necrotic pulpal products diffusing down the dentinal tubules into PDL giant cells activated in PDL - stimulated by infected canal
56
what does external inflammatory resorption appear as?
'punched out' areas of resorption on external root surface
57
what happens if external inflammatory resorption is left untreated?
whole tooth destroyed within months
58
clinical signs of external inflammatory resorption
mobility
59
how to treat external inflammatory resorption?
if restorable, RCT and monitor (pulp extripation and non setting CaOH until infection controlled then permanent root filling) review radiographically
60
explain the process of cervical resorption
damage to cervical region inflammation caused by PDL microflora or infected root canal
61
treatment for cervical resorption
necrotic pulp - start RCT treatment may involve curettage of apical region and resorption defect
62
what causes internal inflammatory resorption?
chronic pulpal inflammation - very infrequent complication
63
explain the process of internal inflammatory resorption
root canal having necrotic, infected pulp above the ballooning resorption caused by inflammatory response from vital pulpal tissue trying to clear away and revascularise the necrotic portion infected necrotic pulp may cause activation of underlying vital tissue progresses rapidly and causes perforation of root surface
64
what does internal inflammatory resorption present as clinically?
'pink spot' discolouration if the resorption affects coronal 1/3 of canal
65
what does internal inflammatory resorption present as radiographically?
round, symmetrical radiolucency usually centered on canal canal walls are NOT superimposed (unlike external resorption)
66
how do you manage internal inflammatory resorption?
endodontic tx - dress with CaOH
67
what is ankylosis?
fusion of the root and surrounding bone
68
what is replacement resorption?
root structure is removed and replaced by investing bone tissue - there is no infection and no inflammation
69
what is the main difference between inflammatory resorptions and replacement resorption?
there is no infection and inflammation in replacement resorption
70
when does replacement resorption occur?
after large luxation or avulsion injuries
71
what type of luxation injuries are at higher risk of replacement resorption?
intrusive and lateral resorption
72
why does replacement resorption occur?
when more than 20% of the PDL is damaged before replanting or repositioning, bone cells are able to colonise root surface faster than PDL
73
what is the long term complication of replacement resorption?
crown falls out - bone turnover is slow so dentine replaces bone, after few years there will be no root and crown will fall out, tooth then integrated into bone and remodelled in the normal bone remodelling process
74
signs of replacement resorption and ankylosis?
no mobility, solid metallic tone on percussion no distinct dermarcation between bone and tooth radiographically
75
replacement resorption and ankylosis treatment
if pt has fully grown, can monitor in growing patients, tooth may be infraoccluded, inhibiting alveolar growth if gingival margin discrepancy exceeds 1-2m, may have to decoronate tooth below bone level and remove any root filling material to promote alveolar growth
76
list 9 tests for tooth vitality
colour EPT thermal test transillumination TTP mobility sinus/ alveolar tenderness history radiographic exam
77
what determines pulp vitality?
presence of an intact blood supply - NOT an intact nerve supply
78
what is mobility pathognomic of?
periapical infection
79
what classification is used to assess mobility?
Miller classification
80
what may TTP indicate?
apical periodontitis
81
what investigation is useful for detecting craze lines?
transillumination if available, fibre optic transillumination
82
what does EPT test?
pulpal sensory nerve supply - not true pulp vitality
83
how common is pulp necrosis as a result of root fractures?
20%
84
how to treat root fractures?
apical 1/3 and mis 1/3 root fracture - treat up to point of fracture MTA at fracture line if apical portion becomes non vital, surgical removal coronal 1/3 root fracture - splinting coronal segment, xLA coronal and apical portion, xLA coronal portion
85

MODULE 6 (69 decks)

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