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Trauma II Flashcards

1
Q

root fractire

A

dentine and cementum fracture involving the pulp

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2
Q

classifications of root fractures (3)

A

position of fracture

displacement of fragments

stage of root development

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3
Q

position of root fracture classes (3)

A

apical 1/3

middle 1/3

coronal 1/3

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4
Q

displacement of fragments of root fracture classes (2)

A

displaced

undisplaced
- edges of tooth still in tact

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5
Q

stage of root development root fracture classes (2)

A

mature (closed apex)

immature (open apex)

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6
Q

apical 3rd root fractures

A

Best prognosis, especially if no displacement has occurred.

If heals well the fracture line may be undetectable in future radiographs.

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7
Q

middle 3rd root fractures

A

Important to reduce fracture as much as possible
- i.e. get both halves touching again like a jigsaw

Different views of the same tooth can be important for diagnosis in some cases

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8
Q

coronal 3rd root fractures

A

Very poor prognosis as very little PDL support to keep the crown in position during function.
Creation of an extremely unfavourable crown:root ratio.

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9
Q

radiographic appearance of root fractures - imp to remember

A

Remember a radiograph is a 2 dimensional picture.

Occasionally it looks like there are multiple fracture lines when the break has occurred at an angle cutting across the beam

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10
Q

prognosis of root fracture depends on (5)

A

Age of child; mature / immature tooth

Degree of displacement

Associated injuries – e.g. crown fractures

Time between injury and treatment

Presence of infection

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11
Q

clinical exam for root fracture do

A

trauma stamp

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12
Q

special investigations for root fracture (2)

A

Sensibility tests

Radiographs from at least 2 angles
- E.g. 2 periapical from different angles and 1 Maxillary occlusal

Alternatively a cone beam CT

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13
Q

how to treat a root fracture

apical or middle third fracture (if displaced)

A

Clean area with water/saline/chlorohexidine

Reposition tooth with digital pressure
(LA not usually needed)

Splint: flexible splint for 4 weeks
(Soft diet for 1 week and Good OH)

Review: 6-8weeks, 6 months, 1 year and 5 year with radiographs

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14
Q

how to treat a root fracture

coronal third

A

Clean area with water/saline/chlorohexidine

Reposition tooth with digital pressure
(LA not usually needed)

Splint: flexible splint for 4 months
(Soft diet for 1 week and Good OH)

Review: 6-8weeks, 6 months, 1 year and 5 year with radiographs

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15
Q

what to attempt when repositioning fragments

A

attempt to completely approximate edges - like a jigsaw

- smooth outline on radiograph

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16
Q

healing outcomes of root fracture (4)

A

Calcified tissue union across fracture line

Connective tissue

Calcified + connective tissue

Bone/osseous

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17
Q

non-healing outcome of root fracture

A 
Granulation tissue (usually associated with loss of vitality). 
- Radiolucent area seen on radiograph surrounding fracture line
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18
Q

calcified tissue healing of root fracture

A

Healed with dentine-like material,

- almost indistinguishable on second radiograph

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19
Q

connective tissue healing of root fracture

A

Fracture lines remain visible.

  • Edges of fracture show signs of eburnation
  • Smoothed out – not jagged
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20
Q

osseous healing of root fracture

A

Separate parts of the root become discrete entities with no connection
- each part has its own distinct PDL space and bone is clearly seen between the fragments

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21
Q

what happens if root fractured tooth becomes non-vital

A

20% chance of pulp necrosis

Apical and Middle Third Fractures

  • extirpate to fracture line
  • dress CaOH then MTA / Biodentine just coronal to # line (as no apical stop)
  • GP - root fill to # line

Coronal fragment of root

  • Remain in situ with own PDL
  • Resorb
  • If infected - antibiotics/apicectomy
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22
Q

root fracture -> pulp necrosis of

coronal fragment of root

A
  • Remain in situ with own PDL
  • Resorb
  • If infected - antibiotics/apicectomy
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23
Q

root fracture -> pulp necrosis of

apical and middle third fractures

A
  • extirpate to fracture line
  • dress CaOH then MTA / Biodentine just coronal to # line (as no apical stop)
  • GP - root fill to # line
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24
Q

classification of PDL injuries (6)

A

Concussion, subluxation

Extrusive luxation

Lateral luxation

Intrusive luxation

Avulsion

Dentoalveolar fractures

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25
what should be considered when assessing PDL injuries
impact on: - Surrounding bone (fracture?) - Neurovascular Bundle - Root surface
26
concussion PDL injury
Concussion injury to the tooth supporting structures without increased mobility, displacement of the tooth or gingival bleeding. There is pain on percussion and sensibility tests may be negative on initial assessment.
27
subluxation PDL injury
traumatic injury has occurred to the periodontal tissues leading to increased mobility but no displacement. Gingival bleeding is often detected.
28
concussion/subluxation injury Tx
Occlusal relief – build up with GI on posterior Flexible splint 2 weeks if necessary, to make patient feel more comfortable Review - Clinical and radiographic control at 4 weeks, 6-8 weeks and 1 year Can have false positive for up to 3 months Would like to see intact lamina dura and continued root level
29
increased mobility in concussion?
no
30
increased mobility in subluxation?
yes
31
TTP in concussion?
Yes
32
TTP in subluxation?
yes
33
follow up clinical and radiographs in concussion?
4 weeks, 6-8 weeks, 1 year
34
follow up clinical and radiographs in subluxation?
2 weeks, 4 weeks, 6-8 weeks, 1 year
35
splint in concussion?
no
36
splint in subluxation?
2 weeks flexible (sometimes if needed)
37
advice for all luxation injuries (3)
Instruct on OHI with chlorhexidine gluconate and gentle brushing Soft Diet – soft bread, foods that don’t need a lot of incising Avoid Contact Sports
38
how to monitor concussion subluxation (3)
Clinical tests - Trauma Sticker Sensibility tests: thermal + electrical - at time of injury - Transient lack of sensibility can occur - This can relate to future pulp necrosis Radiographs: - root development - width of canal and length - comparison with other side - internal + external inflammatory resorption
39
what is included on a trauma sticker/stamp? (8)
Mobility Displacement TTP Colour Sinus/tender in sulcus Thermal (Eth Cl) Electric (EPT) Radiograph
40
% pulpal survival for concussion injuries
open apex 100% | closed apex 95%
41
% pulpal survival for subluxation injuries
open apex 100% | closed apex 85%
42
5 years resorption for concussion injuries
open apex 1% | closed apex 3%
43
5 years resorption for subluxation injuries
open apex 1% | closed apex 3%
44
pulpal survival closed Vs open apex
More frequently in teeth with OPEN apices after severe LUXATION - Usually indicates ongoing pulpal vitality PCO high rates with luxation, extrusion, intrusion, root fractures - Less frequent in subluxed and crown fractured teeth
45
extrusion injury
Tooth injury characterized by partial or total separation of the periodontal ligament resulting in displacement of the tooth out of the socket. The alveolar socket is intact. This is a tearing injury within the PDL (wide)
46
treatment of extruded permanent teeth
Reposition under LA (buccal and palatal) Flexible splint - 2 weeks
47
review of extruded teeth
Clinical and radiographic control at 4 weeks, 6-8 weeks, 6 months, and yearly for 5 years.
48
% pulpal survival of extrusion
open apex 95% | closed apex 45%
49
5 years resorption for extrusion injuries
open apex 5% | closed apex 7%
50
lateral luxation injury
Displacement of a tooth other than axially. - usually palatally or lingually or labially - IMMOBILE Displacement is accompanied by comminution or fracture of either the labial or palatal/lingual bone. - fracture alveolus The PDL has suffered both tearing and crushing injuries
51
special investigation results for lat luxation injury
TTP - gives a high metallic (ankylotic) sound Sensibility tests - likely negative Xray - widened PDL space - take 2 X rays
52
Tx lateral luxation
Reposition under LA (buccal and palatal) - disengage from bony lock forceps or digitally Flexible splint - 4 weeks
53
what to do if pulp becomes necrotic post lateral luxation
If becomes necrotic – extirpate to prevent root resorption See signs of success for extrusion May have replacement resorption or EIR
54
review for lateral luxation
clinical and radiographic control at 4 weeks, 6-8 weeks, 6 months, and yearly for 5 years.
55
% year pulpal survival for lateral luxation
open apex 95% | closed apex 25%
56
5 year resorption for lateral luxation
open apex 3% | closed apex 38%
57
intrusion injury
Tooth has been driven into the alveolar process due to an axially directed impact. most severe form of displacement injury. more likely to occur in teeth with fully developed roots. crushing injury to the PDL
58
most severe form of displacement injury.
intrusion
59
high metallic note on TTP ->
intrusion or luxation need 2 xrays
60
Tx for intrusion options (3)
based on assessment allow for spontaneous reposition Fixate orthodontic elastic around the arch wire and bracket for traction Reposition tooth with forceps
61
spontaneous tooth repositioning for intrusion
Advice re diet and oral hygiene Review patient monthly to observe re-eruption Measure progress against fixed point - E.g. Incisal edge of fully erupted non-displaced adjacent incisor Draw in notes
62
orthodontic repositioning for intrusion
Use of fixed orthodontic appliance - Not relying on pt to reposition Use of removable orthodontic appliance e.g. Orthodontic Extrusion after tooth given opportunity to re-erupt
63
reposition tooth with forceps Tx for intrusion
Reposition with forceps Flexible splint for 4 weeks
64
what is there a high risk of in intrusion injuries
High risk of resorption Endodontic treatment usually necessary with closed apex. (almost always) - Interim calcium hydroxide dressing recommended
65
review of intrusion injuries
Control after 2 weeks. Splint removal and control after 4 weeks, 6-8 weeks, 6 months, 1 year yearly for 5 year
66
% year pulpal survival for intrusion
open apex 45% closed apex 0% - take pulp out as soon as for closed apex intruded teeth
67
5 year resorption for intrusion injuries
open apex 67% | closed apex 100%
68
affect on the prognosis for PDL injury if the crown is fractured too
prognosis is reduced
69
follow up for intrusion
Endodontic treatment can prevent the necrotic pulp from initiating infection-related root resorption. Consider in all cases with completed root formation where the chance of pulp revascularization is unlikely. Endodontic therapy within 3-4 weeks post-trauma. A temporary filling with calcium hydroxide is recommended. Review after 2 weeks. Splint removal and review after 4 weeks, 6-8 weeks, 6 months, 1 year and yearly for 5 years

BDS3 paeds (15 decks)

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