Trauma III Flashcards
(40 cards)
avulsion replantation
Successful healing can occur if there is only minimal damage to the pulp and the PDL
3 critical factors for successful healing after avulsion replantation
Extra-alveolar dry time - EADT
Extra-alveolar time - EAT
Type of storage medium
EADT
Extra-alveolar dry time
EAT
Extra-alveolar time
what to do if pt attends with tooth already replanted after avulsion
Do not remove. Leave as is and follow instructions regarding splinting etc dependent on circumstance
Radiograph important to establish status of root development
3 options for tooth life post avulsion
PDL viable mostly (replanted immediately or v shortly after)
PDL viable but compromised (kept in saline/milk, total dry time <60 mins)
PDL non-viable (dry time >60 mins regardless of what happened after this time)
- After dry time of 60 mins or more, ALL PDL cells are NON VIABLE
if tooth replanted immediately/v shortly after avulsion
PDL viable mostly
if tooth kept in saline/milk, and total dry time is <60 mins
PDL viable but compromised
if tooth dry time >60mins, regardless of what has happened in that time
PDL non-viable
After dry time of 60 mins or more, ALL PDL cells are NON VIABLE
public advice for avulsed tooth
Essential for parents/sports coaches/teachers
Hold by crown only
Wash in cold running water
Replace in socket and child bites on tissue
Or Store in milk/saliva/normal physiological saline (not contact lenses)
Seek immediate dental advice
replantation initial decision making based on
Extra alveolar dry time EADT
2 main time categories to consider when replanting
EADT < 30 mins
EADT > 30 mins
healing outcomes after avulsion
periodontal (4)
Regeneration
PDL/cemental healing
Bony Healing
Uncontrolled infection
healing outcomes after avulsion
pulpal (3)
Regeneration
Controlled necrosis (elective disinfection)
Uncontrolled infection
EAT < 60 mins and stored in an appropriate storage medium (e.g. milk, physiological saline or saliva)
Tx
then there is a chance of cemental/PDL healing.
- AIM: PDL healing
Replant tooth under LA
Flexible splint 14 days
Consider antibiotics and check tetanus status e.g. occurred in muddy environment
Carry out pulp extirpation at 0-10 days UNLESS apex is open (immature root)
Teeth with an open apex may revascularize
EAT < 60 mins immature teeth
Tx after replantation
If the decision is made not to root treat the tooth it must be closely monitored clinically and radiographically for signs of continued growth vs loss of vitality
Review Interval: 2wks (splint removal), 4wks, 2mths, 3mths, 6mths then yearly.
If the tooth is found to be non vital extipate pulp and refer to paediatric specialist. Inter-disciplinary management is recommended
EAT < 60 mins closed apex (mature teeth)
Tx after replantation
After replantation and splinting, remove pulp as soon as possible. (Ideally day 0)
Following extirpation and disinfection, place antibiotic-steroid paste as intra-canal medicament- leave in place for 2 weeks
Remove splint after 14 days
At 2 weeks- clean and replace intracanal medicament with NSCaOH
- Don’t want CaOH in tooth more than 4-6 weeks and cause dentine necrosis
Obturation with GP should take place within 4-6 weeks
Refer to a specialist paediatric dental team for interdisciplinary management
Review 3, 6, 12 monthly then yearly
teeth > 60 mins EAT and closed apex
Tx
Unlikely to get PDL healing
The aim is for bony healing (by ankylosis)
- so scrub root clean of dead PDL cells
Extra-oral endodontics can be carried out prior to replantation
- Harder but possible
Replant tooth under LA
Splint: 4 weeks flexible splint
Consider antibiotic prescription
If extra-oral endodontics not carried out- extirpate at 7-10 days and use NSCaOH as initial intra-canal medicament for 4wks prior to obturation with GP
- Review 3, 6, 12 monthly and then yearly
teeth > 60 mins EAT and closed apex
Tx
If extra-oral endodontics not carried out
extirpate at 7-10 days and use NSCaOH as initial intra-canal medicament for 4wks prior to obturation with GP
- Review 3, 6, 12 monthly and then yearly
teeth > 60 mins EAT and open apex
Tx
Unlikely to get PDL healing
Very small chance that pulp may still revascularize
Do not root treat unless signs of loss of vitality on follow-up
Replant tooth under LA
Splint: 4 weeks flexible splint
Consider antibiotic prescription
Check tetanus status
Monitor closely for signs of necrosis vs continued root development
Review 2 weeks, 4 weeks (splint removal), 2 months, 3 months, 6 months then yearly
When not to replant tooth
Almost never
If very immature apex and EAT> 90mins (may still be best to replant)
Child is immunocompromised
- Cancer etc
The child has other serious injuries and warrant preferential emergency treatment and / or intensive care being dealt with.
? Very immature lower incisors in young child finding it difficult to cope?
- May only last 6 months, space can close easy
Even as a temporary space maintainer- the right choice is usually to replant esp when guiding position of adjacent erupting tooth
- Prevent drifting that child is too young for orthodontic Tx
monitoring of avulsion/replantation
Open Apex Teeth require close monitoring
If pulpal necrosis detected- pulp extirpation must be carried out as soon as possible to avoid inflammatory resorption
Clinical tests - Trauma Stamp
Sensibility tests: thermal + electrical
- at time of injury
- 1 month, 2months, 3 months, then 6-monthly for an average of 2 years
Radiographs:
- root development - width of canal and length
- comparison with other side
- internal + external inflammatory resorption
what to look for on radiographs of avulsed replanted teeth
- root development - width of canal and length
- comparison with other side
- internal + external inflammatory resorption
when to carry out sensibility tests (thermal and EPT) for avulsed replanted teeth
- at time of injury
- 1 month, 2months, 3 months, then 6-monthly for an average of 2 years
