Traumatic Dental Injuries PERMANENT

Question 1

what is the most common injury in primary and permanent

Answer 1

luxation [prim]
subluxation [perm]

Question 2

peak incidence of trauma in permanents

Answer 2

7-10
large overjet >9mm

Question 3

emergency tx aims

Answer 3

retain vitality, protecting exposed dentine
tx ecposed pulp
reduction and immobilisation of displaced teeth
tetanus prophylaxis, antibiotics

Question 4

immediate tx aims

Answer 4

pulp tx
restoration

Question 5

permanent tx aims

Answer 5

apexigenesis apexification
root filling/extrusion
coronal restoration

Question 6

when would you not replant

Answer 6

medical contraindications - severely immunocompromised, another serious injury requiring preferential emergency tx

dental - very immature apex, EAT >90mins, very immature lower incisiors in young child struggling to cope

Question 7

what are the only traumatic injuries where you would splint for 4 weeks instead of 2

Answer 7

intrusion, lateral luxation, extrusion, dento-alveolar fracture

Question 8

types of splints

Answer 8

composite and wire
titanium trauma splint

Question 9

dental hard tissues and pulp trauma

Answer 9

enamel
enamel dentine
enamel dentine pulp
crown root fracture
root fracture

Question 10

supporting tissues trauma

Answer 10

concussion
subluxation
lateral luxation
intrusion
extrusion
avulsion
alveolar fracture

Question 11

concussion

Answer 11

TTP, no abnormal loosening or displacement

tx - observation
4 weeks, 1 year

Question 12

subluxation

Answer 12

TTP, increased mobility, bleeding, abnormal loosening

tx - observation, splint 2 weeks if excessive mobility or tenderness biting

2,12 weeks, 6,12 months

Question 13

lateral luxation

Answer 13

displacement other than axially, accompanied by communication/fracture of alveolar bone plate, displaced in socket, immobile, high ankylotic percussion tone, bleeding, root apex may be palpable in sulcus

tx - reposition under LA, splint 4 weeks, endo evaluation 2 weeks

incomplete root formation = spontaneous revascularisation
complete root formation = pulp likely necrotic, endo tx, CaOH intracnal to avoid inflammatory external resorption

2,4,8,12 weeks, 6/12

Question 14

intrusion

Answer 14

tooth forced into socket in axial direction
locked in bone, shortened crown, ankylotic high, metallic percussion tone, bleeding

tx
immature root formation = spontaneous repositioning, in no eruption in 4 weeks then ortho

mature root formation =
- <3mm if no erupt in 8 weeks, surgical reposition and splint 4 weeks
- 3-7mm, reposition surgical/ortho
- >7mm reposition surgical

tooth will likely become necrotic, endo 2 weeks or when tooth position allows, this avoids inflammatory infection related external resorption

2,48,12 weeks, 6,12

Question 15

extrusion

Answer 15

axial displacement partially out of socket
elongated, displaced palatally, mobile, bleeding

tx - reposition by pushing back into socket, 2 week splint

2,4,8,12 weeks

Question 16

avulsion

Answer 16

tooth completely out of socket
empty socket or coagulum

tx -
closed apex =
- tooth replanted = verify position, suture gingival
- EADT<60mins = PDL viable, not if over, remove debris, replant under LA, endo 2 weeks, splint 2 weeks

open apex =
- tooth replanted = verify, suture
- EAT<60 mins = spontaneous healing, replant and splint
- EAT>60 mins, non viable PDL, likely ankylosis root resorption

frequent necrosis, frequent root resorption

Question 17

alveolar fracture

Answer 17

complete alveolar fracture extending from buccal to palatal bone in maxilla and buccal to lingual bony surface of mandible
segment mobility and displacement of multiple teeth moving together
occlusal disturbance, gingival laceration

tx - reposition displaced segment, stabilise 4 weeks splint, suture lacerations, monitor pulp

follow up = check root development, length/width canal, resorption

Question 18

enamel fracture

Answer 18

bond fragment to tooth or grind sharp edges
periapical to rule out root fracture or luxation

6,8 week, 6/12

Question 19

enamel dentine fracture

Answer 19

bond fragment to tooth, place composite bandage, line if close to pulp

periapical to rule out fracture or luxation

6,8 weeks, 6/12
check root development width/length canal, resorption, pathology

Question 20

enamel dentine pulp fracture

Answer 20

pulp cap, pulpotomy, full coronal pulpotomy

if immature = no apical stop for obturaiton, place MTA/BioDentine at apex of canal to create cement barrier

Question 21

crown root fracture

Answer 21

no pulp exposure =
fragment removal and restore, gingivectomy, endo/extrusion/post-crown, extrusion, XLA

pulp exposure =
fragment removal and gingivectomy, endo/extrusion/post-crown, XLA

Question 22

root fracture

Answer 22

splint 4 weeks, endo if required