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Flashcards in Traumatic injuries Deck (86):
1

Who are the victim of 1/2 of all dental trauma

Children

2

What is the cause of most dental trauma for kids under 1

Fall injuries

3

Possible cause of dental trauma for kids under 3

Battered child syndrome

4

Which age has the most dental injuries

8-12 Play/athletics

5

Why might teens have dental injuries

Fights

6

What are two common reasons for all ages of dental trauma

Auto injuries and fights

7

Which teeth are most commonly injured

Max anteriors

8

What are the most common types of injuries to primary teeth

Luxations/avulsions

9

What is the type of injury most common to the permanent dentition

Crown fractures

10

Steps of pt evaluation

History and Chief Complaint

Neurologic Assessment

Extraoral to Intraoral Soft / Hard Tissue injuries

Radiologic Evaluation

11

What are the classification of crown fractures

Complicated (involving the pulp)and uncomplicated (no plural involvement)

12

What radiographs are needed.

Multiple angulations recommended

  • Standard periapical
  • Occlusal Periapical with lateral angulations
  • Mesial & Distal
  • Consider soft tissue radiograph If lip or cheek laceration To search for tooth fragments

13

How should percussion be tested in a traumatic case

with finger as a mirror handle is likely to much for a pt in pain

14

Why is vitality testing important?

To have a baseline

15

Emergency Management of Uncomplicated Crown Fracture

  • Seal exposed dentin
  • Bond tooth fragment If available
  • Composite Resin
  • Glass ionomer (Vitrebond)

16

What is the incidence of Pulp necrosis in Uncomplicated Crown Fx only in enamel

.2-1%

17

What is the incidence of pulp canal obliteration in uncomplicated crown fx only in enamel

.5%

18

What is the incidence of root resorption in uncomplicated crown fx only in enamel

.2%

19

What is the incidence of Pulp necrosis in Uncomplicated Crown Fx into dentin

1-6%

20

What is the incidence of pulp canal obliteration in uncomplicated crown fx into dentin

0

21

What is the incidence of root resorption in uncomplicated crown fx into dentin

0

22

Assessing either type of crown fx

  • Assessment Radiographs
  • Percussion/mobility testing
  • Baseline vitality testing
  • Visualize Adjacent teeth

23

Treatment options for complicated crown fas

  1. Pulp Capping
  2.  Pulpotomy
  3. Pulpectomy

24

Whats the main factor for tx of complicated crown fracture

Stage of Root Maturation

Mature root -Pulpectomy

Immature root -Pulpotomy -Pulp capping

25

Pulp healing prognosis of pulp capping

71-88%

26

Pulp healing prognosis of partial pulpotomy

94-96%

27

Pulp healing prognosis of Cervical pulpotomy

72-79%

28

Preffered tx for an immature root

Partial pulpotomy (apexogenesis)

29

Average depth of inflammatory change in partial pulpotomy

less than 2 mmm

30

Types of crown-root fx

Uncomplicated and complicated

31

Emergency management of Crown to Root Fx

Radiographs

Splint fragments temporarily to alleviate pain from mastication

32

What determines the definitive tx of crown to root fx

Level of the fracture

33

Treatment modalities of uncomplicated crown to root fx

1 Fragment rem

2 restoration

34

Tx of complicated crown to root fx (restorable)

  • Fragment removal
  • Gingivectomy/ostectomy* 
  • Endodontic therapy Post-retained crown

*(can use orthodox extrusion/surgical extrusion instead of periodontal surgery)

35

Clinical presentation of Root Fractures

Tooth usually slightly extruded

Tooth frequently displaced lingually

Diagnosis entirely dependent upon radiographic examination

36

Radiographs for root fas

Periapical radiographs

  • Standard XCP radiograph
  • Increased vertical angulation

37

Emergency Management of root fx

  • Reposition coronal fragment
  • Flexible Splint
    • -4 Weeks
    • -If Fx near the cervical area - longer splinting time is beneficial Up to 4 months

38

What are the 4 types of root fx healing

1. Hard tissue 2. Conenctive tissue 3. Interposition of Bone and Connective tissue 4. Interposition of granulation tissue

39

What is the incidence of pulpal necrosis after root fx for both segments

Coronal segment - 20 to 44%

Apical segment - 0%

40

What is the incidence of pulpal obliteration after root fx for both segments

69%

41

What is the incidence of root resorption after root fx

60%

42

What is the determinant of prognosis of root fracture

Fracture location

43

Prognosis of root fx in cervical 3rd

poorer

44

Prognosis of root fx in middle and apical 3rd

better

45

Classifications of luxation injuries

  1. Concussion
  2. Subluxation
  3. Extrusive Luxation
  4. Lateral Luxation
  5. Intrusive Luxation

46

Lunation injury complications

  • Pulp necrosis
  • Pulp canal obliteration
  • Root resorption
    • External
    • Internal
  • Loss of marginal bone support

47

Types of Ext root resorption

  1. Surface resorption
  2. Replacement resorption (Ankylosis)
  3. Inflammatory resorption

48

Surface resorption

Superficial resorption cavities

Mainly in cementum

Complete repair of PDL

49

Replacement resorption

Direct union of bone and root

Resorption of root - replacement with bone

Direct result of loss of vital PDL

50

Inflammatory resorption

Resorption of cementum and dentin

Inflammatory reaction in the periodontal ligament

Surface resorption of cementum exposing dentinal tubules

Pulp necrosis

Toxic products from the pulp provoke an inflammatory response in the PDL

51

Internal root resorption types

  1. Internal surface resorption
  2. Internal replacement resorption
  3. Internal inflammatory resorption

52

Internal inflammatory resorption incidence in lunated permanent teeth

2%

53

Concussion injury description

No abnormal loosening No displacement

54

Subluxation description

Abnormal Loosening No displacement

55

Emergency management of concussion and subluxation injuries

  • Radiograph
  • Baseline vitality testing
  • Usually no splinting required 7-10 days for comfort
  • Trauma Dx adjacent teeth Occlusal adjustment, if needed
  • Recall

56

Pulpal necrosis incidence after concussion

3%

57

Pulp canal obliteration incidence after concussion

5%

58

Root resorption incidence after concussion

5%

59

Pulpal necrosis incidence after subluxation

6%

60

Pulp canal obliteration after subluxation

10%

61

Root resorption incidence after subluxation

2%

62

Extrusive luxation description

Partial displacement of tooth out of socket

Tooth appears elongated

Lingual deviation of crown typically

Excessively mobile

63

Emergency management of extrusive luxation

  1. Radiographs
  2. Baseline vitality testing
  3. Anesthesia
  4. Reposition tooth
  5. Flexible splint 2 weeks
  6. Follow-up
    • 2, 4 weeks 6-8 weeks 6 months 1 year Every year for 5 years

64

Pulpal necrosis incidence after extrusive luxation

26%

65

Pulp canal obliteration incidence after extrusive luxation

45%

66

Root resorption incidence after extrusive luxation

9%

67

Lateral luxation description

Eccentric displacement of tooth

Crown usually displaced lingually

Fracture of socket wall

Tooth immobile

Percussion may have ankylotic sound

68

Emergency management of lateral luxation

  • Radiographs
    •  PA
    • Lateral
    • CBCT
  • Baseline vitality testing
    • Usually negative results
  • Anesthesia
  • Reposition
  • Flexible splint 4 weeks
    • Add 3-4 weeks in case of marginal bone breakdown
  • Occlusal adjustment, if needed

69

One week after lateral luxation

  • Start endo / Ca(OH)2
  • Complete within one month
  • Follow-up 2 weeks 4 weeks (splint removal) 6-8 weeks 6 months 1 year Every year for 5 years

70

Incidence of pulp necrosis after lat luxation

58% (77 with closed apex)

71

Incidence of pulp canal obliteration after lat luxation

28%

72

Incidence of root resorption after lat luxation

27%

73

Incidence of loss of marginal bone support after lat luxation

5%

74

Intrusive luxation description

Displacement of the tooth into alveolar bone

Comminution or fracture of socket

Immobile with ankylotic percussion sound

75

Emergency management of Intrusive lunation

  1. Radiographs
  2. Pulp vitality tests Usually negative
  3. Anesthesia
  4. “Slightly luxate the tooth with forceps”

76

Emergency management of Intrusive lunation of teeth with incomplete root

  1. Allow eruption without intervention
  2. If no movement within a few weeks initiate orthodontic repositioning
  3. If tooth intruded >7mm reposition surgically or orthodontically
  4. Monitor pulp vitality -if becomes necrotic Pulp regeneration or apexification

77

What may happen if deciduous tooth is intruded

May damage developing permanent tooth

78

Emergency management of Intrusive lunation of teeth with complete root

  1. Allow eruption without intervention
  2. If tooth intruded <3mm If no movement within a few weeks initiate orthodontic repositioning
  3. If tooth intruded >7mm reposition surgically Pulp will be necrotic Pulpectomy 2 weeks after injury Ca(OH)2 for up to 4 weeks

79

If intruded tooth is repositioned surgically or orthodontically

Flexible Splint 2 weeks 4 weeks if displacement is ‘extensive

80

Intrusion follow up

Follow-up depends on treatment

81

Pulp necrosis and intrusion

complete root 100% Overall 85%

82

Pulp canal obliteration incidence in intrusion

10%

83

Root resorption incidence in intrusion

66%

84

Loss of marginal bone support incidence in intrusive injuries

24%

85

Graph of open apex luxation injury complications

A image thumb
86

Graph of closed apex luxation injury complcations 

A image thumb