Traumatic injuries Flashcards
(86 cards)
1
Q
Who are the victim of 1/2 of all dental trauma
A
Children
2
Q
What is the cause of most dental trauma for kids under 1
A
Fall injuries
3
Q
Possible cause of dental trauma for kids under 3
A
Battered child syndrome
4
Q
Which age has the most dental injuries
A
8-12 Play/athletics
5
Q
Why might teens have dental injuries
A
Fights
6
Q
What are two common reasons for all ages of dental trauma
A
Auto injuries and fights
7
Q
Which teeth are most commonly injured
A
Max anteriors
8
Q
What are the most common types of injuries to primary teeth
A
Luxations/avulsions
9
Q
What is the type of injury most common to the permanent dentition
A
Crown fractures
10
Q
Steps of pt evaluation
A
History and Chief Complaint
Neurologic Assessment
Extraoral to Intraoral Soft / Hard Tissue injuries
Radiologic Evaluation
11
Q
What are the classification of crown fractures
A
Complicated (involving the pulp)and uncomplicated (no plural involvement)
12
Q
What radiographs are needed.
A
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
Q
How should percussion be tested in a traumatic case
A
with finger as a mirror handle is likely to much for a pt in pain
14
Q
Why is vitality testing important?
A
To have a baseline
15
Q
Emergency Management of Uncomplicated Crown Fracture
A
- Seal exposed dentin
- Bond tooth fragment If available
- Composite Resin
- Glass ionomer (Vitrebond)
16
Q
What is the incidence of Pulp necrosis in Uncomplicated Crown Fx only in enamel
A
.2-1%
17
Q
What is the incidence of pulp canal obliteration in uncomplicated crown fx only in enamel
A
.5%
18
Q
What is the incidence of root resorption in uncomplicated crown fx only in enamel
A
.2%
19
Q
What is the incidence of Pulp necrosis in Uncomplicated Crown Fx into dentin
A
1-6%
20
Q
What is the incidence of pulp canal obliteration in uncomplicated crown fx into dentin
A
0
21
Q
What is the incidence of root resorption in uncomplicated crown fx into dentin
A
0
22
Q
Assessing either type of crown fx
A
- Assessment Radiographs
- Percussion/mobility testing
- Baseline vitality testing
- Visualize Adjacent teeth
23
Q
Treatment options for complicated crown fas
A
- Pulp Capping
- Pulpotomy
- Pulpectomy
24
Q
Whats the main factor for tx of complicated crown fracture
A
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
86
Graph of closed apex luxation injury complcations
