Questions and Answers
What type of fractures has minimal to no risk of pulpal or periodontal complications?
What is the success rate of pulp capping in completely developed roots?
88%
What is the percentage range of pulpal necrosis in enamel-dentin fractures?
0.5% - 3.2%
In subluxation injuries, what is the range of pulpal necrosis percentage?
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What type of luxation results in a pulpal necrosis of 96%?
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What are the three categories of external root resorption?
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Concussion injuries lead to ___ tenderness to percussion.
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Which injuries have the most serious effects on permanent dentition?
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Teeth with immature roots should be treated immediately after intrusive luxation.
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What is the percentage range of color changes in primary dentition due to trauma?
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What is indicated when canal narrowing is observed in teeth after trauma?
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Match the causes of root resorption to their descriptions.
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What is internal resorption?
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Who conducted a study on Internal Resorption in 1973?
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What are the key differences between internal and external root resorption?
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What is the classification of invasive cervical resorption according to Heithersay?
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What is the recommended treatment for non-perforating internal resorption?
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What is extracanal invasive resorption?
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How do you differentiate between internal and external resorption?
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The healing with calcified tissue occurs in ___% of fractured cases according to Andreasen & Hjorting-Hansen.
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The success rate of Class 4 invasive cervical resorption is ___%.
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What are the clinical findings associated with invasive cervical resorption?
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Study Notes
Classification of Dental Trauma
- Enamel infractions & fractures: Minimal risk of pulpal/periodontal issues.
- Enamel-dentin fractures: Pulp necrosis risk is 0.5% - 3.2%; treat deeply neglected fractures to reduce necrosis likelihood.
- Complicated crown fractures: Pulp exposure; responds well to pulp capping (90.5% success) and Cvek pulpotomy (96% success).
- Crown-root fractures: Can involve pulp; require surgical exposure and restoration.
- Root fractures: Healing varies with 20% - 44% pulp necrosis linked to coronal fragment dislocation.
Luxation Injuries
- Concussion: Tooth injuries with tenderness but no displacement; low pulpal necrosis (2%).
- Subluxation: Abnormal loosening without displacement; higher necrosis rate (26% - 47%).
- Extrusive luxation: Partial tooth avulsion; high necrosis (64% - 98%).
- Intrusive luxation: Forceful dislocation into the bone; high necrosis (96%).
- Lateral luxation: Eccentric displacement with socket fracture; necrosis varies (77% closed apex).
Avulsion and Root Resorption
- Avulsion types: Categorized by external root resorption appearances (surface, inflammatory, replacement).
- Pulp necrosis in avulsion: Linked to storage conditions and root development stage.
Sequelae of Trauma
- Primary dentition injuries: 53% show color changes; 25% pulp necrosis observed.
- Complications in primary teeth: Monitoring essential; extraction if sinus tract develops.
- Supporting bone injuries: Increased necrosis risk if splinting occurs after 1 hour.
Neurological Assessment
- Pre-treatment evaluations: Conduct swift neurological checks for communication and motor function issues before dental interventions.
Canal Obliteration
- Incidence: Canal obliteration seen in 20% - 25% of trauma cases; conservative management often preferred.
- Pulp necrosis rates: Varies from 1% - 21% in cases with canal obliteration; avoid routine endodontic intervention unless symptoms arise.
Internal and External Resorption
- Internal resorption: Typically asymptomatic; requires prompt treatment to avoid extensive tooth destruction.
- Differentiation of resorption types: Internal lesions have smooth borders; external exhibits ragged edges.
Treatment Protocols
- Conservative care for canal obliteration: Follow-up evaluations critical; manage symptomatic cases with endodontic interventions.
- Endodontics for complicated fractures: Involves pulp capping or full endodontic therapy based on the maturity of root development.
Studies and Prognosis
- Research shows varying success rates for endodontic treatment depending on canal obliteration and root maturity.
- Protocols recommend observation unless complications arise; higher success rates found when periapical health is intact before treatment.
Overall Takeaways
- Injuries have diverse impacts: Side effects of dental trauma are profound across primary and permanent dentition.
- Continued care essential: Frequent monitoring post-trauma required to catch complications early and address effectively.### Lesions and Resorption
- Lesions on the external surface appear displaced over the canal on angled radiographs.
- Internal defects retain their position over the canal despite angulation changes.
- Differentiation between caries and resorption often requires clinical examination due to their similar appearance, particularly in periodontally involved midroot areas.
- External resorption begins below the attachment and extends to the crown, unlike internal resorption that requires vital tissue contact.
Canal System Structure
- Early pulpal death results in large canal systems with divergent walls producing a blunderbuss appearance.
- Internal resorption reflects sharp, defined margins and needs vital tissue contact, with a ballooning effect of canal walls.
- External resorption shows asymmetrical patterns with a "moth-eaten" appearance due to density variation, canal paths remain discernible.
Types of Resorption
- Coronal internal resorption can initiate within the crown, while external resorption typically starts below epithelial attachments.
- Caries diagnosis is primarily based on clinical examination.
Research Insights on Resorption
- Wedenberg & Zetterqvist (1987) highlight that inflammation replaces normal pulp to allow internal resorption to develop.
- Yaacob (1980) classifies dentine zones affected by idiopathic external resorption, with varying mineral content affecting protective qualities.
- Successful outcomes in external invasive resorption treatment rely on early intervention with complete debridement.
Clinical Observations
- Heithersay (1999) identifies clinical signs of invasive cervical resorption, such as pink crowns and irregular gingival contours.
- Heithersay classifies invasive cervical resorption into four classes with varying success rates based on depth and involvement with the root structure.
Treatment Protocols
- Frank & Torabinejad (1998) emphasize that early debridement is critical for successful treatment of extracanal invasive resorption.
- Treatment of invasive cervical resorption involves a 90% solution of trichloroacetic acid and careful removal of resorbing tissue.
Fractures and Healing Processes
- Andreasen & Hjorting-Hansen identify four healing categories for root fractures, focusing on the necessity of maintaining fragment reduction for better outcomes.
- Michanowicz et al. outline treatment steps for horizontal root fractures, emphasizing the importance of checking pulp vitality periodically.
Pulp Responses and Diagnosis
- A variety of traumatic injuries lead to different pulpal necrosis rates, with less than half experiencing necrosis for many types of luxation.
- Diagnosis of pulp necrosis often relies on radiolucencies adjacent to fractures, with discoloration occurring within two months post-injury.
Practical Treatment Considerations
- Cvek (1974) finds calcium hydroxide treatment promotes healing across fractured segments.
- Cvek et al. (2004) categorizes endodontic treatments based on the location of root fractures, highlighting varying healing success rates linked to treatment methods.
Internal vs. External Resorption Differentiation
- Internal resorption is identifiable through symmetrical, sharply defined margins and larger canals, while external resorption presents asymmetrical, ragged margins.
- Extracanal invasive resorption (EIR), detailed by Frank, involves external processes affecting dentin without pulp damage and is treated surgically with acid application.
Emergency and Follow-Up Procedures
- Immediate repositioning is crucial in managing horizontal root fractures, with success dependent on appropriate splinting and monitoring for pulp vitality.
- Studies reveal a need for multiple radiographic views to accurately diagnose horizontal root fractures and ensure comprehensive treatment evaluation.
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Description
This quiz covers key concepts related to dental trauma, including the classification of luxation injuries and crown root fractures. Explore the details of canal obliteration secondary to trauma and resorption types related to dental injuries. Enhance your understanding of enamel and dentin fractures as part of your dental education.
