Dental Trauma and Resorption

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Questions and Answers

What is the aim of management of missing incisors?

To recover or maintain space for prosthetic replacement (correct)

To achieve a Class I molar relationship

To provide a 32|23 smile

To create a functional occlusion

What is the percentage of population where upper central incisors are congenitally absent?

10%

2% (correct)

What is the frequency of pulp necrosis in luxation-type injuries?

20-25%

30-35%

13-16% (correct)

5-10%

What is the success rate of subsequent RCT in luxation-type injuries?

80% Signup and view all the answers

What is the type of resorption that is not influenced by endodontic therapy?

Replacement resorption Signup and view all the answers

What is the characteristic radiographic feature of replacement resorption?

Ankylosis with a high percussion note Signup and view all the answers

What is the frequency of root canal obliteration in luxation-type injuries?

6-35% Signup and view all the answers

What is the management option for missing upper anterior teeth?

Both A and B Signup and view all the answers

What is the recommended working length for extirpating necrotic pulp under a rubber dam?

1–2mm short of the radiographic apex Signup and view all the answers

What type of files are used to negotiate undercuts during pulp extirpation?

Narrow files Signup and view all the answers

What is the purpose of using a radiopaque non-setting calcium hydroxide in the canal?

To medicate the canal Signup and view all the answers

How often should the calcium hydroxide dressing be replaced during treatment?

Every 3 months Signup and view all the answers

What is the average time required for a calcific barrier to form?

9 months Signup and view all the answers

What is the reported 5-year survival rate for teeth treated with calcium hydroxide?

86% Signup and view all the answers

What is a common complication associated with long-term dressing with calcium hydroxide?

Cervical root fracture Signup and view all the answers

What is the purpose of using MTA as an alternative to calcium hydroxide?

To achieve obturation more quickly Signup and view all the answers

What is the primary consequence of pulp breakdown products seeping into the periodontal ligament?

Inflammatory resorption Signup and view all the answers

What is the recommended time frame for revascularization in a tooth with an open apex?

Within 30 minutes Signup and view all the answers

What should be avoided when handling an avulsed tooth?

Handling the root surface Signup and view all the answers

What type of wire is ideal for splinting in teeth with avulsion?

A light twist-flex SS wire Signup and view all the answers

When should a tetanus booster be arranged for a patient with an avulsed tooth?

If the patient has not had a tetanus shot in the last 10 years Signup and view all the answers

What is the purpose of using chlorhexidine mouthwash in patients with avulsed teeth?

To reduce the risk of infection in patients with compromised oral health Signup and view all the answers

What should be done if the tooth is still mobile after 2 weeks of splinting?

Check for any overlooked root fracture or loss of vitality Signup and view all the answers

What is the gold standard for dressing a tooth with an open apex?

Mineral trioxide aggregate (MTA) plug Signup and view all the answers

Study Notes

Pulpal Sequelae Following Trauma

Raising a flap, removal of granulation tissue, and direct repair can be attempted for pulpal sequelae following trauma.

External Resorption

Radiographically, external resorption appears as a loss of periodontal ligament (PDL) with no radiolucent areas visible.
There are three types of external resorption: surface (transient), replacement, and inflammatory.
Replacement resorption is usually due to irreversible damage to the cementum, leading to ankylosis, and is often associated with a high percussion note.
Inflammatory resorption is frequently related to pulp necrosis and can often be halted by appropriate endodontic management.

Root Canal Obliteration

Occurs in 6–35% of luxation-type injuries.
Prophylactic endodontic treatment is not necessary, as pulp necrosis occurs in only 13–16% of cases.
A high rate of success (80%) has been reported for subsequent RCT, despite a hairline or no root canal detectable on X-ray.

Management of Missing Incisors

Missing upper anterior teeth are noticed by the general public before other types of malocclusion.
The aim of treatment is to provide a 32|23 smile.
Management involves either recovery or maintenance of space for prosthetic replacement, or orthodontic space closure.

Endodontic Treatment

Under a rubber dam, the necrotic pulp should be extirpated.
The working length is set 1–2mm short of the radiographic apex (unless vital pulp tissue is encountered earlier).
Narrow files are used to negotiate any undercuts.
The canal should be filled with a radiopaque non-setting calcium hydroxide (e.g. Hypocal™ or Ultracal®) to the apex and sealed.

Calcific Apical Barrier

The average time for a calcific barrier to be formed is 9 months.
Then the canal can be filled.

Obturation

A large GP point (a conventional point upside down) can be used.
The point should be warmed in a flame before pressing into place and then lots of laterally condensed points used to obtain a good seal.
Alternatively, thermoplasticized GP (e.g. Obtura®) can be used.

Resorption

Resorption is commonly seen after avulsion, luxation, intrusion, or extrusion.
Internal resorption is associated with chronic pulpal inflammation, which results in resorption of dentine from the pulpal surface.
Dressing the tooth with calcium hydroxide appears to help arrest the resorption.

Viability of Pulp

Seepage of pulp breakdown products into PDL will contribute to the development of inflammatory resorption.
Revascularization is possible in a tooth with an open apex which is replaced within 30 minutes.
Teeth with closed apices and longer extra-alveolar times should be considered non-vital.

Immediate Treatment

Avoid handling the root surface.
If the tooth is contaminated, hold the crown and agitate gently in saline.
Place the tooth in the socket.
If it does not readily seat, get the patient to bite on gauze for 15–20 minutes.
Compress buccal and lingual alveolar plates.
Splint a curved piece of light wire (a light twist-flex SS wire is ideal) to acid-etched enamel of affected and adjacent teeth using temporary crown material.

Intermediate Treatment

Review splinting.
Stop if the tooth appears firm, continue for further week if still mobile.
If still mobile after 2 weeks, check nothing has been overlooked, e.g. root # or loss of vitality.
If the apex is closed (or tooth with open apex, but extra-alveolar period >30 minutes), extirpate the pulp within 7–10 days, clean the canal.
If an intermediate dressing is required or monitoring inflammatory resorption, place an initial intra-canal dressing of calcium hydroxide.

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Description

This quiz covers the effects of dental trauma on the pulp and surrounding tissues, including external resorption and its types.