Podcast
Questions and Answers
Why does a more frequent hard tissue follow-up take priority over a less frequent follow-up routine for periodontal injuries?
Why does a more frequent hard tissue follow-up take priority over a less frequent follow-up routine for periodontal injuries?
Due to the worse prognosis over combination injuries.
What is the key characteristic of an enamel infraction?
What is the key characteristic of an enamel infraction?
Incomplete fracture of enamel without loss of tooth structure.
Why might etching and bonding with resin be considered in cases of marked enamel infraction?
Why might etching and bonding with resin be considered in cases of marked enamel infraction?
To prevent staining and bacterial ingress.
In an enamel fracture, what clinical sign, if absent during the initial appointment, could indicate a future risk of necrosis?
In an enamel fracture, what clinical sign, if absent during the initial appointment, could indicate a future risk of necrosis?
What is the primary treatment for small enamel fractures to smooth sharp edges?
What is the primary treatment for small enamel fractures to smooth sharp edges?
In an enamel-dentine fracture without pulp exposure, why should clinicians proceed cautiously when using a probe if a pinkish area is observed?
In an enamel-dentine fracture without pulp exposure, why should clinicians proceed cautiously when using a probe if a pinkish area is observed?
If a tooth fragment from an enamel-dentine fracture is dry, how should it be prepared before re-bonding?
If a tooth fragment from an enamel-dentine fracture is dry, how should it be prepared before re-bonding?
What emergency treatment is recommended for an enamel-dentine fracture when the fragment isn't available, and the fracture line is close to the pulp?
What emergency treatment is recommended for an enamel-dentine fracture when the fragment isn't available, and the fracture line is close to the pulp?
What is the expected long-term prognosis regarding fragment retention after five years in enamel-dentine fractures?
What is the expected long-term prognosis regarding fragment retention after five years in enamel-dentine fractures?
If a patient presents with a complicated enamel-dentine fracture involving a pin-point pulp exposure that is less than one hour old, what initial treatment is indicated?
If a patient presents with a complicated enamel-dentine fracture involving a pin-point pulp exposure that is less than one hour old, what initial treatment is indicated?
When is a Cveck pulpotomy not recommended in the treatment of complicated enamel-dentine fractures?
When is a Cveck pulpotomy not recommended in the treatment of complicated enamel-dentine fractures?
What is the appropriate treatment for a complicated enamel complex fracture with delayed presentation and a non-vital pulp?
What is the appropriate treatment for a complicated enamel complex fracture with delayed presentation and a non-vital pulp?
In uncomplicated crown-root fractures extending below the gingival margin, what immediate step must be taken to stabilize the coronal fragment?
In uncomplicated crown-root fractures extending below the gingival margin, what immediate step must be taken to stabilize the coronal fragment?
Following removal of the coronal fragment in an uncomplicated crown-root fracture, what orthodontic procedure may be necessary as part of the long-term treatment?
Following removal of the coronal fragment in an uncomplicated crown-root fracture, what orthodontic procedure may be necessary as part of the long-term treatment?
Why might intentional replantation be considered in the treatment of uncomplicated crown-root fractures?
Why might intentional replantation be considered in the treatment of uncomplicated crown-root fractures?
What is the key difference in managing a complicated versus an uncomplicated crown-root fracture, and why is it important?
What is the key difference in managing a complicated versus an uncomplicated crown-root fracture, and why is it important?
What is the first step in managing a root fracture?
What is the first step in managing a root fracture?
In a root fracture, what does a positive sensibility test result indicate regarding the risk of pulpal necrosis?
In a root fracture, what does a positive sensibility test result indicate regarding the risk of pulpal necrosis?
What is the critical degree of displacement (in mm) in root fractures that can significantly affect the prognosis?
What is the critical degree of displacement (in mm) in root fractures that can significantly affect the prognosis?
When managing a root fracture with no displacement or normal mobility, why is splinting generally avoided?
When managing a root fracture with no displacement or normal mobility, why is splinting generally avoided?
What is the recommended splinting duration for a horizontally fractured root near the cervical third of the root?
What is the recommended splinting duration for a horizontally fractured root near the cervical third of the root?
For what duration of time should a clinician monitor pulp status after treating horizontal root fractures?
For what duration of time should a clinician monitor pulp status after treating horizontal root fractures?
In cases of dental concussion, what are the key clinical features that differentiate it from other types of dental trauma?
In cases of dental concussion, what are the key clinical features that differentiate it from other types of dental trauma?
During sensibility testing, what initial test result would indicate transient pulpal damage?
During sensibility testing, what initial test result would indicate transient pulpal damage?
What is the purpose of using occlusal and periapical radiographs when diagnosing subluxation?
What is the purpose of using occlusal and periapical radiographs when diagnosing subluxation?
In extrusive luxation injuries involving immature teeth, what is the expected pulpal response, and how does it typically differ from mature teeth?
In extrusive luxation injuries involving immature teeth, what is the expected pulpal response, and how does it typically differ from mature teeth?
What accounts for the high metallic/ankylotic sound on percussion in lateral luxation?
What accounts for the high metallic/ankylotic sound on percussion in lateral luxation?
What immediate clinical sign suggests perforation of the nasal cavity in intrusive luxation?
What immediate clinical sign suggests perforation of the nasal cavity in intrusive luxation?
In intrusive luxation cases with immature root development where spontaneous re-eruption is not observed within 4 weeks, what is the next recommended step?
In intrusive luxation cases with immature root development where spontaneous re-eruption is not observed within 4 weeks, what is the next recommended step?
Why storage in water has to be avoided for avulsed teeth?
Why storage in water has to be avoided for avulsed teeth?
Why does the more frequent follow-up routine for periodontal injuries take priority over hard tissue follow-up in cases of combination injuries?
Why does the more frequent follow-up routine for periodontal injuries take priority over hard tissue follow-up in cases of combination injuries?
What clinical sign might suggest an enamel infraction, and how is it best visualized?
What clinical sign might suggest an enamel infraction, and how is it best visualized?
In managing enamel fractures, what determines whether a smooth sharp edge treatment is sufficient or a composite restoration is needed?
In managing enamel fractures, what determines whether a smooth sharp edge treatment is sufficient or a composite restoration is needed?
When treating an enamel-dentine fracture without pulpal exposure, why is it important to avoid probing a pinkish area of dentine?
When treating an enamel-dentine fracture without pulpal exposure, why is it important to avoid probing a pinkish area of dentine?
Why would a soft tissue radiograph be recommended in addition to a periapical radiograph for an enamel-dentine fracture?
Why would a soft tissue radiograph be recommended in addition to a periapical radiograph for an enamel-dentine fracture?
In a complicated enamel-dentine fracture of an immature tooth, why is maintaining pulp vitality crucial?
In a complicated enamel-dentine fracture of an immature tooth, why is maintaining pulp vitality crucial?
For a complicated enamel-dentine fracture with pinpoint pulp exposure, what two factors determine whether direct pulp capping is appropriate?
For a complicated enamel-dentine fracture with pinpoint pulp exposure, what two factors determine whether direct pulp capping is appropriate?
In cases where a post is required to maintain a coronal restoration in a mature tooth with a complicated crown-dentine fracture, what treatment is indicated?
In cases where a post is required to maintain a coronal restoration in a mature tooth with a complicated crown-dentine fracture, what treatment is indicated?
What radiographic findings would indicate an uncomplicated crown-root fracture?
What radiographic findings would indicate an uncomplicated crown-root fracture?
Why is a CBCT sometimes considered for better visualization of the apical extension for an uncomplicated crown-root fracture?
Why is a CBCT sometimes considered for better visualization of the apical extension for an uncomplicated crown-root fracture?
In a complicated crown-root fracture, why does the treatment plan emphasize pulp vitality, and is this more important for immature or mature teeth?
In a complicated crown-root fracture, why does the treatment plan emphasize pulp vitality, and is this more important for immature or mature teeth?
For a root fracture, apart from the location of the fracture, what is another critical factor that influences the prognosis?
For a root fracture, apart from the location of the fracture, what is another critical factor that influences the prognosis?
In cases of root fracture, why is sensibility testing initially negative, and why is continued monitoring recommended?
In cases of root fracture, why is sensibility testing initially negative, and why is continued monitoring recommended?
If a horizontal root fracture line is below the alveolar crest, what is the immediate first step in management after repositioning?
If a horizontal root fracture line is below the alveolar crest, what is the immediate first step in management after repositioning?
Why is root fracture in the coronal third of the root considered to have a worse prognosis?
Why is root fracture in the coronal third of the root considered to have a worse prognosis?
What is the primary difference between concussion and subluxation injuries to the PDL?
What is the primary difference between concussion and subluxation injuries to the PDL?
In cases of subluxation, why might sensibility testing be negative initially, and what does this indicate?
In cases of subluxation, why might sensibility testing be negative initially, and what does this indicate?
What distinguishes extrusive luxation from other types of luxation injuries, such as lateral luxation?
What distinguishes extrusive luxation from other types of luxation injuries, such as lateral luxation?
In an extrusive luxation injury of an immature tooth, what is more likely to occur: pulp necrosis or pulpal revascularization?
In an extrusive luxation injury of an immature tooth, what is more likely to occur: pulp necrosis or pulpal revascularization?
How is a lateral luxation distinguished from an alveolar fracture on clinical examination?
How is a lateral luxation distinguished from an alveolar fracture on clinical examination?
Why might a metallic or ankylotic sound be present when percussing a tooth with lateral luxation?
Why might a metallic or ankylotic sound be present when percussing a tooth with lateral luxation?
Following the repositioning of a tooth with lateral luxation, how long is stabilization with a flexible splint typically required, assuming no marginal bone fracture?
Following the repositioning of a tooth with lateral luxation, how long is stabilization with a flexible splint typically required, assuming no marginal bone fracture?
What radiographic finding is most indicative of an intrusive luxation?
What radiographic finding is most indicative of an intrusive luxation?
If a tooth with immature root development is intruded and shows no re-eruption within 4 weeks, what is the next recommended treatment?
If a tooth with immature root development is intruded and shows no re-eruption within 4 weeks, what is the next recommended treatment?
Why is the timing of root canal treatment critical in mature teeth with intrusive luxation injuries?
Why is the timing of root canal treatment critical in mature teeth with intrusive luxation injuries?
How should a tooth be handled when providing first aid instructions to a patient for an avulsed tooth?
How should a tooth be handled when providing first aid instructions to a patient for an avulsed tooth?
What is the recommended storage medium for an avulsed tooth if immediate replantation is not possible?
What is the recommended storage medium for an avulsed tooth if immediate replantation is not possible?
In managing an avulsed tooth, if the tooth is replanted within 48 hours of the injury but is located in the wrong socket, what is the correct procedure?
In managing an avulsed tooth, if the tooth is replanted within 48 hours of the injury but is located in the wrong socket, what is the correct procedure?
If an avulsed tooth with a closed apex has been replanted, when must root canal treatment (RCT) be initiated and why?
If an avulsed tooth with a closed apex has been replanted, when must root canal treatment (RCT) be initiated and why?
How does the definition of comminution of the alveolar socket differ from the definition of an alveolar fracture?
How does the definition of comminution of the alveolar socket differ from the definition of an alveolar fracture?
Why is a combination of dental injuries considered more detrimental compared to a single injury following dental trauma?
Why is a combination of dental injuries considered more detrimental compared to a single injury following dental trauma?
What is the key difference between an enamel infraction and an enamel fracture, and how would you clinically differentiate between them?
What is the key difference between an enamel infraction and an enamel fracture, and how would you clinically differentiate between them?
In the case of an enamel fracture, why is it important to consider a follow-up radiograph even if the initial radiograph appears normal?
In the case of an enamel fracture, why is it important to consider a follow-up radiograph even if the initial radiograph appears normal?
If an enamel-dentine fracture fragment is dry upon presentation, what immediate step should be taken before attempting to re-bond it?
If an enamel-dentine fracture fragment is dry upon presentation, what immediate step should be taken before attempting to re-bond it?
What are the key differences in treatment approach between a pinpoint pulp exposure less than 1 hour old versus a larger pulp exposure older than 24 hours in a complicated enamel-dentine fracture?
What are the key differences in treatment approach between a pinpoint pulp exposure less than 1 hour old versus a larger pulp exposure older than 24 hours in a complicated enamel-dentine fracture?
What immediate steps are recommended for managing an uncomplicated crown-root fracture?
What immediate steps are recommended for managing an uncomplicated crown-root fracture?
How does the treatment approach for a complicated crown-root fracture differ from that of an uncomplicated crown-root fracture?
How does the treatment approach for a complicated crown-root fracture differ from that of an uncomplicated crown-root fracture?
Describe the three potential healing responses that can occur following a root fracture.
Describe the three potential healing responses that can occur following a root fracture.
In managing a root fracture with no displacement and normal mobility, why is it advised not to splint the tooth?
In managing a root fracture with no displacement and normal mobility, why is it advised not to splint the tooth?
How does the location of a root fracture (cervical, middle, or apical third) influence its prognosis and why?
How does the location of a root fracture (cervical, middle, or apical third) influence its prognosis and why?
Contrast the clinical features of concussion versus subluxation injuries to the PDL.
Contrast the clinical features of concussion versus subluxation injuries to the PDL.
In managing subluxation injuries, what is the rationale for using a flexible splint, and for how long is it typically applied?
In managing subluxation injuries, what is the rationale for using a flexible splint, and for how long is it typically applied?
In an extrusive luxation injury, what clinical findings would differentiate it from an avulsion?
In an extrusive luxation injury, what clinical findings would differentiate it from an avulsion?
What radiographic findings would differentiate a lateral luxation from an extrusive luxation?
What radiographic findings would differentiate a lateral luxation from an extrusive luxation?
Explain the immediate management of a lateral luxation, including the role of splinting and considerations for teeth with incomplete versus complete root formation.
Explain the immediate management of a lateral luxation, including the role of splinting and considerations for teeth with incomplete versus complete root formation.
What clinical signs would suggest that an intruded tooth has perforated the nasal cavity?
What clinical signs would suggest that an intruded tooth has perforated the nasal cavity?
Outline the different treatment approaches for intruded teeth with immature versus mature root development.
Outline the different treatment approaches for intruded teeth with immature versus mature root development.
Why is storage in water contraindicated for an avulsed tooth?
Why is storage in water contraindicated for an avulsed tooth?
What are the key differences in the management of an avulsed tooth that has been replanted prior to arrival at the dental office versus one that has not?
What are the key differences in the management of an avulsed tooth that has been replanted prior to arrival at the dental office versus one that has not?
Following reimplantation of an avulsed tooth, what are the different management approaches for teeth with closed versus open apices, and why do they differ?
Following reimplantation of an avulsed tooth, what are the different management approaches for teeth with closed versus open apices, and why do they differ?
What are the consequences of delayed reimplantation of an avulsed tooth (dry time >60 minutes), and how does this influence treatment planning?
What are the consequences of delayed reimplantation of an avulsed tooth (dry time >60 minutes), and how does this influence treatment planning?
Following the replantation of an avulsed tooth, why is it recommended to clean the root surface and apical foramen with a stream of saline?
Following the replantation of an avulsed tooth, why is it recommended to clean the root surface and apical foramen with a stream of saline?
How does management of the alveolar socket differ in cases of comminution versus alveolar fracture?
How does management of the alveolar socket differ in cases of comminution versus alveolar fracture?
What clinical findings would make you suspect an alveolar fracture in a patient presenting with dental trauma?
What clinical findings would make you suspect an alveolar fracture in a patient presenting with dental trauma?
Why is radiographic parallax recommended when assessing a patient suspected of having an alveolar fracture?
Why is radiographic parallax recommended when assessing a patient suspected of having an alveolar fracture?
Following manual repositioning of an alveolar fracture, what steps are taken to confirm the repositioning and stabilize the area?
Following manual repositioning of an alveolar fracture, what steps are taken to confirm the repositioning and stabilize the area?
Following the successful replantation of an avulsed tooth, what long-term post-operative instructions should be provided to the patient to ensure successful healing and prevent later complications?
Following the successful replantation of an avulsed tooth, what long-term post-operative instructions should be provided to the patient to ensure successful healing and prevent later complications?
Crown fractures significantly increase the risk of what complication in teeth with concussion or subluxation injuries that also have mature root development?
Crown fractures significantly increase the risk of what complication in teeth with concussion or subluxation injuries that also have mature root development?
In cases of enamel-dentine fracture, what is the rationale for covering the exposed dentine, and what material is commonly used for emergency treatment?
In cases of enamel-dentine fracture, what is the rationale for covering the exposed dentine, and what material is commonly used for emergency treatment?
Describe the key elements to consider when providing first aid advice to a patient or parent immediately following the avulsion of a permanent tooth.
Describe the key elements to consider when providing first aid advice to a patient or parent immediately following the avulsion of a permanent tooth.
Why do periodontal injuries take priority over hard tissue injuries in follow-up routines after combination injuries?
Why do periodontal injuries take priority over hard tissue injuries in follow-up routines after combination injuries?
How is an enamel infraction typically detected during a dental examination?
How is an enamel infraction typically detected during a dental examination?
What is the treatment considerations for marked enamel infractions?
What is the treatment considerations for marked enamel infractions?
What is a key clinical feature distinguishing enamel fractures from enamel infractions?
What is a key clinical feature distinguishing enamel fractures from enamel infractions?
How are sharp edges resulting from enamel fractures typically managed?
How are sharp edges resulting from enamel fractures typically managed?
What steps should be taken if there is an enamel-dentine fracture where a thin layer of dentine remains over the pulp?
What steps should be taken if there is an enamel-dentine fracture where a thin layer of dentine remains over the pulp?
Prior to bonding a reattached fragment in an enamel-dentine fracture, what is done if the fragment has dried out?
Prior to bonding a reattached fragment in an enamel-dentine fracture, what is done if the fragment has dried out?
Describe the emergency treatment for an enamel-dentine fracture when the fragment isn't available.
Describe the emergency treatment for an enamel-dentine fracture when the fragment isn't available.
When considering treatment options for a complicated enamel-dentine fracture in an immature tooth, what is the primary goal?
When considering treatment options for a complicated enamel-dentine fracture in an immature tooth, what is the primary goal?
Discuss the treatment differences when managing a pinpoint pulp exposure in a complicated enamel-dentine fracture if it's less than one hour old.
Discuss the treatment differences when managing a pinpoint pulp exposure in a complicated enamel-dentine fracture if it's less than one hour old.
In cases of complicated crown-root fractures, how does the presence of pulp involvement influence the treatment approach?
In cases of complicated crown-root fractures, how does the presence of pulp involvement influence the treatment approach?
What are the emergency treatment options for an uncomplicated crown-root fracture?
What are the emergency treatment options for an uncomplicated crown-root fracture?
What is the best long-term treatment option for teeth with uncomplicated crown-root fractures that extends far apically into bone?
What is the best long-term treatment option for teeth with uncomplicated crown-root fractures that extends far apically into bone?
Why is soft tissue radiography recommended in specific enamel-dentine fractures?
Why is soft tissue radiography recommended in specific enamel-dentine fractures?
In root fractures, what radiographic techniques are helpful for diagnosis and why?
In root fractures, what radiographic techniques are helpful for diagnosis and why?
What are the three categories of healing responses seen in root fractures, and which indicates no healing and coronal pulp necrosis?
What are the three categories of healing responses seen in root fractures, and which indicates no healing and coronal pulp necrosis?
What distinguishes a horizontal root fracture that is above the alveolar crest, and how is it treated?
What distinguishes a horizontal root fracture that is above the alveolar crest, and how is it treated?
What is the general recommendation regarding sensibility testing in cases of root fractures, and what does a positive sensibility test indicate?
What is the general recommendation regarding sensibility testing in cases of root fractures, and what does a positive sensibility test indicate?
What clinical features are characteristic of concussion injuries to the PDL?
What clinical features are characteristic of concussion injuries to the PDL?
How does the sensibility testing typically present in subluxation injuries, and what does it indicate?
How does the sensibility testing typically present in subluxation injuries, and what does it indicate?
In managing extrusive luxation injuries, why is it important to consider the maturity of the tooth?
In managing extrusive luxation injuries, why is it important to consider the maturity of the tooth?
What are the clinical features of extrusive luxation?
What are the clinical features of extrusive luxation?
What is surgical repositioning?
What is surgical repositioning?
In lateral luxation injuries, what clinical sign differentiates them from other types of luxation?
In lateral luxation injuries, what clinical sign differentiates them from other types of luxation?
Outline the treatment approach for an intruded permanent tooth with immature root development.
Outline the treatment approach for an intruded permanent tooth with immature root development.
For an intruded tooth with fully developed roots, what is the recommended approach when the intrusion is greater than 7mm?
For an intruded tooth with fully developed roots, what is the recommended approach when the intrusion is greater than 7mm?
How should a tooth be stored when avulsed?
How should a tooth be stored when avulsed?
What is the sequence if tooth is reimplanted prior to arrival?
What is the sequence if tooth is reimplanted prior to arrival?
In the treatment of avulsed teeth, when is tetracycline indicated and what are the dosage considerations for children and adults?
In the treatment of avulsed teeth, when is tetracycline indicated and what are the dosage considerations for children and adults?
Describe how to clinically identify an alveolar fracture.
Describe how to clinically identify an alveolar fracture.
Flashcards
Combination injuries
Combination injuries
A combination of dental injuries that can be more detrimental than a single injury.
Enamel infraction
Enamel infraction
An incomplete fracture of the enamel that is without loss of tooth structure.
Enamel fracture
Enamel fracture
Fracture confined to the enamel with loss of tooth structure.
Enamel-dentine fracture
Enamel-dentine fracture
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Complicated enamel-dentine fracture
Complicated enamel-dentine fracture
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Uncomplicated Crown-root fracture
Uncomplicated Crown-root fracture
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Complicated Crown-root fracture
Complicated Crown-root fracture
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Root fracture
Root fracture
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Concussion
Concussion
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Subluxation
Subluxation
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Extrusive luxation
Extrusive luxation
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Lateral luxation
Lateral luxation
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Intrusive luxation
Intrusive luxation
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Avulsion
Avulsion
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Comminution of alveolar socket
Comminution of alveolar socket
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Alveolar fracture
Alveolar fracture
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Combination of injuries
Combination of injuries
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Resin Application
Resin Application
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Enamel Fracture Treatment
Enamel Fracture Treatment
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Enamel-Dentine Tx
Enamel-Dentine Tx
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Complicated Fracture Tx
Complicated Fracture Tx
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Avulsed Coronal Fragment
Avulsed Coronal Fragment
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Concussion Definition
Concussion Definition
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Extrusive Luxation Signs
Extrusive Luxation Signs
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Extrusive Luxation Tx
Extrusive Luxation Tx
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Avulsion Patient Advise
Avulsion Patient Advise
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Reimplantation steps.
Reimplantation steps.
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Follow-up Priority
Follow-up Priority
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Enamel-dentine fracture treatment (2)
Enamel-dentine fracture treatment (2)
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Avulsed tooth
Avulsed tooth
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Root fracture prognosis
Root fracture prognosis
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Signs of extrusive luxation
Signs of extrusive luxation
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TX of extrusive luxation
TX of extrusive luxation
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Vertical root fracture
Vertical root fracture
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Concussion in PDL
Concussion in PDL
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Concussion in PDL
Concussion in PDL
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Replantation Verification
Replantation Verification
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Signs and symptoms of lateral luxation
Signs and symptoms of lateral luxation
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Immature teeth luxation
Immature teeth luxation
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Lateral luxation/bone fracture
Lateral luxation/bone fracture
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Bone/connective union
Bone/connective union
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Connective tissue union
Connective tissue union
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Socket comminution
Socket comminution
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Subluxation Dx
Subluxation Dx
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Extrusive Definition
Extrusive Definition
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H-fractures at alveolar crest
H-fractures at alveolar crest
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Below alveolar crest
Below alveolar crest
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Replanted Time
Replanted Time
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Definition of Avulsion
Definition of Avulsion
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Storage conditions
Storage conditions
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Lateral displacement
Lateral displacement
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Luxation immature formation
Luxation immature formation
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metallic percussion
metallic percussion
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Crown root
Crown root
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Gingival margin
Gingival margin
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Open Apex Follow-Up
Open Apex Follow-Up
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Initial crown root
Initial crown root
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Study Notes
Combination Injuries
- With dental trauma, a combination of injuries can occur, which can be more detrimental than a single injury
- Crown fractures significantly increase the risk of pulpal necrosis in teeth with concussion or subluxation injuries, especially in teeth with mature root development
- Crowns without pulp involvement increase the risk of pulp necrosis with lateral luxation
- Due to a less favorable outlook, frequent follow-ups are needed for periodontal injuries because hard tissue follow-up is less frequent
Enamel Infraction
- It is an incomplete fracture of enamel without loss of tooth structure and often missed
- Visualized when a light beam is perpendicular to the long axis
- A visible fracture line exists on the tooth surface, known as craze lines
- No tenderness to percussion (TTP) and normal mobility
- Sensibility tests are usually positive
- Periapical radiographs are recommended, with no abnormalities
- Treatment not typically required; etching and bonding with resin prevents staining and bacterial ingress
- No follow-up is needed
Enamel Fractures
- A fracture confined to the enamel with loss of tooth structure
- Visible loss of enamel structure
- No tenderness to percussion (TTP) and normal mobility
- Sensibility testing normal, but a lack of response could indicate necrosis in future
- Periapical radiographs are recommended. An additional radiograph is indicated with other injuries
- Radiographic findings show a loss of enamel
- Treatment involves smoothing sharp edges with soflex or rainbow discs and restoring larger fractures with composite
- An enamel fragment is bonded to the tooth, if available
- Clinical and radiographic follow-up is advised at 6-8 weeks and 1 year
Enamel-Dentine Fracture
- A fracture of both enamel and dentine, but there is no pulpal exposure
- There is a visible loss of both enamel and dentine
- Pulp might be covered by a thin layer of dentine that has a pinkish color
- Ensure not to probe this area to prevent exposure
- There is typically no tenderness to percussion (TTP), normal mobility, and normal sensibility
- Radiographic evaluation involves periapical radiographs, additional radiographs for other injuries, and soft tissue radiographs if a fragment cannot be located
- Radiographic findings will show loss of enamel and dentine and evaluate the distance between the fracture and the pulp chamber
- Treatment involves cleaning with water or saline and disinfecting with NaOCI or CHX
- Re-bond any available fragments using flowable composite, rehydrating dry fragments in water or saline for 20 minutes before bonding
- If fragments are not available, use GIC as an emergency bandage; if the fracture line is 0.5mm within the pulp, place CaOH liner, followed by composite restoration free-hand or with crown
- Clinical and radiographic follow-up is done at 6-8 weeks and 1 year, with 92% maintaining vitality
- Fragment retention has a 60% loss after 5 years, and discoloration may occur at the fracture line
Complicated Enamel-Dentine Fracture
- It involves fracture of enamel and dentine with loss of tooth structure and exposure of the pulp
- Visible loss of tooth structure and exposed pulp, with normal mobility and a sensibility test
- No TTP unless lateral luxation or root fracture is observed
- Additional radiographs rule out root fracture or to locate a fragment
- Radiographic findings indicate a loss of enamel/dentine and a fracture line
- Treatment depends on its extent, the age of injury and maturity of the apex
- RCT is complicated in immature teeth due to their wide open apices
- Pin-point exposure, less than 1 hour old open or closed apex, performs pulp capping with a success rate of 81.5% by Anna Fuks
- For larger exposures and greater than 24 hours old, Cveck pulpotomy, which has a success rate of 96%, unless signs of radicular pathosis
- Exposure for 3-6 days requires a full coronal pulpotomy
- Delayed presentation and pulp is non-vital with signs of infection, requires extirpation and RCT
- In cases where a post is required to maintain a coronal restoration, extirpation and RCT is indicated
- Avoid biting into hard food items with the affected tooth
- Requires clinical and radiographic follow-up at 6-8 weeks, 3 months, 6 months and 1 year
Uncomplicated Crown-Root Fracture
- Involves fracture of enamel, dentine, and cementum with loss of tooth structure and without pulp exposure
- Crown fracture extends below the gingival margin and split into at least two fragments where one is mobile
- Positive sensibility testing for the apical fragment
- Occlusal and periapical radiographs establish a baseline, with radiographs at two different angulations (parallax)
- May consider CBCT for better visualization
- Temporary stabilization with GIC or composite, followed by longer-term options after fragment removal
- Orthodontic extrusion of the apical fragment requires endodontic therapy or gingival recontouring
- Surgical extrusion involves surgical repositioning where endodontic treatment is needed for teeth with mature apices
- MTA apexification or obturation is performed with root canal treatment if non-vital
- An implant is planned at a later date with root submergence performed to avoid bone resorption
- Root can be replanted with or without rotation of it
- Auto transplantation is also an option
- Requires soft food for 1 week, brushing with a soft brush, and rinsing with 0.1% CHX
- Clinical and radiographic follow-up at 1 week, 6-8 weeks, 3 months, 6 months and yearly for 5 years
Complicated Crown-Root Fracture
- It is a fracture of enamel, dentine, cementum, and pulp
- Crown fracture extends below the gingival margin and split into at least two fragments where one is mobile
- TTP will be positive and requires sensibility testing
- Apical extension of fracture usually not visible
- Radiographs must be taken at two different horizontal or vertical angulations (parallax)
- Fragment removable with pulp therapy, can have temporary stabilization
- In non-vital teeth, endodontic therapy is necessary
- A post retained crown is used in root canal treatment and restoration
- Patients should eat soft food for 1 week
- Brush with soft brush and rinse with 0.1% CHX to prevent accumulation of plaque
- Follow up clinically and radiographically at 1 week, 6-8 weeks, 3-6 months, and 1 year
Root Fracture
- It is a fracture confined to the root of the tooth involving dentine, cementum, and pulp
- Can be classified by whether the coronal fragment is displaced
- Root fractures commonly occur in the middle or apical third
- The cervical third is the worst prognosis and apical third is the best
- The coronal segment is mobile and may be displaced along with possible crown discoloration
- Bleeding may occur from the gingival sulcus with possible TTP
- Sensibility testing initially negative, but monitoring status of pulp is recommended
- A positive sensibility test indicates a significantly reduced risk of later pulpal necrosis
- Prognosis depends on concomitant root fracture, maturity and location of the root, and the tooth's degree of displacement
- 0.5 - 1 mm is a critical point
- Three healing categories include repair with calcified tissue, connective tissue, or bone and connective tissue
Healing Process and Prognosis
- Healing leads to connective tissue union leading to a direct radiolucent line and rounded sharp edges
- Bone and connective tissue union leads to a bony bridge separated from result of trauma
- Granulation tissue leads to no healing and coronal pulp necrosis
- Treatment depends on location of the fracture line and the degree of displacement
- Effect of splinting is not significant in maintaining pulp vitality
- Pulp obliteration: hard tissue healing can result in partial or complete canal obliteration. Teeth usually remain vital; however, excess tertiary dentine produces a tallow colour
- Necrosis prognosis: likely for avulsion and severe intrusion/extrusion, but is also influenced by maturity of apex. Immature apex with lack of root development indicates loss of vitality
Radiographs and Treatment
- Occlusal and periapical radiography helps to rule out any other injuries; two radiographs at different angles will help with diagonal fractures
- CBCT may aid treatment planning
- Do not splint non-displaced root fractures
- Treat coronal avulsion as per an avulsion
Injuries to PDL - Concussion
- Damage to the tooth and tooth supporting tissues with pain on percussion without increased tooth mobility or displacement
- No gingival bleeding
- There is TTP, no displacement or mobility, and usually positive sensibility testing
- Treatment is not required
- Soft foods are recommended for 1 week
- Good oral hygiene should be observed
- Requires clinical and radiographic follow-up at 4 weeks and 1 year
Subluxation
- Damage to the tooth and tooth supporting tissues, with pain on percussion and increased mobility, but without displacement
- Confirmed diagnosis requires gingival bleeding
- Clinical features: TTP, increased mobility, no displacement
- Sensibility testing initially negative indicating damage and the risk of pulpal necrosis
- Radiographic findings are normal
- Occlusal and periapical radiographs check signs of displacement or root fracture
- Soft foods are recommended for 1 week with good oral hygiene
- Treatment is not required, but a flexible splint may be applied for comfort for 2 weeks
- Clinical and radiographic follow-ups are done at 2 weeks for splint removal, 12 weeks, 6 months and 1 year
Extrusive Luxation
- Axial displacement of tooth out of the socket characterized by separation of PDL and alveolar bone is intact
- It is excessively mobile and also lacks response to sensibility testing
- Tooth can appear protrusive and retrusive
- In immature teeth, pulpal revascularization usually occurs, less likely in mature teeth
- Check signs of displacement or root fracture
- Radiographic findings show increased PDL space apically
- Treatment is LA, clean the root with saline, reposition the tooth, flexible splint for 2-4 weeks
- Patient should eat soft food for a week, brush softly and rinse with 0.1% CHX for good oral hygiene
- Requires clinical and radiographic follow-up at 2 weeks, 4 weeks, 8 weeks, 6 months and yearly for 5 years
Lateral Luxation
- Displacement of tooth out of the socket in a labial or palatal/lingual direction as it is forced to bone
- Accompanied by comminution or fracture of one side
- Clinical features: tooth displaced labial/palatal, premature contact/occlusal interference, high metallic sound on percussion, and usually non-mobile
- Radiographic findings show increased PDL space, and radiographs check for displacement or root fracture
- Perform surgical repositioning with splint, then rinse expose the root
- Requires clinical & radiographic follow-ups at 2-4 weeks, 8-12 weeks, 6 months, & yearly for 5 years
- Teeth with incomplete root formation means spontaneous revascularisation may occur
- Teeth with complete root formation means pulp necrosis will likely occur & RCT is indicated
Intrusive Luxation
- Defined as displacement of tooth into the alveolar socket accompanied by comminution or fracture of alveolar socket wall
- Clinical indications include a highly metallic ankylotic sound on percussion and mobility is decreased
- Absence/negativity from the pulp
- A lateral view will be taken if perforation is a concern
- The CEJ is located more apically in intruded tooth compared to adjacent tooth
- Treatment depends on the stage of root development and intrusion
Orthodontic Repositioning
- Cleaning area, adapting the steel arch wire, spot etching for enamel, fixation, and applying elastic traction
Surgical Repositioning
- Applying local anesthetic, using forceps, cleaning area
Avulsion
- Complete displacement of tooth out of socket where treatment will depend on maturity of root/condition of PDL
- Clinical feature - Socket may be empty or filled with blood clots
- Length of time out of mouth is a condition
- Viable PDL cells are kept in a storage medium
- Do not reimplant primary tooth
- Transport tooth in milk or saliva if not possible
- Treat the injured site/area depending on the tooth's condition
Avulsed Tooth Treatment
- If teeth are reimplanted into the wrong socket, reposition up to 48hrs after injury
- If the tooth has a closed apex, then RCT within 2 weeks
- If the tooth has an open apex, then monitor the tooth
- Dry time applies the same treatment in minutes
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