Traumatic Dental Injuries

Traumatic Dental Injuries
Endodontic Management Dents 428/QP428 UWO January 24,2005

Manual. 2nd Edition Andreassen, Bakland and Flores. 2003 Treatment of Traumatic Dental Injuries A.A.E 2004

Examination and Diagnosis Radiographic Follow up Classification Treatment Priorities

Splinting Endodontic Implications Tooth Survival after Trauma

Avulsion

Examination and Diagnosis Clean the area Time of injury Consciousness Medical History Clinical and X-Ray Examination

Examination and Diagnosis

Radiographic Follow up

Classification Injuries to Hard Dental Tissues and The Pulp Injuries to the Tooth and/or Alveolar Process Injuries to Periodontal Tissues

Classification Injuries to Hard Dental Tissues and The Pulp Enamel Infraction Enamel Fracture Enamel-Dentin Fracture Complicated Crown Fracture

Classification Injuries to the Tooth and/or Alveolar Process Root Fracture Fracture of the Alveolar Socket Wall Fracture of the Alveolar Process

Classification Injuries to Periodontal Tissues Concussion Subluxation Extrusive/Intrusive Luxation Lateral Luxation Avulsion

Crown Fracture Without Pulp Exposure Enamel Infraction Enamel Fracture Enamel-Dentin Fracture

Crown Fracture Without Pulp Exposure

Crown Fracture Without Pulp Exposure Expected Outcome for Pulp and PDL Close to 100 % Monitor for 2 months.

Crown Fracture With Pulp Exposure

Crown Fracture With Pulp Exposure Very high success of Pulp Capping and Pulpotomy Hard tissue barrier at 3 months on X-Ray Follow up for 1-5 years.

Crown-Root Fracture

Crown-Root Fracture Restorability ?? Immediate or delayed treatment Ortho Extrusion 4-6 weeks Surgical Extrusion Splint to alleviate discomfort or mobility. 4 weeks

Root Fracture

Root Fracture Optimal reposition is essential Different angles X-Rays Semi-rigid splinting 3-4 weeks Pulp Outcome: higher in open apexes

Fracture of the Alveolar Process

Fracture of the Alveolar Process Pulp Outcome: Pulp necrosis is a frequent finding. PDL Outcome: Root resorption is a rare finding Reposition under L.A. Tooth alignment Rigid or semi-rigid splint for 3-4 weeks Monitor for more than a year.

Concussion

Concussion Occlusal adjustment Soft diet for 2 weeks Follow up at 6 weeks and one year. Pulp and PDL high outcome.

Subluxation

Subluxation Occlusion adjustment Soft diet for 2 weeks Pulp outcome higher in open apexes PDL high outcome

Extrusive Luxation

Extrusive Luxation Gentle reposition Non rigid splint Control X-Ray Recall 2-3 weeks RCT if apexes are closed. Pulp outcome poor in closed apexes Canal obliteration in open apexes PDL: Surface or inflammatory resorption

Lateral Luxation

Lateral Luxation Unlocking and reposition of the tooth under L.A. Occlusion and X-Ray Splint for periods of 3-4 weeks Pulp outcome better in open apexes but longer follow up required. Close apexes: RCT prior splint removal. Inflammatory and replacement resorption

Intrusive Luxation

Intrusive Luxation Open apexes: Tooth loosened to facilitate re-eruption Ortho extrusion within 3 weeks after injury and follow up Closed apexes: Ortho and/or Surgical extrusion* Splint for 4-8 weeks RCT

Avulsion

Avulsion Minimize extra oral time If contaminated 10 sec. rinse Store it in HBSS, Milk or inside the mouth Age (adult: use fluoride solution 2 NaF for 20’) RCT extra oral ?? Carious destruction Perio support Medical History

Avulsion Rinse with S.S. both socket and root surface Replant tooth gently with digital pressure Semi-Rigid splint 1 weeks Antibiotic coverage 1 week Tetanus prophylaxis recommended Ca(OH)2 and RCT X-Ray control at 3 weeks 2,6, 12 months and yearly for 5 years.

Avulsion Success depends on Extra oral time, Storage and root development.

Treatment Priorities Acute Approach Tooth Avulsion Alveolar Fracture

Treatment Priorities Acute Approach Extrusion Lateral Luxation Root Fracture

Treatment Priorities Sub-Acute Approach Intrusion Concussion Subluxation Crown Fracture with Pulp Exposure

Treatment Priorities Delayed Treatment Crown Fractures without pulp exposure.

Splinting

Endodontic Implications of Dental Trauma Pulp and PDL

Endodontic Implications of Dental Trauma Pulp and PDL Bacterial Control will determine success Constriction development will determine therapeutics Ankilosis can jeopardize the prognosis Resorption will not stop if Bacteria still present Ca(OH)2 from one week to several months

Endodontic Implications of Dental Trauma Pulp Therapy

Endodontic Implications of Dental Trauma Root Fractures

Endodontic Implications of Dental Trauma Apexification

Tooth Survival Crown Fx, Concussion,Subluxation,Extrusion and Lateral Luxation have the best survival rate.

Tooth Survival

Traumatic Dental Injuries

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