1. BY THE NAME OF ALLaH

2. Trauma management (4)

3. Complication in endodontic management of avulsed teeth:
1- External inflammatory root resorption
The progressive loss of tooth structure by an inflammatory process caused by the presence of infected and necrotic debris in the root canal.
This resorption can be prevented or managed with appropriate treatment:
A- Prophylitic antibiotics: high-dose, broad spectrum antibiotics (amoxicillin) should be ginen as soon as possible after avulsion and continued for 2 weeks.

4. B- Pulp extirpation: this should be completed as soon as possible after the replantation.
Avoid medicaments that may cause inflammation, such as calcium hydroxide, in the first 3 months after trauma. Ledermix paste is an ideal first dressing medicament as it has been shown to prevent inflammatory root resorption.
Management:
1-the canal must be re-instruminted and dressed with ledermix paste for 3 months, but changing the dressing every 6 weeks.
2-Calcium hydroxide can then be placed for a further 3 months after which time.
3- if there is no progression of the resorption, the canal can be filled.

6. 2- External replacement root resorption:
this is the progressive resorption of tooth structure, and replacement with bone.
It cannot be treated, so the aim must be to prevent replacement resorption and subsequent ankylosis. Factors in prevention and management include:
A- Extra-oral time: prognosis decreases dramatically after 15 minitues if tooth is dry. 50% of periodontal ligament cells are dead after 30 minutes. All are dead after 60 minutes.

7. B- Storage media: milk is the best medium and may keep cells viable for up to 6 hours. It has the advantage that it is pasteurized, with few bacteria, is readly available and is cold. Saliva is suitable for up to 2 hours, saline for 1 hrs. water is hypotonic and causes cell lysis.
C- Mechanical damage: ankylosis will result if > 2 mm of cementium has been removed or damaged.
D- Splinting: flexible splinting allows physiological movement and result in less ankylosis and replacement resorption.

9. ** future options for management of resorption
Emdogin: the use of enamel matrix protein derivatives has been proposed in the management of avulsed teeth.
The enamel matrix derivative composed of amelogenesis has a key role in a both enamel formation and the development of a cellular cementum.
Alendronate: this is another topical agent that may show promise.
Both this products may allow regeneration of the periodontal ligament and inhibit or prevent replacement resorption that is the major cause of tooth loss after avulsion.

10. **Auto-transplantation
Has been successfully used in the management of tooth loss following trauma.
Indications:
- management of complicated crown/root fractures.
-traumatized anterior tooth with poor long-term prognosis.
-after avulsion injuries.

11. b-lower 1st premolar upper central incisor
** procedures :
1-selection of donor tooth
donor tooth recipient site
a- 3rd molars st molars
b-lower 1st premolar upper central incisor
c-lower 2nd premolar upper lateral incisor
d-lower incisors upper lateral incisor
e-supernumerary tooth upper incisors

12. a-size & shape of recipient area. b-need for socket expansion.
2- analysis of recipient site:
a-size & shape of recipient area.
b-need for socket expansion.
3- surgical procedure:
a-remove traumatized incisor.
b-prepare socket :
I-socket can be enlarged if required.
II- removal of any necrotic debris (gutta percha ) , intracanal medicament , or granulation tissue.
III- irrigation of socket with saline.

13. c-extract donor’s tooth :
d- position donor tooth into recipient site with rotation 45 degree .
e- splint with flexible splint &follow up .
f- need for endodontic treatment depend on root development .

15. 1-inflammatory or replacement ankylosis. 2-pulp necrosis .
** signs of failure :
1-inflammatory or replacement ankylosis.
2-pulp necrosis .
4-incomplete root formation .

16. Bleaching must be carried out under rubber dam.
** bleaching of non-vital incisors: one consequence of loss or trauma is tooth discoloration. Bleaching is a common procedure following root canal treatment.
Method:
Bleaching must be carried out under rubber dam.
Ensure adequate root canal obturation and remove gatta-percha to a level 3 mm below the cementoenamel junction.
Place a zinc phosphate just above the cementoenamel junction.
Ensure that the access cavity is clean and free of all debris.

17. Acid etch the access cavity to open dentinal tubules and place cotton pellet in 30% hydrogen peroxide into the access cavity for 3 minutes.
Remove the cotton pellet and place a mixture of sodium perborate and hydrogen peroxide into the cavity and seal with a cotton pellet and temporary sealer.
After 1 week , the pulp chamber is filled with a glass ionomer base and the access cavity restored with composite resin.

18. soft tissue injuries

19. 1- Alveolar mucosa and skin
A- bruising
The simplest and most common type of soft tissue injury. This will often be present without any dental involvement. Treatment is symptomatic.

20. B- Laceration:
Carful suturing of skin wounds within the first 24 hours will be needed to avoid scarring.
Muscle closure and deep suturing is achieved with a fine re-sorbable material.
Final skin closure is with 6-0 monofilament nylon on a cutting needle.

21. One of the most common injuries.
2- Attached gingival tissues
Degloving
One of the most common injuries.
A full-thickness mucoperiosteal flap is stripped off the bone, the separation line usually being the mucogingival junction .
The flap is tightly sutured and a pressure dressing placed if the lower arch is involved. This prevents the swelling in the submental region, which may embarrass the airway.

23. Seat belts and child restraints. Helmets for bike riding.
Prevention:
Education of parents:
Seat belts and child restraints.
Helmets for bike riding.
Mouth guards.
Supervision of pets, especially dogs.
Education parents and teachers about primary care for dental trauma is essential. The correct protocols for dealing with avulsed teeth should be available to all schools.

24. ” الحمد لله الذي هدانا لهذا وماكنا لنهتدي لولا أن هدانا الله ”
THANKS FOR YOUR ATTENTION
” الحمد لله الذي هدانا لهذا وماكنا لنهتدي لولا أن هدانا الله ”