Clinical Dentistry 3- Traumatic Injuries to Permanent Teeth

max incisors

which teeth are most commonly injured

pulp test

you should .... following trauma to a tooth as a baseline, however its not always immediately accurate

3

pulp testing is considered accurate ... months following trauma

modality of choice

CBCT is the imaging ..... for most dental diagnosis including trauma

75

crown fractures make up ....% of tooth fractures

complicated

a crown fracture that includes the pulp is considered to be ...

uncomplicated

a crown fracture that does not include the pulp is considered to be ...

pulp chamber; root development

in the PA to diagnosis an uncomplicated crown fracture it is important to evaluate the size of the ... and stage of the ....

no

will an uncomplicated or complicated crown fracture be sensitive to percussion

no

is an NS-RCT needed to treat an uncomplicated crown fracture

24; PDL

you should pulp cap a complicated crown fracture when:

- Short exposure period after trauma (<.... h)

- Small exposure

- Not associated with .... injury

Ca(OH)2; MTA

to pulp cap after a complicated crown fracture, cover the pulp with ..... or .... and restore the tooth

cementum

a crown root fracture involves the enamel, dentin, and ....

2

in diagnosis of a crown root fracture you need ....+ PA radiographs

immature

when treating a crown root fracture pulp capping or pulpotomy is acceptable for an .... tooth

pulp

a root fracture involves dentin, cementum, and ....

no

is the apical segment usually displaced in a root fracture

apical 1/3

in what segment of the tooth root is the prognosis of a root fracture the best

cervical 1/3

in what segment of the tooth root is the prognosis of a root fracture the worst

angles

diagnosis of a root fracture requires 2+ PA radiographs taken at different ...

4; 4

a root fracture can be treated with a splint for .... weeks (apical or middle 1/3) or up to ..... months (coronal third)

pulp necrosis

a root fracture can be treated with NS-RCT if .... occurs

25

...% of root fractures will develop pulp necrosis

alveolar fracture

if when the mobility of one tooth is tested and several move, this is associated with an ...

4

to treat an alveolar fracture reposition and then splint involved teeth with a flexible splint for ... weeks

concussion

which type of traumatic luxation injury:

- No displacement

- No mobility

- Usually sensitive to percussion and/or

tender to touch

Treatment:

- Flexible splint is optional - can be

used for the comfort of the patient for 7-10 days

subluxation

which type of traumatic luxation injury:

- Tooth is tender to touch and mobile,

but not displaced

- Hemorrhage from gingival sulcus

possible

Diagnosis:

- 2+ PA radiographs

- No radiographic abnormalities

Treatment:

- Flexible splint is optional

- splint for 2 weeks using a flexible splint up to .4mm

extrusion

which type of traumatic luxation injury:

- Elongated, mobile tooth

- Partial displacement of the tooth out

of socket.

- Angulated radiograph: increased PDL space apically

Treatment:

- Reposition

- Stabilize tooth with flexible splint for

1-2 weeks

2

you should splint an extrusion for .... weeks

lateral luxation

which type of traumatic luxation injury:

- Displacement of a tooth buccally or lingually

- Usually accompanied by fracture of socket

- Usually locked into bone

- Not tender to touch, not mobile

Diagnosis:

- 2+ angulated PA radiographs

Treatment:

- Reposition the tooth into normal

position

- Confirm with radiograph

- Stabilize tooth with a flexible splint for 1-2 weeks

- Follow up

- Necrotic? → NS-RCT

2

you should splint an lateral luxation for .... weeks

intrusion

which type of traumatic luxation injury:

- Apical displacement of tooth into the alveolar bone

- Tooth is driven into the socket, compressing the PDL

- Tooth appear to be shortened or missing

- Severe type of luxation injury

Treatment:

- Reposition the tooth with orthodontic or surgical extrusion

- Prognosis is poor

- High rate of Pulp Necrosis (96%)

and Root Resorption

- Initiate endodontic treatment at 2 weeks

- Recommend Ca(OH)2 for up to 4

weeks

poor

the prognosis of an intruded tooth is ...

2; 4

on an intruded tooth initiate endodontic treatment at ... weeks and use Ca(OH)2 for up to .... weeks

4

you should splint an intrusion for .... weeks

avulsion

what type of traumatic injury:

- The tooth is separated from socket

completely

- PDL torn

extra alveolar time

.... in the most critical factor in avulsion injury healing

ankylosis

extra alveolar time causes the PDL cell to dry out and causes an inflammatory response to the tooth and .....

propolis

what is the best storage media for an avulsed tooth

milk

what is the best most readily available storage medium for an avulsed tooth

crown

if an tooth is avulsed, the patient should handle the tooth by the .... only

dirty

the patient should rinse an avulsed tooth only if its ... without scrubbing or scraping

no

should you curette the socket of an avulsed tooth

revascularization

an avulsed tooth with <60 minutes extraoral time and an open apex:

- the main goal is .... of the pulp

1-2

an avulsed tooth with <60 minutes extraoral time and an open apex:

- after replanting the tooth, splint for ... weeks with a flexible wire with a diameter up to 4 mm

pulp necrosis

an avulsed tooth with <60 minutes extraoral time and an open apex:

- only perform NS-RCT if there is ...

NS-RCT; Ca(OH)2

an avulsed tooth with <60 minutes extraoral time and an closed apex:

- always begin ..... within 7-10 days

- this perform in 2 visits with ..... placed inbetween

1-2

an avulsed tooth with <60 minutes extraoral time and an closed apex:

- splint for .... weeks

nsrct; closed

- the main difference between management of an avulsed tooth with an extra-alveolar time <60 minutes with an open vs closed apex is ... is always required for a .... apex.

- replantation, splinting, and antibiotics are otherwise the same

60

an avulsed tooth with an extraoral time >.... minutes will have a poor long term prognosis

ankylosis; resporption

an avulsed tooth with an extraoral time >60 minutes has an expected outcome of .... related root ....

esthetics; function

the treatment of an avulsed tooth with an extraoral time >60 minutes has the main goal of restoring ... and ....

1-2

an avulsed tooth with >60 minutes extraoral time and an open apex:

- splint for ... weeks

- administer antibiotics for 7 days

4-6

an avulsed tooth with >60 minutes extraoral time and an closed apex:

- splint for .... weeks with a flexible wire with a diameter up to 4 mm

- always begin NS-RCT within 7-10 days

- this perform in 2 visits with Ca(OH)2 placed inbetween

doxycycline; penacillin

an avulsed tooth may include adjunct medication of:

- .... 2x/day for 7 days at appropriate dose for patient age and weight

- ..... VK 500 mg q6h for 7 days

nylon fishing line (.13-.25 mm)

what is an alternative to flexible wire in splinting a tooth

1-2

obturation of an avulsed tooth should have Ca(OH)2 in place for .... months

30

<.... minutes extraoral time for an avulsed tooth has the best prognosis

transport conditions

what is the 2nd most important factor in the prognosis of an avulsed tooth

time before endo treatment

what is the 3rd most important factor in the prognosis of an avulsed tooth

7-10

when an avulsed tooth requires RCT, it should be initiated within .... days

splinting technique

what is the 4th most important factor in the prognosis of an avulsed tooth

stage root development

what is the 5th most important factor in the prognosis of an avulsed tooth

root surface treatment

what is the 6th most important factor in the prognosis of an avulsed tooth

intrusion with closed apex

what luxation injury has the worst prognosis (about 0%)

yellow

.... discoloration is common in teeth with pulp obliteration

asymptomatic

>2/3 of teeth with pulpal obliteration are ....

1-27

The incidence of pulp necrosis following PCO is variable ranging from .....%, but is generally considered low

periapical

RCT is indicated for PCO when there are clinical symptoms and/or definite

radiographic findings suggestive of ..... disease

nonvital bleaching

If RCT is required after pulp canal obliteration and there are aesthetic concerns, a ..... technique can be considered

surface

what type of external root resorption:

- Localized injury to cementum (Concussion, Subluxation)

- Local inflammatory response

- Periodontal healing and root surface

repair will occur within 14 days

- May or may not be radiographically

visible

- No treatment is required

concussion; subluxation

what 2 injuries are associated with surface resorption

inflammatory

what type of external root resorption:

- Damage of the periodontium

- Bacteria within tubules

- 2-visit NS-RCT with Ca(OH)2 can

arrest resorptive process and

promote healing

replacement

what type of external root resorption:

- Severe damage to the periodontium (Intrusion, Avulsion)

- “Fusion” of the tooth root with the

adjacent alveolar bone

Diagnosis:

- Tooth is immobile

- High percussive tone

- No visible PDL space

Treatment:

- Cannot be arrested or repaired

- Survive for a number of years

intrusion; avulsion

what 2 injuries are associated with replacement resorption