5- traumatic luxations

Injury to a permanent tooth is dictated by…

Concern for vitality of PDL and pulp

Endo may be indicated if spontaneous pain, abnormal response to pulp sensitivity tests, lack of root formation, apexogenesis

May need to stabilise tooth with splint

What are 7 characteristics of an ideal splint?

Easily fabricated in the mouth without additional trauma

Passive unless orthodontic forces are intended

Allows physiologic mobility

Non-irritating

Doesn’t interfere with occlusion

Allows endodontic access and vitality testing

Easily cleansed and removed

Concussion- what, treatment, radiographic

Tooth tender to touch but not displaced- normal mobility, no sulcular bleeding

None- observe, careful when eating, prevent plaque- clean area with soft brush/cotton swab with alcohol free mouth rinse, apply chx gluconate topically 2x daily for 1 week

Only do if pathology present

Subluxation- what, radiographic recommendations and findings, treatment

Tender to touch AND increased mobility BUT not displaced, maybe bleeding in gingival crevice

Periapical (size 0) or occlusal (size 2) initially- normal to slightly widened pdl space

None- same as concussion

A passive/flexible splint used to stabilise tooth for up to 2 weeks- ONLY if excessive mobility or tenderness when biting

Extrusive luxation- what, radiographic, treatment depends on and is?

Partial displacement out of socket, tooth appears elongated and very mobile, possible occlusal interference

Periapical (size 0) or occlusal (size 2) initially, slight increase to very wide pdl space

Depends on degree of displacement, mobility, interference with occlusion, root formation and child’s compliance

If not interfering with occlusion- let it spontaneously reposition

If very mobile or extruded over 3mm- extract with LA

What is lateral luxation- what, radiographic, treatment if- minimal occ interference, severe displacement, unstable in new position, necrotic?

Tooth displaced, usually palatal/labial direction- immobile, possible occlusal interference

Periapical (size 0) or occlusal (size 2) initially, increase pdl space apically- better seen on occlusal esp if tooth displaced labially

Minimal/no occlusal interference- spontaneously reposition- occurs within 6 months

If severe displacement- under LA- extract if risk of ingesting tooth or gently reposition

If unstable in new position- flexible splint attached to adjacent uninjured tooth for 4 weeks

If pulp becomes necrotic- endo

Intrusive luxation- what, radiographic findings, treatment

Displaced through labial bone plate or can impinge on permanent tooth bud- almost/completely disappeared into socket, can be palpated labially

Periapical or occlusal initially-

When apex displaced toward or through labial plate- can see apical tip and tooth will appear shorter

Apex displaced toward permanent tooth germ- can’t see apical tip and tooth looks longer

Spontaneous reposition

Avulsion- what, radiographic findings, DONT, treatment depends on…

Tooth completely out socket, explore location of missing tooth, risk of embedded in lip, cheek or tongue, if tooth not found- refer to hospital

If tooth lost, xray ensures it not intruded

DONT REPLANT

Treatment depends on maturity of root and condition of PDL cells which depend on time out of mouth and medium in which it’s stored

After an extra alveolar dry time of 30 mins, most PDL cells are non viable

How can you classify an avulsed tooth in 3 groups before treatment?

PDL cells…

Most likely viable- planted immediately or within 15 mins at accident site

Viable but compromised- tooth kept in storage medium (milk, HBSS, saliva, saline) for under 60 mins

Non viable- extra oral dry time over 60 mins

What are the treatment guidelines for a avulsed permanent tooth with CLOSED APEX?- tooth replanted before clinic

Clean injured area with water, saline or chx

Verify correct position clinically and with x ray

Admin LA (no VC)

If tooth replanted in wrong socket or rotated- reposition within 48hrs

Suture gingival lacerations if present

Initiate RCT within 2 weeks

Admin systemic ATB

Check tetanus status

What are the treatment guidelines for an avulsed permanent tooth with CLOSED APEX?- tooth replanted in storage medium for less than 60 mins

Check avulsed tooth for surface debris- remove by gently agitating it in storage and rinse

Give LA without VC

Irrigate socket with sterile saline

Examine alveolar socket, if socket wall is fractured- reposition fractured fragment into og position

Remove coagulum with saline and replant tooth slowly with slight pressure

Stabilise tooth for 2 weeks with passive splint the RCT treatment

Why do avulsed tooth extraoral have poor long term diagnosis?

PDL becomes necrotic, can’t regenerate

May result in ankylosis related (replacement) root resorption

We can replant to temporarily restore aesthetics and function

What are the treatment guidelines for an avulsed permanent tooth with OPEN APEX?

Potential for spontaneous healing in forms of new ct with vascular supply- allow continued root dev

Only do endo if definite signs of pulp necrosis and infection

What appliances (other than education) can be used to prevent dental injuries?

Face guards- prefabricated cage attached to helmet

Mouth guards- absorb/deflect blows, shields from laceration, prevents opposing teeth violently contacting, support for mandible

3 types of mouth guards?

Stock prefabricated

Mouth formed

Custom made

Effects on permanent teeth any trauma in primary teeth