Soft tissue and dentoalveolar injuries

abrasion

injury caused by friction between object and soft tissue

Abrasion

key features:

surface wound, bleeding capillaries, iatrogenic

saline rinses

copious irrigation

what is the treatment for abrasion injuries?

contusion

key features:

tissue disruption, submucosal hemorrhage without break in tissue surface

None, but apply ice or pressure

tx for contusion?

laceration

key features:

tear in the sub/epithelial tissues

Laceration

most frequent type of soft tissue injury

1 layer (mucosal)

how many layers are sutured in gingival laceration?

1 layer (mucosal)

how many layers are sutured in alveolar mucosa laceration?

1 layer (mucosal)

how many layers are sutured in floor of the mouth laceration?

2 layers (muscle, mucsal)

how many layers are sutured in a tongue laceration involving the muscle?

3 layers (oral, muscle, dermal)

how many layers are sutured in a laceration of entire thickness of the lip?

1. sutures will loosen

2. sutures will be harder to close

what are the consequences in laceration injuries if hard tissue injuries are not treated first?

1. cleansing

2. debridement

3. hemostasis

4. closure

what are the 4 major steps of managing laceration injuries?

uncomplicated crown fracture

crown fracture that does not expose the pulp

complicated crown fracture

A fracture of the crown that exposes the pulp

ellis class I

enamel fracture

ellis class II

crown fracture (enamel, dentin)

ellis class III

enamel, dentin, pulp fracture

ellis class IV

CEJ fracture (nonvital tooth, discolored)

ellis class V

avulsed tooth

ellis class VI

fractured root (with or without crown involvement)

ellis class VII

luxation injuries (tooth displacement without fracture)

ellis class VIII

complete crown loss (fracture of the crown en masse)

ellis class IX

traumatic injuries of primary teeth

1. VRF

2. Mobility grade III

3. Furcal lesions

4. External root resorption

5. Non-strategic tooth

what are the indications for direct extraction of teeth?

open apex/immature root - tooth can still recover

closed apex/mature root - lesser chance of regeneration

what is the prognosis for open/closed apex?

non-strategic tooth

any useless teeth that are deemed nonrestorable

concussion

tooth damage w/o injury to the supporting structures, so tooth is not loosened nor displaced

dis-occlude

what is the treatment for concussed tooth?

subluxation

tooth damage with injury to supporting structures, so tooth is loosened but not displaced

splint for 2 weeks

tx for subluxated teeth?

crown haze

are usually limited to enamel and does not reach the DEJ, and can lead to extrinsic staining

- smoothen sharp edges

- reshape with composite resin

tx for ellis class I fracture?

- seal dentinal tubules

- promote secondary dentin deposition

tx for ellis class II fracture?

- pulpotomy

- pulpectomy

- rct

tx for ellis class III fracture?

1. small exposure

2. px is seen soon after injury

3. no root fractures

4. tooth not displaced

5. no deep or large fillings that indicate chronic inflammation

what are the 5 indications for pulp capping?

indirect capping

between direct and indirect capping, which has better prognosis?

exposure is due to mechanical, accidental, and small in a clean environment

what is the best scenario/situation for a pulp cavity exposure?

remove to assess depth of fracture

tx for coronal fragment still in place?

same with crown fracture management (smoothen sharp edges, composite resin)

tx for crown-root fractures not deep w/o pulp exposure?

RCT

tx for crown-root fractures with pulp involvement and tooth is restorable?

EXO

tx for crown-root fractures with pulp involvement and tooth is not restorable?

delay exo for several weeks to permit fracture to heal

tx for crown-root fracture w/ alveolar fracture?

position of fracture in relation to gingival crevice. closer to crevice, poorer prognosis

what is the determining factor of horizontal root fractures?

cervical 3rd

tx - remove fragment, RCT, post and core

which horizontal root fracture has the worst prognosis? tx?

reposition and immobilization

tx for HRF at middle third

apical 3rd

tx - reposition and immobilization

which HRF has the best prognosis? tx?

intrusion

socket sustained compression fracture causing new tooth position

if minimal, allow to re-erupt

if not minimal, orthodontic/surgical repositioning

tx for intrusion of permanent teeth?

if touching permanent follicle, remove atraumatically

if not touching, just observe

tx for intrusion of temporary teeth?

extrusion

displacement of the tooth out of its socket

1-3 weeks

how long are recently extruded teeth splinted for?

reposition and splint

tx for minimal lateral displacement? (slight displacement w/o alveolar fracture)

reposition tooth and bone, splint, and suture

tx for severe lateral displacement? (severe displacement w/ alveolar fracture)

avulsion

complete displacement of the tooth out of its socket

TIMEEEEEEE

what is the most important factor in avulsed teeth?

water (hypotonic; cell lysis)

what is the least desirable storage medium for avulsed teeth, why?

incompatible osmolality, pH, bacteria

why is saliva not ideal as a storage medium for avulsed teeth?

milk

best alternative for storing avulsed teeth?

hanks balanced salt solution

the most ideal storage medium of avulsed teeth