Permanent Trauma

Permanent Trauma

Crown Fracture
1. Enamel #
  1. Composite bandage/restoration
  2. Review
    1. 6-8wks, 1yr
  3. Bond tooth fragment
2. Enamel-dentine #
  1. Composite bandage
    1. Definitive composite restoration
    2. If close to pulp, place indirect pulp cap (setting CaOH)
  2. Review
    1. 6-8wks, 1yr
  3. Bond tooth fragment
3. Enamel-dentine-pulp #
  1. Closed apex
    1. RCT
      1. Extirpate within 7-10 days
  2. Open apex
    1. >24hrs
      1. Extirpate within 7-10 days + bandage
        wait 6m for apex to close
        RCT
        MTA plug
        RCT
    2. <24hrs
      1. Direct pulp cap
        Very small exposure
      2. Partial pulpotomy
        Setting CaOH (or MTA/Biodentine
  3. Review
    1. 6-8wks, 1yr
Periodontium Injury
1. Advice
  1. Soft diet
  2. Keep tooth clean
  3. Chx MW (0.1%)
  4. Painkillers
2. Concussion
  1. = TTP+ but not displaced or mobile
  2. No treatment
  3. Review
    1. 4wks, 6-8wks, 1yr
3. Subluxation
  1. = TTP+ & mobile but not displaced
  2. 2wk flexible splint
  3. Review
    1. 2wks
    2. 4wks, 6m, 6-8wks, 1yr
4. Avulsion
  1. EADT >60mins = Poor prognosis
    1. Ankylosis + replacement resoprtion will occur
      1. Infraposition
  2. Closed apex
    1. RCT
      1. Extirpate within 7-10 days
  3. Re-implant
    1. If dirty - wash for 10s in cold water/saline
    2. Best done immediately
    3. Storage - saliva, hank's solution, milk
  4. Open apex
    1. No RCT
      1. Hope for revascularisation
  5. 2wk flexible splint
  6. Amoxicillin 3xday, 5 days
  7. Check tetanus
  8. Review
    1. 2wks
    2. 4wks, 3m, 6m, 1yr, yearly
  9. Complications
    1. Ankylosis
    2. Pulp necrosis
    3. Root resorption
5. Extrusion
  1. Reposition
  2. 2wk flexible splint
  3. Review
    1. 2wks
    2. 4wks, 6-8wks, 6m, 1yr, yearly for 5yrs
  4. Complications
    1. No pulp revascularisation
      1. likely with closed apex
    2. Root resorption
  5. = tooth displaced occlusally
6. Intrusion
  1. Reposition
    1. Closed apex
      1. <3mm
        Spontaneous
        No movement in 2-4wks -> Surgical or Ortho
      2. 3-7mm
        Surgical or Ortho
      3. >7mm
        Surgical
      4. RCT
        Extirpate within 7-10 days
    2. Open apex
      1. <7mm intrusion
        Spontaneous
        No movement in 2-4wks -> Ortho
      2. >7mm
        Surgical or Ortho
  2. 4wk flexible splint
  3. = tooth displaced apically + alveolar #
  4. Review
    1. 2wks
    2. 4wks
    3. 6-8wks, 6m, 1yr, yearly for 5yrs
  5. Complications
    1. Pulp necrosis
    2. Root resorption
    3. Ankylosis
7. Lateral luxation
  1. = tooth displaced non-axially e.g. labial or palatal + alveolar #
  2. Reposition
  3. 4wk flexible splint
  4. Review
    1. 2wks
    2. 4wks
    3. 6-8wks, 6m, 1yr, yearly for 5yrs
Aveolar Process Fracture
1. = section of alveoalr bone # with group of teeth mobile together
2. Reposition
3. 4wk flexible splint
4. Review
  1. 4wks
  2. 6-8wks, 6m, 1yr, 5yr
5. Suture any gingival lacerations
Root Fracture
1. = horizontal or oblique # through root
2. Middle or Apical third #
  1. 4wk flexible splint
3. Cervical third #
  1. 4m flexible splint
  2. Worse prognosis
4. Reposition coronal part if displaced
5. Review
  1. 4wks, 4m
  2. 6-8wks, 6m,1yr, yearly for 5yrs
6. Complications
  1. Pulp necrosis
    1. RCT up to # line

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