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Examination and diagnosis Consider traumatic injuries as emergency, To relieve pain. Reduce psychological stress. Facilitate reduction of # or avulsion. For good prognosis.
Class 2 Fracture
Expose Dentine Dentine is more yellow compared to the peripheral enamel Patient feels thermal/tactile sensitivity
Complicated Fracture
Class III Fracture Fracture involves enamel and dentin and the pulp is exposed. The 3 angulations described in radiographic examination In young patients with immature (open apex) preserve pulp vitality : local anaesthetic pulp capping : pin piont expose
Mature teeth (close apex) : local anaesthetic Direct pulp capping : pin point exposure not more than 24 h Pulpectomy / vital Root canal treatment Restoration: temporary restoration or reattached fracture fragmen
Komposite masukkan crown form sedikit2 = gelembung udara Crown form+isi diselubungkan disinar Resin berlebih(lubang/cervikal) diambil Mahkota dibuka, iris bagian lingual (skalpel) Cek gigitan poles
Ad. SSC
Pilih ssc (size, form) disesuaikan bag. Cervic Prep = perlu kecuali kontak prox perlu bebas sedikit email di prox diambil Buat jendela di labial Mahkota disemen isi jendela dgn komposite SSC perlindungan max = tumpatan sementara of choice
Tumpatan sementara dibiarkan > 8 minggu = waktu yang perlu untuk pulpa menjadi normal
Class IV fracture
Emergancy treatment : Periodontitis : root canal treatment reduce occlusion Abscess :
Acute : drainage from pulp chamber keep it open for 24h antibiotic Cronic : root canal treatment
Emergency Treatment
Replantation technique
Local anesthetic, if necessary Radiograph to verify position Check occlusion Physiologic splint
Emergency Treatment
Additional Considerations
Analgesics
Emergency Treatment
Additional Considerations
Analgesics Chlorhexidine
Emergency Treatment
Additional Considerations
Analgesics Chlorhexidine Tetanus
Rothstein RJ, Baker FJ. Tetanus: Prevention and treatment. J Am Med Assoc 1978;240:6756.
Emergency Treatment
Additional Considerations
Analgesics Chlorhexidine Tetanus Antibiotics
Antibiotics
Penicillin
500 mg qid for 4-7 days
Andreasen JO. Atlas of replantation and transplantation of Philadelphia: W.B. Saunders Co., 1992;57- 92. teeth.
Remove tissue tags Soak in accepted dental fluoride solution for 20 min
Fluoride Treatment
1.0-2.4% topical fluoride solution
Sodium fluoride (Andreasen) Stannous fluoride (Krasner)
20 minute soak
Titanium Trauma Splint (TTS) Ortho wire with brackets Ortho wire with unfilled resin Monofilament line with unfilled resin Unfilled resin Suture(s) Ribbond
Monofilament line
Ribbond
Antrim DD, Ostrowski JS. A functional splint for traumatized teeth. J Endodon 1982;8:328-31.
Cross-Suture Splint
Indications
No adjacent teeth to splint to Unmanageable traumatized children
Cross-Suture Splint
Splinting Time
Effect of splinting time
7 days 30 days
The effects of different splinting on replantation of teeth in monkeys. Oral Surg 1982;53:557-66.
Splinting Time
Recommended time
7 to 10 days
The effects of different splinting on replantation of teeth in monkeys. Oral Surg 1982;53:557-66.
Class VI Fracture
Root fracture The coronal segment may be mobile and may be displaced. The tooth may be tender to percussion. monitoring the status of the pulp is recommended. Transient crown discoloration (red or grey) may occur
Emergency Management
Reposition coronal fragment
Emergency Management
Previous recommendation
Rigid splinting for 2-3 months
Emergency Management
Previous recommendation
Rigid splinting for 2-3 months
New recommendation
Splinting for 3 weeks
Class VII
Subluxation Definition: injury to tooth-supporting structures with abnormal loosening but without tooth displacement. Th/ : Permanent teeth: Stabilize the tooth and relieve any occlusal interferences. For comfort, a flexible splint can be used. Splint for no more than 2 weeks.
Lateral luxation Definition: displacement of the tooth in a direction other than axially. The periodontal ligament is torn and contusion or fracture of the supporting alveolar bone occurs Emergancy treatment for Permanent teeth:
-
Local anasthetic to reposition as soon as possible and then to stabilize the tooth in its
Intrusion Definition: apical displacement of tooth into the alveolar bone. The tooth is driven into the socket, compressing the periodontal ligament and commonly causes a crushing fracture of the alveolar socket Emergency treatment: - For immature teeth with more eruptive potential (root to / formed): Clean the wound with NaCl, H2O2
In mature teeth: Clean the wound with NaCl, H2O2 and anticeptic solution Local Anesthetic reposition the tooth with orthodontic or surgical extrusion (local anesthetic if nescessery) stabilize the tooth with a splint for up to 4 weeks in its anatomically correct
Extrusion Definition: partial displacement of the tooth axially from the socket; partial avulsion. The periodontal ligament usually is torn Permanent teeth:
-
Clean the wound with NaCl, H2O2 and anticeptic solution Give Local Anesthetic. Using fingers, grab extruded teeth and surrounding alveolus then
Clean wound Local Anesthetic If the pulp is exposed, pulpal treatment alternatives are pulp capping, pulpotomy, and root canal
Emergency Treatment for dental trauma in primary Crown fracture with pulp involvement (vital) Teeth
Clean wound Local Anesthetic Perform Pulpotomy or pulpectomy Root fracture Apical third : observation Cervical third and midle third : Local anasthetic Extraction
Crown/root fracture : Local anesthetic The entire tooth should be removed unless retrieval of apical fragments may result in damage to the succedaneous tooth
Displacement
Lateral luxation Primary teeth:
-
to allow passive or spontaneous repositiong if there is no occlusal interference. When there is occlusal interference, local anestheticthe tooth can be gently repositioned or slightly reduced if the interference is minor.
Intrusion : Reeruption spontaneuly Dammage to premanent teeth extraction Extrusion Local Anesthetic reposition spontaneously or reposition and allow for healing for minor extrusion (<3 mm) in an immature developing tooth.