My Teeth Came Out Because of Traffic Accident

A 21 year-old man came to RSGM after s vehicle accident he experienced an hour ago. As a
result of this incident, the patients upper front teeth came loose and his next teeth felt rocking.
The loose teeth are brought by the patient soaked in bottle filled with water. The patient
wants treatment for his teeth.

Fracture in tooth 11 enamel-dentin structure

General condition: good

Pulse : 46x/minutes

RR : 25/menit

EO: no abnormallities

IO : 11, 21 avultion, bleeding +, region 12 fracture percussion +, second degree

STEP 1

STEP 2

1. What is the diagnosis of the scenario?

2. How the procedure for reimplantation of scenario?
3. What is the media storage for teeth?
4. How manage the case of the scenario?
5. Explain the success factor of the treatment!
6. What is the clinical examination of the scenario?
7. Explain about process healing to tissue in this scenario?
8. How long golden period in the avultion?
9. Intruction and education after treatment?
10. Explain about kind of trumatic dentoalveolar in tissue!

STEP 3

1. What is the diagnosis of the scenario?

Diagnosis :
21 is avultion is displacement of the teeth from socket because of trauma (fracture
ellis class V)

11 fracture ellis class II (fracture enamel-dentin)

2. What is the clinical examination of the scenario?

- Condition of socket (palpation,
- Inspection : laseration of the gingiva
- without blood (darah menggumpal),
- alveolar bone in a good condition, no fracture
- anamnesa for know cause avulsion and how long came out teeth from socket
 - radiographic to see condition of alveolar bone, to help operator to treatment
planning in tis case
EO :
- check the abnormalities of TMJ (auskultasi, sound clicking), head,
- check inflamation of nodus limfa
- check condition open-close mouth use sliding caliper measure of
- Vital sign (blood pressure, respiratory rate, temperature)
- Any laseration in mouth or skin
3. What is the media storage for teeth?
- HBSS : Hanks Balance Salt Solution, biocompatible
- Milk (susu pasteurisasi) : no sugar
- Saliva : save in the room temperature
- Saline : solution contain 0,9% NaCl
- Coconut water : help survival for periodontal ligament because contains protein,
asam amino and mineral, advantage more cheap and easy to get, same with HBSS
(to help viability cell)
- Water : pH 5-7 so ligament periodontal cell still alive (no smell, no taste, no color)
4. How long golden period in the avultion?
- 2 hours after trauma : not be good condition
- 30 minutes : 90% success and more long time will be down, socket stay moist
because if socket dry make alveolar bone wrinkle
- If more than 2 hours prognosis will be worse causes ankilosis
5. Explain about kind of trumatic dentoalveolar in tissue!
- Luxation : teeth rocking
1 degree : mesial-distal luxation
2 degree : 2-3 bagian
3 degree : >60 degree shake atau 4 bagian
- Extrution : teeth out a little to socket
- Intrution : teeth get in to socket
- Rotation : teeth rotate
- Avulsion : teeth loose from the socket, we not allow hold on apex because can kill
tissue cells in root
- Version : base on teeth (palatoversi, labioversi)
6. How the procedure for reimplantation of scenario?
- Anamnesa : to know causes avulsion, how long the teeth loose from trauma so we
can menentukan treatment planning
- Radiograpic : to know the condition of alveolar bone
- Patient teeth save in the saline, operator not allow hold on apex
- Operator washing teeth but not rub it
- Endodontic treatment
- Teeth replace to the socket with soft massage, occlusion maxillary and
mandibulary to prevent loose teeth
- Counting long of teeth to splinting with matrix band, abutment teeth in the case is
13,12, 22, 23
 - Aplication etsa in the teeth and wash
- Aplication bonding agent and curing (20 seconds)
- Aplication flowable composite in the teeth and fiber, then curing
- Lapisi kembali dengan flowable composite
- Checking occlusion
- Finishing and polishing
7. Explain the success factor of the treatment!
8. Explain about process healing to tissue in this scenario?
9. Intruction and education after treatment?

STEP 4

STEP 5

1. Explain about kind of trumatic dentoalveolar in tissue!

2. What is the clinical examination of the scenario?
3. How the procedure for reimplantation of scenario with KIE?
4. Explain the success factor of the treatment!
5. Explain about process healing to tissue in this scenario!
6. Hadist