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Emergancy Treatment Of Dental trauma in Children

Examination and diagnosis Consider traumatic injuries as emergency, To relieve pain. Reduce psychological stress. Facilitate reduction of # or avulsion. For good prognosis.

Uncomplicated Crown Fracture Class 1 Fracture
If <2mm tooth structure is missing, no intervention is necessary No Emergancy treatment

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

Mahkota PilihSeluloid crown form: patokan size & bentuk gigi sama pada kuadran ber><an Gunting bgn cervix crown form sesuai gingival margin  1mm dibwh free gingival margin Buat 2 lubang di lingual pd 1/3 bag.Ad. Incisal  kelebihan komposite & udara dpt keluar Etch .

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. 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” . SSC Pilih ssc (size. form)  disesuaikan bag.

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 ● .

Management of the Avulsed Tooth / Class V fracture .

Management of the Avulsed Tooth Ultimate goal PDL healing without root resorption Most critical factor Maintaining an intact and viable PDL on the root surface .

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 .

. Tetanus: Prevention and treatment.240:6756.Emergency Treatment Additional Considerations Analgesics Chlorhexidine Tetanus ● Refer to physician for tetanus prophylaxis prn Rothstein RJ. Baker FJ. J Am Med Assoc 1978.

Emergency Treatment Additional Considerations Analgesics Chlorhexidine Tetanus Antibiotics .

teeth. .57. Saunders Co..92. 1992.B. Atlas of replantation and transplantation of Philadelphia: W.Antibiotics Penicillin 500 mg qid for 4-7 days Andreasen JO.

Hank’s Balanced Salt Solution Proper pH and osmolality Reconstitutes depleted cellular metabolites Washes toxic breakdown products from the root surface .

Socket (immediate replantation) 2.Recommended Storage Media 1. Cell culture medium 3. Milk 4. Physiologic saline 5. Saliva .

Root Surface Manipulation Extraoral dry time determines handling .

Root Surface Manipulation Extraoral dry time < 1 hr PDL healing is still possible Handling recommendations ● Keep root moist Do not handle root surface Gentle debridement ● ● .

Root Surface Manipulation Extraoral dry time > 1 hr Loss of PDL cell viability inevitable Treatment recommendations ● ● Remove tissue tags Soak in accepted dental fluoride solution for 20 min .

4% topical fluoride solution Sodium fluoride (Andreasen) Stannous fluoride (Krasner) 20 minute soak .0-2.Fluoride Treatment 1.

Management of the Socket Remove contaminated coagulum in socket Irrigate with sterile saline .

Management of the Socket Examine socket  If fracture is evident Reposition fractured bone with a blunt instrument .

Management of the Socket Replant using light digital pressure .

Types of Splints (flexible/physiologic) • • • • • • • Titanium Trauma Splint (TTS) Ortho wire with brackets Ortho wire with unfilled resin Monofilament line with unfilled resin Unfilled resin Suture(s) Ribbond® .

Splints for Stabilization Round or rectangular wire Monofilament line Orthodontic brackets and wire .

Splints for Stabilization 1 Ribbond® Titanium Trauma Splint (TTS) .

Acid Etch Composite Splints Interproximal composite .

Acid Etch Composite Splints Composite with arch wire .

Acid Etch Composite Splints Composite with monofilament nylon .

Ostrowski JS. A functional splint for traumatized teeth. .8:328-31.Acid Etch Composite Splints Functional Splint 20-30 lb monofilament nylon Bonded with composite Allows physiologic movement Antrim DD. J Endodon 1982.

Cross-Suture Splint Indications No adjacent teeth to splint to Unmanageable traumatized children .

Cross-Suture Splint .

Castelli WA. Caffesse RG. times ● The effects of different splinting on replantation of teeth in monkeys. ● .53:557-66. Oral Surg 1982.Splinting Time Effect of splinting time 7 days 30 days ● Nasjleti CE.

Castelli WA. Caffesse RG.Splinting Time Recommended time 7 to 10 days ● Nasjleti CE. times ● 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. Transient crown discoloration (red or grey) may occur . The tooth may be tender to percussion. monitoring the status of the pulp is recommended.

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 .

Th/ : Permanent teeth: Stabilize the tooth and relieve any occlusal interferences. For comfort. . Splint for no more than 2 weeks. a flexible splint can be used.Class VII Subluxation Definition: injury to tooth-supporting structures with abnormal loosening but without tooth displacement.

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 - .

compressing the periodontal ligament and commonly causes a crushing fracture of the alveolar socket Emergency treatment: .Intrusion Definition: apical displacement of tooth into the alveolar bone. H2O2 .For immature teeth with more eruptive potential (root ½ to ²/³ formed): Clean the wound with NaCl. The tooth is driven into the socket.

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 .

Using fingers.Extrusion Definition: partial displacement of the tooth axially from the socket. grab extruded teeth and surrounding alveolus then - - . partial avulsion. The periodontal ligament usually is torn Permanent teeth: - Clean the wound with NaCl. H2O2 and anticeptic solution Give Local Anesthetic.

and cementum fracture with or without pulp exposure Emergency treatment : Permanent teeth: - Clean wound Local Anesthetic If the pulp is exposed. dentin. and root canal - - . pulpal treatment alternatives are pulp capping.Class VIII: Crown and Root Fracture Enamel. pulpotomy.

• - 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 .

local anestheticthe tooth can be gently repositioned or slightly reduced if the interference is minor.Displacement Lateral luxation Primary teeth: - to allow passive or spontaneous repositiong if there is no occlusal interference. - . When there is occlusal interference.

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. .