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15-Traumatic Injuries of The Teeth
15-Traumatic Injuries of The Teeth
primary teeth.
ANDREASEN’S CLASSIFICATION
Displacement of teeth.
Interference in occlusion.
Mobility of teeth.
Two types:
Unipolar: Current pass through the dentist.
Bipolar: Current pass through the patient.
Teeth with wide open apices may not respond to electrical tests.
Light source:
Mouth mirror - Fibreoptic equipment
RADIOGRAPHIC
EXAMINATION
Can be seen only when we dry the tooth and reflect light
through it.
Intermediate treatment
Review after 7-10 days or in some cases after 6-8 weeks.
Corrective grinding may be undertaken with or without orthodontic
extrusion of the fractured tooth.
Long-term treatment
Review after 6 months looking for necrosis of pulp, calcification,
resorption etc.
Pulp vitality tests continue upto 2 years.
Uncomplicated crown fracture
Enamel + dentine fracture
The aims of treatment
– Pulp protection.
– Space maintenance.
– Aesthetics.
Treatment:
The immediate treatment consists of protecting the pulp from bacterial
contamination or thermal stimuli by covering the exposed dentine.
Method:
Isolate and dry the tooth.
Cover the exposed dentine with a calcium hydroxide lining material.
Place an acid-etch composite restoration.
In case of insufficient time or lack of co-operation, a ‘composite bandage’
may be placed. Composite build up may be done at a future appointment.
Review the patient after 1week, 1month, 3months and then at 6- monthly
interval for at least 2 years. At these appointments, vitality tests should be
carried out and a radiograph taken to check that root development is
continuing.
Complicated crown fracture
The immediate treatment aims to preserve the vitality of the pulp. This
is essential to allow continuing root development, apical closure,
narrowing of the pulp cavity and thickening of the root walls.
Treatment options:
Pulp capping
Partial pulpotomy
Vital pulpotomy (Apexogenesis)
Review after:
1 week --- for discomfort and retention of composite.
1 month--- periapical radiograph for apical pathology. Vitality tests.
3 months--- periapical radiograph to see root development. Hard tissue barrier
seen in case of vital pulpotomy (apexogenesis).
6 monthly---for at least 3 years. In case of vital pulpotomy – elective root canal
carried out after apical closure.
In case of non-vital pulp
Open apex - apexification
Closed apex - RCT
Uncomplicated crown-root fracture
Pulp treatment.
Gingivectomy + osteotomy for post and core.
Crowning.
Root fracture
Classification & treatment
Fracture not communicating with gingival crevice.
Fracture communicating with gingival crevice.
Longitudinal root fracture.
OR
Apical root fracture.
Middle root fracture.
Coronal root fracture.
Splinting
Rigid splinting for 2-3 months.
Root fracture continues
5. Foil splint.
Concussion
Usually front teeth are involved. Child may complain that the front teeth hurt
when he tries to eat.
Treatment:
Usually no treatment is necessary.
If vitality tests negative after 8 weeks, start pulp treatment. As vitality tests are
not reliable, start pulp treatment without LA. If patient respond while touching
ADJ, it means tooth is vital. Give calcium hydroxide lining & composite repair.
Subluxation
Treatment:
Treatment:
Re-eruption potential of immature teeth is taken into
account. Leave the tooth initially to re-erupt for 1 month.
Treatment
Grasp the tooth with finger and thumb.
Treatment:
Reposition the tooth.
Splint for 3-6 weeks (because bone is involved).
Recent displacement
Delayed presentation
Review of displacement injuries
Review regularly.
Orthodontic status.
Method for Re-implantation
Management of Root Resorption
Loss of the incisor
Child may complain that his mouth is sore or that the front teeth
hurt when he tries to eat.
Treatment:
Usually no treatment is necessary.
Treatment:
Usually no treatment is necessary.
Parents advised to maintain fluid intake, soft diet and gentle brushing is
recommended.
Intrusion
Intrusion is common and the tooth may not be visible.
Radiograph to confirm the presence of the tooth.
Treatment:
Primary prevention
Secondary prevention
Primary prevention
Commonest cause of tooth injury in children is falling
on a hard surface. So the following precautions may
be taken:
Crowded arches
Extraction of primary canines and overjet reduction.
Custom
Secondary prevention
Reducing the complications of trauma by prompt intervention can have
a “secondary preventive effect”.