Download - Management of Dental Trauma
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MANAGEMENT OF DENTAL TRAUMA
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ASSESSMENT
History
Clinical examination
Radiograph
Additional tests
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Primary Dentition
Treatment is dictated by the concern for the
safety of the permanent dentition. If displaced tooth has encroached upon
permanent tooth germ extraction indicated.
Inform parents about possible pulpal
complications, appearance of sinus tract,
color change
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Also caution parents of permanent teeth
complications including: Enamel hypoplasia
Hypocalcification
Crown/root dilaceration Disruption in eruption.
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Permanent Teeth
Treatment is dictated by the concern for
vitality of the periodontal ligament and pulp. Periodical review is mandatory.
Initiation of endodontic treatment is indicated
in cases of spontaneous pain, abnormal
response to pulp test, lack of continued root
formation
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Splint
Used to stabilise a tooth following traumatic
injury Flexible splinting assists in periodontal
healing.
Characteristics of ideal splin :
Easily fabricated in the mouth Passive unless orthodontic forces are
intended
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Allows physiologic mobility (except for root
fractures Non-irritating to soft tissues
Does not interfere with occlusion
Allows endodontic access Easily cleansed
Easily removed
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Instruction to patient
Avoid biting on splint tooth
Maintain meticulous oral hygiene Call immediately if splint breaks / loosens
Use chx / antibiotics as prescribed.
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Guidelines
Infraction: incomplete fracture of the enamel
without loss of tooth structure. Treatment objective: maintain structural
integrity and pulpal vitality.
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Crown fracture-uncomplicated:
An enamel fracture or enamel-dentinefracture that does not involve the pulp.
Small fractures can be smoothed.
Larger fractures the lost tooth structure canbe restored.
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Crown fracture complicated:
An enamel dentine fracture with pulp exposure. Primary of teeth pulpal treatment alternatives are
pulpotomy, pulpectomy, extraction.
Permanent teeth pulpal treatment include, direct pulp
capping, partial pulpotomy, pulpectomy. Prognosis depends injury to PL, age of the pulp
exposure, entent of dentine exposed, stage of root
development.
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Crown root fracture:
Enamel, dentine and cementum fracture withor without pulp exposure.
Clinically may reveal a mobile coronalfragment attached to the gingiva with or
without exposure. Root fractures only demonstrated
rdiographically.
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Primary teeth if cannot restore extract
Permanent teeth remove coronal fragmentfollowed by supragingival restoration or
necessary gingivectomy, ororthodontic
extrution to prepare for restoration.
Pulp treatment pulp capping, pulpotomy and
rct.
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Root fractures:
Dentin and cementum fracture involving pulp Clinically reveal a mobile coronal fragment
attached to gingiva that may be displaced.
Radiogaphically may reveal 1 or more
radiolucent lines
Primary teeth extraction of coronal portion.
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Permanent teeth: reposition and stabilise the
coronal fragment. Location of root fracture in permanent teeth
affects survival after injury.
Root fractures occuring in the cervial third or
apical third can be treated succefully by
stabilisaion of repositioned fragment.
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Concussion:
Injury to the tooth suporting structureswithout abnormal loosening or displacement
of the tooth.
PL absorbs injury and is inflammed.
Signs include ttp, without mobility or
displacement.
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Nil abnormality radiographically.
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