Trauma

Question 1

Imaging for uncomplicated crown fracture (enamel only)?

Answer 1

• Missing fragments should be accounted for (soft tissue injuries - lips and cheeks).
• One parallel periapical radiograph.

Question 2

Treatment for uncomplicated crown fracture (enamel only)?

Answer 2

• Bond back tooth fragment.
• Smooth tooth edges.
• Composite resin restoration.

Question 3

Follow up for uncomplicated crown fracture (enamel only)?

Answer 3

• 6-8 weeks.
• 1 year.

Question 4

Imaging for uncomplicated crown fracture (enamel-dentine)?

Answer 4

• Missing fragments should be accounted for (soft tissue injuries - lips and cheeks).
• One parallel periapical radiograph.

Question 5

Treatment for uncomplicated crown fracture (enamel-dentine)?

Answer 5

• Bond back tooth fragment (rehydrate in saline for 20 minutes).
• Cover exposed dentine with glass ionomer or resin composite.
• If exposed dentine within 0.5mm of pulp (pink but no bleeding) place a calcium hydroxide lining and cover with GI.

Question 6

Follow up for uncomplicated crown fracture (enamel dentine)?

Answer 6

• 6-8 weeks.
• 1 year.

Question 7

Imaging for complicated crown fracture (enamel-dentine-pulp)?

Answer 7

• Missing fragments should be accounted for (soft tissue injuries - lips and cheeks).
• One parallel periapical radiograph.

Question 8

Treatment for complicated crown fracture (enamel-dentine-pulp)?

Answer 8

1. FIRST LINE - VITAL/CONSERVATIVE PULP TREATMENT
   - Immature teeth: Pulp capping/ partial pulpotomy to promote further root development (use non setting calcium hydroxide OR non staining calcium silicates).
   - Mature teeth: partial pulpotomy.
2. MATURE TEETH
   - If post required for crown retention, RCT is preferred treatment.
3. RESTORE CROWN
   - Bond back tooth fragment (rehydrate).
   - Cover exposed dentine with GI or composite.

Question 9

Follow up for complicated crown fracture (enamel dentine pulp)?

Answer 9

• after 6-8 wk
• after 3 mo
• after 6 mo
• after 1 y

Question 10

Imaging for uncomplicated crown-root fracture (enamel-dentine without pulp exposure)?

Answer 10

• Apical extension of fracture usually not visible.
• Account for missing fragments.
• One parallel periapical.
• Two additional radiographs at different vertical/ horizontal angulations.
• Occlusal radiographs.
• CBCT

Question 11

Treatment for uncomplicated crown-root fracture (enamel-dentine without pulp exposure)?

Answer 11

1. Until tx plan finalized, temporarily stabilize fragment to adjacent teeth.
2. If PULP NOT EXPOSED –> remove coronal/ mobile segment and COVER exposed dentine with GI or resin composite.
   - Future tx options: orthodontic extrusion, surgical extrusion, RCT (necrotic, infected pulp), root submergence, replantation, autotransplantation, extraction.

Question 12

Follow up for uncomplicated crown-root fracture (enamel-dentine without pulp exposure)?

Answer 12

• 1 week.
• 6-8 weeks.
• 3 months.
• 6 months.
• 1 year.
• Yearly for at least 5 years.

Question 13

Imaging for complicated crown-root fracture (enamel-dentine with pulp exposure)?

Answer 13

• Apical extension of fracture usually not visible.
• Account for missing fragments.
• One parallel periapical.
• Two additional radiographs at different vertical/ horizontal angulations.
• Occlusal radiographs.
• CBCT

Question 14

Treatment for complicated crown-root fracture (enamel-dentine with pulp exposure)?

Answer 14

1. Until tx plan finalized, temporarily stabilize fragment to adjacent teeth.
   IMMATURE TEETH WITH INCOMPLETE ROOT FORMATION:
   - Partial pulpotomy with rubber dam (non setting calcium hydroxide or non staining calcium silicates).
   MATURE TEETH WITH COMPLETE ROOT FORMATION:
   - Remove pulp, cover exposed dentine with GI or resin composite.
   - Future tx options: completion of root canal treatment and restoration, orthodontic extrusion, surgical extrusion, root submergence, replantation, autotransplantation, extraction.

Question 15

Follow up for complicated crown-root fracture (enamel-dentine with pulp exposure)?

Answer 15

• 1 week.
• 6-8 weeks.
• 3 months.
• 6 months.
• 1 year.
• Yearly for at least 5 years.

Question 16

Imaging for root fracture?

Answer 16

• Fracture may be at any level of the root.
• One parallel periapical.
• Two additional radiographs at different vertical/ horizontal angulations.
• Occlusal radiographs.
• CBCT

Question 17

Treatment of root fracture?

Answer 17

1. Reposition displaced coronal fragment.
2. Check repositioning radiographically.
3. Cervical fracture splint 4 months (do NOT remove coronal fragment at emergency visit). Mid/ apical root fracture splint 4 weeks.
4. NO endodontic treatment at emergency visit.
5. MONITOR healing of fracture for AT LEAST ONE YEAR. Monitor PULP STATUS.
   - IF PULP NECROSIS OCCURS: RCT of the coronal segment using apexification technique.
   - MATURE TEETH WHERE FRACTURE IS ABOVE ALVEOLAR CREST: Remove coronal segment, RCT, post-retained crown.
   - Future procedures: orthodontic/ surgical extrusion, crown lengthening, extraction.

Question 18

Follow up times for root fracture?

Answer 18

• 4 weeks (mid/apical fracture).
• 6-8 weeks.
• 4 months (cervical fracture).
• 6 months.
• 1 year.
• yearly for at least 5 years.

Question 19

Imaging for alveolar fracture?

Answer 19

• Parallel periapical.
• Two additional radiographs of the tooth taken with different vertical and/or horizontal angulations.
• Occlusal
• if insufficient consider DPT or CBCT.

Question 20

Treatment for alveolar fracture?

Answer 20

• Reposition displaced segment.
• Stabilize segment by splinting teeth for 4 weeks.
• Suture gingival lacerations.
• RCT is CONTRAINDICATED at emergency appointment.
• MONITOR the pulp condition of all involved teeth to determine if/ when endo tx necessary.

Question 21

Follow up for alveolar fracture?

Answer 21

• 4 weeks
• 6-8 weeks
• 4 months
• 6 months
• 1 year
• yearly for at least 5 years.

Question 22

Imaging for concussion?

Answer 22

• No radiographic abnormalities.
• One parallel periapical.

Question 23

Treatment for concussion?

Answer 23

• No treatment needed.
• Monitor pulp condition for at least one year but preferably longer.

Question 24

Follow up for concussion?

Answer 24

• 4 weeks.
• 1 year.

Question 25

Radiographic assessment for subluxation?

Answer 25

- One parallel periapical. - Two additional radiographs at different vertical/ horizontal angulations. - Occlusal radiographs.

Question 26

Treatment for subluxation?

Answer 26

- Usually no treatment needed. - Splint for **2 weeks** if excessive mobility of tenderness when biting on the tooth. - Monitor the pulp dor at least one year.

Question 27

Follow up for subluxation?

Answer 27

- 2 weeks (splint removal). - 3 months. - 6 months. - 1 year.

Question 28

Radiographic assessment of extrusive luxation?

Answer 28

- Increased periodontal ligament space both apically and laterally. - Tooth will not be seated in socket and appear elongated incisally. - One parallel periapical. - Two additional radiographs at different vertical/ horizontal angulations. - Occlusal radiographs.

Question 29

Treatment for extrusive luxation?

Answer 29

1. Local anesthesia. 2. Reposition tooth by gentily pushing it back into the socket. 3. Splint for 2 weeks. Splint for a further 4 weeks if BREAKDOWN/ FRACTURE of marginal bone. - Monitor pulp condition. - RCT if pulp becomes necrotic.

Question 30

Follow up for extrusive luxation?

Answer 30

- 2 weeks (splint removal). - 4 weeks. - 8 weeks. - 3 months. - 6 months - 1 year. - Yearly for at least 5 years. - Advise patients (and parents) to watch for any unfavourable outcomes (symptoms, mobility) and return to clinic if they observe any.

Question 31

Radiographic investigation of lateral luxation?

Answer 31

- Widened periodontal space which is best seen on radiographs taken with horizontal angle shifts or occlusal exposures. - One parallel periapical. - Two additional radiographs at different vertical/ horizontal angulations. - Occlusal radiographs.

Question 32

Treatment for lateral luxation?

Answer 32

1. Local anesthesia. 2. Reposition tooth digitally. 3. Stabilize tooth for **4 weeks** (additional splinting if marginal bone breakdown). 4. Monitor pulp condition at follow up appointments. 5. **2 weeks** post injury make endodontic evaluation: - **INCOMPLETE ROOT FORMATION**: spontaneous revascularization may occur. If pulp becomes necrotic and signs of ERR RCT ASAP. - **COMPLETE ROOT FORMATION**: Pulp will likely become necrotic, RCT.

Question 33

Follow up for lateral luxation?

Answer 33

- 2 weeks. - 4 weeks (splint removal). - 8 weeks - 3 months - 6 months - 1 year. - yearly for at least 5 years. - Advise patients (and parents) to watch for any unfavourable outcomes (symptoms, mobility) and return to clinic if they observe any.

Question 34

Radiographic examination of intrusive luxation?

Answer 34

- The periodontal ligament space may not be visible for all or part of the root (especially apically). - The cemento- enamel junction is located more apically in the intruded tooth than in adjacent non- injured teeth. - One parallel periapical. - Two additional radiographs at different vertical/ horizontal angulations. - Occlusal radiographs.

Question 35

Treatment for intrusive luxation?

Answer 35

**TEETH WITH INCOMPLETE ROOT FORMATION** - Allow re-eruption without intervention for **4 weeks**. - If not re eruption within 4 weeks, initiate **orthodontic repositioning**. - Monitor pulp condition. - Revasculirization may occur. If pulp becomes necrotic/infected/ signs of root resorption start RCT ASAP. - Inform parents of importance of follow up visits. **TEETH WITH COMPLETE ROOT FORMATION** - Intruded **less than 3mm**: if no re eruption within **8 weeks** reposition surgically and splint for **4 weeks** or reposition **orthodontically**. - Intruded **3mm-7mm**: reposition surgically (preferably) or orthodontically. - Tooth intruded **beyond 7mm**: reposition surgically. - Pulp almost always becomes necrotic. Start RCT at 2 weeks.

Question 36

Follow up for intrusive luxation?

Answer 36

- 2 weeks. - 4 weeks (splint removal). - 8 weeks. - 3 months - 6 months - 1 year - yearly for the next 5 years. - inform patients/ parent to watch for unfavourable outcomes.

Question 37

First aid for avulsed teeth? (8)

Answer 37

1. MAKE SURE IT IS A PERMANENT TOOTH. 2. Keep the patient calm. 3. Find the tooth and pick it up by the crown (the white part). Avoid touching the root. Attempt to place it back immediately into the jaw. 4. If the tooth is dirty, rinse it gently in milk, saline or in the patient's saliva and replant or return it to its original position in the jaw. It is important to encourage the patient/guardian/teacher/other person to replant the tooth immediately at the emergency site. 5. Once the tooth has been returned to its original position in the jaw, the patient should bite on gauze, a handkerchief or a napkin to hold it in place. 6. If replantation at the accident site is not possible, or for other reasons when replantation of the avulsed tooth is not feasible (eg, an unconscious patient), place the tooth, as soon as possible, in a storage or transport medium that is immediately available at the emergency site. This should be done quickly to avoid dehydration of the root surface, which starts to happen in a matter of a few minutes. In descending order of preference, milk, HBSS, saliva (after spitting into a glass for instance), or saline are suitable and convenient storage mediums. Although water is a poor medium, it is better than leaving the tooth to air-dry. 7. The tooth can then be brought with the patient to the emergency clinic. 8. See a dentist or dental professional immediately.