Systematic approach
- Observation
- Enquiry
- Clinical exams
- Radiographs
Extra oral exam (signs of possible mandibular fracture)
- step formation
- paresthesia
- range of movement
- pain or swelling
- racoon eyes or battle sign🐼
Hard tissue injuries🦷
Class I- #of enamel, pulp not involved
Class II- #of enamel and dentine, pulp
not involved
Class III- #of enamel and dentine, pulp exposure
Class IV- root #
Class V- avulsion/ total displacement
Soft tissue injuries
- Concussion (sensitive tooth that isn’t loose)
- monitor soft diet, reinforce OH - Subluxation (loose tooth, not displaced, bleeding might be present)
- soft diet, carefully reposition tooth and splint for 7-10 days - Luxation (loose and displaced)
- extrusive luxation is splinted for 2 weeks
- lateral luxation is splinted for 4 weeks - Intrusion (forced into socket)
- half of crown palatally placed
- orthodontic repositioning
- RCT if non vital - Extrusion (forced partially out of socket)
- XLA - Avulsion (complete displacement)
- no re implantation
ACSLIE
How do we treat a primary Class III fracture? (NB-4)
- pulp involved
- never DPC
- always pulpotomy
- GI/ STRIP CROWN
- extensive fracture requires Xtr
Avulsion Tx options
- Time outside the mouth
- <20 min you’ll get ideal outcome
- re-implant within 20-25 min - Transport medium
- cold storage such as dentosafe, milk, saline, patient’s mouth, not tap water - Open or closed apices
- OPEN- better prognosis and revascularization is possible
- CLOSED- no revascularization possible - Treating root surface
- antibiotics for open apices
- fluoride for closed apices
Ideal splinting
Splinting is either fixed (rigid or flexible <0.4mm) or removable
- passive
- allows physiologic movement
- non irritating
- does not interfere with occlusion
- easy access for endo
- easy to remove and clean
Fixed splints
- rigid are for dento- alveolar fractures, splint for 4 weeks
- flexible allows for normal physiologic movement splint for 2-4 weeks
How do we treat a permanent Class III fracture?
- DPC
- Pulpotomy (cvek)
- Pulpotomy (cervical)
- Pulpectomy
- XLA
- Revascularization
Cvek method
- LA
- Enlarge exposure site by 2mm in all directions
- Rinse thoroughly
- Control bleeding
- Calcium hydroxide and dycal and life
- GI
- Restore with composite
- Follow up after 3 months
Cervical pulpotomy
For young permanent tooth with open apex
Facilitated closure of apices
Revascularization
Indicated for non vital teeth with open apices
Stimulates closure of apex using vital pulp cells
Root fractures
How does tooth react to trauma?
- internal resorption
- necrosis
- haemorrhage
- root resorption
- calcification
- ankylosis
