Trauma Procedures

Question 1

When are you going to perform a pulp cap ?

Answer 1

• Vital Immature tooth with pulp exposed
• Small exposure of pulp
• <24 hrs old
• Arrest haemorrhage with P and saline dipped moistened cotton pledget
• Apply non setting CaOH direct to exposure site
• RMGIC lining and def rest

Question 2

What does survival of the pulp depend on?

Answer 2

• Associated peridontal ligament injury
• Size of exposed dentine
• Age of pt (open vs closed apex)
• Length of time injury exposed (longer time more bacterial ingress more likely for necrosis to occur)

Question 3

When are you going to perform a pulpotomy? What does it do?

Answer 3

• Vital immature tooth with pulp exposed
• Larger exposure
• Delay in txt
• It maintains vitality of remaining (non infected pulp)
• Allows root formation to continue
• Allows ctd thickening of dentine in root walls

Question 4

What is the technique for Pulpotomy in permanent tooth?

Answer 4

• LA
• Dental dam
• Endodontic access
• Removal of pulp tissue 2-3mm coronal
• Arrest haemorrhage with sterile saline dipped in cotton pledget
• Assess bleeding
  - If deep crimson still inflamed and need to remove more
  - If no bleeding then necrotic and need to remove more until normal bleeding
  - If normal bleeding bright red then good to go
• non setting CaOH dressing over exposed root canal
• RMGIC lining
• Restoration with etch and bond
• Assess for symptoms at review appointment
• Wanting to see apexigenesis in an immature root where root development occurd and thickening of dentine in root walls continues

Question 5

When to Perform Pulpectomy? What is it ?

Answer 5

• Non vital immature tooth
• Tooth previously pulpotomy becomes symptomatic
• Removal of all necrotic pulp

Question 6

What is apexification / Apical barrier formation ? When should i refer a pt for this?

Answer 6

• Process of using MTA or bioceram to induce an apical barrier therefore RC filling can be condensed against
• Done in secondary care
• If immature apex tooth has had pulpotomy and now has become symptomatic - perform pulp extirpation , CaOH dress and referral to paeds for apexification to ensure tooth it not lost

Question 7

Properties of CaOH

Answer 7

• High PH (alkaline) and help decres micorbial load (antimicrobial)
• Induces calcific barrier by stimulating odontoblasts to create reparative tertiary dentine bridge

Question 8

Splinting times for injury

Answer 8

2 weeks
- Avulsion
- Extrusion

4 weeks
- Luxation
- Apical and middle 3rd root fracture
- Dentoalveolar fracture

4weeks -4months
- Cervical 1/3 root fracture

Question 9

Technique for trauma splint

Answer 9

• Composite passive flexible wire
• Cut and bend SS wire
• Apply comp resin to traumatised tooth and adjacent
• Sink contoured passive wire into comp
• Shape and cure comp
• Smooth rough comp and wire ends