How many teeth should you test?
2 teeth either side and lower teeth
Important questions to ask after trauma?
Was there bleeding at the time?
What are the review timeframes?
1 week: Soft tissues
3-4: PDL
6-8 weeks: Pulp
6 months
1 year
Every year until 4-5 years
Where are permanent sucessors positioned and how do we know if tooth is displaced toward or away?
Permanent sucessors are palatally placed. If tooth crown is displaced palatally, it means the root is displaced away from successor.
How does the location of horizontal root fracture impact prognosis?
More coronal the fracture, lesser the prognosis as there is more mobility
If a primary tooth is fractured and discoloured with no infection or symptoms, what should be done?
Monitor
What are tx options for pulpal necrosis in primary teeth?
- Monitor & review 6-8 weeks
- Pulpectomy (long procedure and don’t want pt to have GA)
- Exo
What are tx options intruded primary tooth?
Monitor or extract
What are the tx options for complicated crown fracture?
- Pulp capping (Ca(OH)2 or MTA)
- Pulpotomy
- Pulpectomy
If not much tooth structure remaining: can do elective pulpecotmy, extrude tooth and place post retained crown.
What are some potential reasons for buccal swelling near apex of 22?
- Infection
- Trauma
- Dens invaginitus
After doing extirpation due to EIRR, how long until next appt?
1 month- take another radiograph and change dressing
Features of splints
- 1-2 weeks
- Flexible
- Need to be able to clean properly
When can you do class II GIC in primary dentition?
If only has to last 2 years or less (otherwise will wash out)
What do the different tooth colours indicate?
- Grey- pulpal necrosis or transient bruising
- Yellow- pulp obliteration
- Pink- internal root resorption
What are characteristics of pulp obliteration?
- Pulp is vital but irritated.
- May be difficult to navigate canals if you need to do RCT
- Sensibility testing may be reduced
- Yellow discolouration
What are possible outcomes if there is lateral luxation in primary tooth?
- Nothing
- External inflammatory resorption
- Surface reparative resorption
- Ankylosis
- Disoclouration
- Abscess and pulpal necrosis
What should you do if there is root resorption of primary tooth?
As long as patient remains asymptomatic, you can leave it. Monitor for infection
What are treatment options for primary tooth with abscess?
- Leave and monitor (if tooth will exfoliate soon)
- Pulpectomy (unfavourable as pt will likely need GA)
- Exo
What are possible outcomes of leaving an intruded primary tooth and monitoring?
- May stay there and become necrotic and infect the successor, EIRR or ankylosis
- If it doesn’t erupt, exo (GA)
- May erupt into position
How can you differentiate between apical infection and normal appearance of immature tooth apex?
- Test TTP and sensibility
What are tx options for intruded permanent tooth?
- Spontaneous re-eruption
- Orthodontic repositioning
- Surgical repositioning
Immature tooth (<12) or Mature tooth (12-17 with <6mm intrusion)
- Left to re-erupt – assess in 1 month
- If no change in position- Ortho traction
Mature teeth (12-17 with >6mm intrusion) OR >17years
- Orthodontic or surgical repositioning and then splint
- RCT within 3-4 wks (prevent EIRR), remove splint at 4 weeks
What are possible outcomes for intruded permanent tooth?
Ankylosis
EIRR
Why should ankylosed teeth be decoronated in some cases?
Tooth becomes infraoccluded and gum line is moves apically. Adjacent teeth shift towards ankylosed tooth space. Need to decoronate to prevent this happening and then place bridge/denture. Decoronation will allow preservation of alveolar ridge.
How can you differentiate between EIRR and surface reparative resorption?
Surface reparative resorption will have radiolucency only on root surface and will not involve the bone. Tooth is also vital
EIRR will resorb both the root and the bone and the pulp will be infected
