• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Traumatic injuries of teeth
 

Traumatic injuries of teeth

on

  • 12,937 views

 

Statistics

Views

Total Views
12,937
Views on SlideShare
12,937
Embed Views
0

Actions

Likes
7
Downloads
1,395
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Traumatic injuries of teeth Traumatic injuries of teeth Presentation Transcript

    • TRAUMATICINJURIES OF TEETH Prepared by: Dr. Rea Corpuz
    • Traumatic Injuries ofTeeth Case History  Chief complaint  History of present illness  Medical History
    • Traumatic Injuries ofTeeth Clinical Examination  External Examination  Soft Tissues  Facial Skeleton  Teeth and Supporting Structures
    • Traumatic Injuries ofTeeth Radiographic Examination  Periapical  Occlusal  Panoramic
    • Traumatic Injuries ofTeeth (1) Concussion (2) Luxation (3) Fracture
    • Concussion tooth is not mobile not displaced periodontal ligament (PDL) absorbs injury + inflammed  leaves tooth tender to biting pressure + percussion
    • Concussion Visual sign:  not displaced Percussion test:  tender to touch or tapping Mobility test:  no increased mobility
    • Concussion Pulp Sensibility Test:  positive result  it is important in assessing future risk of healing complications  lack of response to the test indicates an increased risk of later pulp necrosis
    • Concussion Radiographic findings:  no radiographic abnormalities Radiographs:  occlusal  periapical  lateral view from mesial + distal aspect of tooth in question
    • Concussion Treatment Objectives:  usually there is no treatment Treatment:  monitor pulpal condition for at least 1 year
    • Concussion Patient Instructions:  soft food for 1 week  brush with soft bristle  rinse with chlorhexidine 0.1% to prevent plaque accumulation
    • Luxation tooth is displaced in a labial, lingual or lateral direction PDL is usually torn fractures of supporting alveolus may occur
    • Luxation similar to extrusion injuries  partial or total separation of periodontal ligament
    • Luxation Visual sign:  displaced, usually in a palatal/lingual or labial direction Percussion test:  usually gives a metallic (ankylotic) sound Mobility test: 
    • Luxation Pulp Sensibility Test:  likely give a lack of response except for teeth with minor displacement  test is important in assessing risk of healing complications  positive result at the initial examination indicates a reduced risk of future pulp necrosis
    • Luxation Radiographic findings:  widened periapical ligament space best seen on occlusal or eccentric exposures Radiographs:  occlusal  periapical  lateral view from mesial + distal aspect of tooth in
    • Luxation Treatment Objective:  reposition + splint a displaced tooth to facilitate pulp + periodontal ligament healing
    • Luxation Treatment:  rinse the exposed part of root surface with saline before repositioning  apply local anesthesia  reposition tooth with forceps or with digital pressure to disengage it from its bony socket
    • Luxation Treatment:  gently reposition it into its original position  stabilize the tooth for 4 weeks using a flexible splint  4 weeks is indicated due to associated bone fracture
    • Luxation Patient Instructions:  soft food for 1 week  brush with soft bristle  rinse with chlorhexidine 0.1% to prevent plaque accumulation
    • Fracture Ellis and Davey classification of crown fracture is useful in recording extent of damage to crown  Class I – simple fracture of crown involving little or no dentin  Class II – extensive fracture of crown involving considerable dentin but not dental pulp
    • Fracture  Class III – extensive fracture of crown with an exposure of dental pulp  Class IV – loss of entire crown
    • Fracture Enamel Fracture Enamel-Dentin Fracture Enamel-Dentin-Pulp Fracture Root Fracture
    • Enamel Fracture fracture confined to the enamel with loss of tooth structure
    • Enamel Fracture Visual sign:  visible loss of enamel  no visible sign of exposed dentin Percussion test:  not tender  if tenderness is observed evaluate tooth for a possible luxation or root fracture injury
    • Enamel Fracture Mobility test:  normal mobility Sensibility test:  usually positive  test may be negative initially indicating transient pulpal damage
    • Enamel Fracture Sensibility test:  monitor pulpal response until definitive pulpal diagnosis can be made  test is important in assessing risk of future healing complications  lack of response at initial examination indicates an increased risk of later pulpal necrosis
    • Enamel Fracture Radiographic findings:  enamel lost is visible Radiographs:  occlusal  periapical  recommended to rule out possible presence of root fracture or a luxation injury
    • Enamel Fracture Treatment:  if tooth fragment is available, it can be bonded to the tooth  grinding or restoration with composite resin depending on extent + location of fracture
    • Enamel-Dentin Fracture fracture confined to enamel + dentin with loss of tooth structure, but not involving pulp
    • Enamel-Dentin Fracture Visual sign:  visible loss of enamel + dentin  no visible sign of exposed pulp tissue Percussion test:  not tender  if tenderness is observed evaluate tooth for a possible luxation or root fracture injury
    • Enamel-Dentin Fracture Mobility test:  normal mobility Sensibility test:  usually positive  test may be negative initially indicating transient pulpal damage
    • Enamel-Dentin Fracture Sensibility test:  monitor pulpal response until definitive pulpal diagnosis can be made  test is important in assessing risk of future healing complications  lack of response at initial examination indicates an increased risk of later pulpal necrosis
    • Enamel-Dentin Fracture Radiographic findings:  enamel-dentin lost is visible Radiographs:  occlusal  periapical  recommended to rule out displacement or possible presence of root fracture
    • Enamel-Dentin Fracture Treatment:  if tooth fragment is available, it can be bonded to the tooth  otherwise perform provisional treatment by covering exposed dentin with glass ionomer or a permanent restoration using a bonding agent + composite resin
    • Enamel-Dentin-PulpFracture (Complicated Crown Fracture) a fracture involving enamel + dentin with loss of tooth structure + exposure of pulp
    • Enamel-Dentin-PulpFracture Visual sign:  visible loss of enamel + dentin  exposed pulp tissue Percussion test:  not tender  if tenderness is observed evaluate tooth for a possible luxation or root fracture injury
    • Enamel-Dentin-PulpFracture Mobility test:  normal mobility Sensibility test:  usually positive
    • Enamel-Dentin-PulpFracture Sensibility test:  test is important in assessing risk of future healing complications  lack of response at initial examination indicates an increased risk of later pulpal necrosis
    • Enamel-Dentin-PulpFracture Radiographic findings:  lost of tooth substance is visible Radiographs:  occlusal  periapical  recommended to rule out displacement or possible presence of luxation or root fracture
    • Enamel-Dentin-PulpFracture Treatment:  if young patients with open apices, it is very important to preserve pulp vitality by pulp capping or partial pulpotomy in order to secure further root development  this treatment is also treatment of choice in patients with closed apices
    • Enamel-Dentin-PulpFracture Treatment:  Calcium hydroxide compunds + MTA are suitable materials for such procedures  in older patients with closed apices + luxation injury with displacement, root canal treatment is usually treatment of choice
    • Crown-Root Fracturewithout pulp involvement fracture involving:  enamel  dentin  cementum  with loss of tooth structure  but not exposing pulp
    • Crown-Root Fracturewithout pulp involvement Visual sign:  crown fracture extending below gingival margin Percussion test:  tender
    • Crown-Root Fracturewithout pulp involvement Mobility test:  coronal fragment mobile Sensibility test:  usually positive for apical fragment
    • Crown-Root Fracturewithout pulp involvement Radiographic findings:  apical extension of fracture usually not visible Radiographs:  occlusal  periapical  recommended to detect fracture lines in root  cone beam exposure can reveal whole fracture extension
    • Crown-Root Fracturewithout pulp involvement Treatment:  Fragment removal only • removal of superficial coronal crown-root fragment • subsequent restoration of exposed dentin above gingival level
    • Crown-Root Fracturewithout pulp involvement Treatment:  Fragment removal + gingivectomy (sometimes ostectomy) • removal of coronal segment with subsequent endodontic treatment + restoration with a post-retained crown
    • Crown-Root Fracturewithout pulp involvement Treatment:  Orthodontic extrusion of apical fragment • removal of coronal segment with subsequent endodontic treatment + orthodontic extrusion of remaining root with sufficient length after extrusion to support a post- retained crown
    • Crown-Root Fracturewithout pulp involvement Treatment:  Surgical extrusion • removal of mobile fractured fragment • subsequent surgical repositioning of root in a more coronal position
    • Crown-Root Fracturewithout pulp involvement Treatment:  Decoronation (root submergence) • implant solution is planned, root fragment may be left in situ after in order to avoid alveolar bone resorption • thereby maintaining volume of alveolar process for later implant installation
    • Crown-Root Fracturewithout pulp involvement Treatment:  Extraction • with immediate or delayed implant-retained crown restoration or a coventional bridge • fractures with severe apical extension, the extreme being a vertical fracture
    • Crown-Root Fracturewith pulp involvement fracture involving:  enamel  dentin  cementum  with loss of tooth structure  exposure of pulp
    • Crown-Root Fracturewith pulp involvement Visual sign:  crown fracture extending below gingival margin Percussion test:  tender
    • Crown-Root Fracturewith pulp involvement Mobility test:  coronal fragment mobile Sensibility test:  usually positive for apical fragment
    • Crown-Root Fracturewithout pulp involvement Radiographic findings:  apical extension of fracture usually not visible Radiographs:  occlusal  periapical  cone beam exposure can reveal whole fracture extension
    • Crown-Root Fracturewith pulp involvement Treatment:  Fragment removal + gingivectomy (sometimes ostectomy) • removal of coronal segment with subsequent endodontic treatment + restoration with a post-retained crown
    • Crown-Root Fracturewith pulp involvement Treatment:  Orthodontic extrusion of apical fragment • removal of coronal segment with subsequent endodontic treatment + orthodontic extrusion of remaining root with sufficient length after extrusion to support a post- retained crown
    • Crown-Root Fracturewith pulp involvement Treatment:  Surgical extrusion • removal of mobile fractured fragment • subsequent surgical repositioning of root in a more coronal position
    • Crown-Root Fracturewith pulp involvement Treatment:  Decoronation (root submergence) • implant solution is planned, root fragment may be left in situ after in order to avoid alveolar bone resorption • thereby maintaining volume of alveolar process for later implant installation
    • Crown-Root Fracturewith pulp involvement Treatment:  Extraction • with immediate or delayed implant-retained crown restoration or a coventional bridge • fractures with severe apical extension, the extreme being a vertical fracture
    • Root Fracture fracture confined to the root of tooth involving:  cementum  dentin  pulp
    • Root Fracture Visual sign:  coronal segment may be mobile  some cases displaced  transient crown discoloration (red or gray) may occur  bleeding from gingival sulcus may be noted
    • Root Fracture Percussion test:  tooth may be tender Mobility test:  coronal segment may be mobile
    • Root Fracture Sensibility test:  the test is important in assessing risk of healing complications  a positive sensibility test at the initial examination indicates a significantly reduced risk of later pulpal necrosis
    • Root Fracture Sensibility test:  may give negative results initially  indicating transient or permanent neural damage  pulp sensibility test is usually negative for root fractures except for teeth with minor displacements
    • Root Fracture Radiographic findings:  root fracture line is usually visible  fracture involves root of the tooth in a horizontal or diagonal plane
    • Root Fracture Treatment:  rinse exposed root surface with saline before repositioning  if displaced, reposition the coronal segment of the tooth as soon as possible  check that correct position has been reached radiographically
    • Root Fracture Treatment:  stabilize the tooth with flexible splint for 4 weeks  if the root fracture is near cervical area of the tooth stabilization is beneficial for a longer period of time (upto 4 months)
    • Root Fracture Treatment:  monitor healing for at least 1 year to determine pulpal status  if pulp necrosis develops, then root canal treatment of the coronal tooth segment to the fracture is indicated
    • References: Books McDonald, Avery et al: Dentistry for the Child and Adolescent • (pages 458-459) Internet http://www.dentaltraumaguide.org