FATIMA ASWAD TRUMA OF PERMENANET TEETH.pdf

FATIMA ASWAD TRUMA OF PERMENANET TEETH.pdf

1. TRAUMA OF PERMANENT
TEETH
DR:FATIMA ASWAD

2. INTRODUCTION
Dental trauma is one of the most common presentation in the paediatrics
clinic. The fears and anxiety of these patients make management difficult. If
improperly managed, it could affect the patient self-esteem and quality of life
Aetiological factors include;
1.Falls
2.Playing and running
3.Contact sports
4.Road traffic accident
5.Child abuse
The most accident times include:
2-4 years for primary dentition
7-10 yrsfor permanent dentition

3. PREDISPOSING FACTORS
1. Angle class 11 div 1
2. Increased overjet;
3-6mm..double the risk
>6mm….triple the risk
3. Incompetent lip closure
4. Improperly fitted mouthguard
.twice the risk

4. Clinical examination
1-Inspection of
-gingival and soft tissue for embedded fragments of tooth or debris.
-vital structures, such as the parotid duct, submandibular duct, nerves, and blood vessels.
-Missing teeth or pieces of teeth that have not been left at the scene of the accident must
be considered to have been aspirated, swallowed, or displaced into soft tissue of the lip,
cheek, floor of the mouth, neck, nasal cavity, or maxillary sinus.
-Lips there is often substantial bruising and swelling and there may be portions of tooth
or foreign bodies embedded in the soft tissues.

5. 2-Palpationof teeth should be examined for abnormal mobility
horizontally and axially, all teeth should be accounted for at the time of
examination.
3-Percussion
pain elicited with percussion is suggestive of injury to the periodontal
ligament.
The sound elicited by percussion is also of diagnostic value; a sound
resembling a hard metallic ring is elicited with teeth that are locked
into bone, whereas a dull sound indicates a subluxatedtooth.
4-Transilluminationtest: for infractions and cracks
5-Pulp testing during the acute phase of injury is of questionable value

6. RADIOGRAPHIC EVALUATION
Indication for radiograph;
1.To detect root fracture
2.Ascertain extent of root development
3.To determine resorption
4.To detect foreign body in soft tissue
5.To detect jaw fracture
6.To note position and stage of development of permanent teeth
7.To detect size of pulp chamber
8.To detect periapicalradiolucency
9.For follow-up evaluation

7. CLASSIFICATION
•Injuries to the hard dental tissue and pulp.
•Injuries to the periodontal tissue.
•Injuries to the supporting bone.
•Injuries to the gingiva.

8. HARD TISSUE INJURIES AND
MANAGEMENT
Enamel infraction;
Incomplete fracture in the enamel
Examinationreveal craze lines on transillumination
Treatmentno treatment is required for Infraction.
periodic recalls are necessary.

9. Uncomplicated crown fracture
Loss of enamel -/+ dentine fracture without pulp involvement.
Treatment;
for small fracture use fine disk to
smoothen the margins
for larger loss, protect the pulp with
calcium hydroxide or GIC then restore
with acid-etch composite.
Enamel and dentine bonding agents have
also been used to protect the pulp from
thermal irritants and bacterial ingress.

11. COMPLICATED CROWN FRACTURE
A fracture involving enamel and dentin with loss of tooth
structure and exposure of the pulp

12. TREATMENT OPTIONS
Pulp capping
Small exposure
2-4 hrafter injury
Pulpotomy
immature tooth exposure and has no
inflamed tissue
Apexogenesis
remain the vital tissue to
facilitate continued root
development
Apexification
fill the necrotic Immature
root canal with MTA Plug
Endodontic
Treatment

13. Closed apex Open apex
RCT
Vital toothNon-vital tooth
Direct Pulp Capping Pulpotomy Apexification
Treatment summary for
Complicated crown fracture;
Non-vital tooth

14. ROOT FRACTURE
•Fracture radical part of tooth.
1.coronal third : Remove the mobile fragment then post and crown the
remaining root
2.middle third :stabilization of tooth with flexible splint for (2-4 months)
lead to calcification and fibrous bridge that heal the tooth and maybe
remain vital.Iftooth lose vitality → RCT
3.apical third :Treatment needed if there is pathological evidence
RCT: for all tooth or left the broken part
Apicectomy
clinically mobile teeth and 1 or more
radiolucent lines separating fracture
segments

15. INJURIES TO THE PERIODONTAL
TISSUE
CONCUSSION
Diagnosis; an injury to the tooth-supporting structures
without abnormal loosening or displacement of the tooth
but with marked reaction to percussion
Radiograph; usually no abnormality.
Treatment; soft diet for 2wks, relieve it from occlusion if
there is complain of pain
Follow-up; vitality test for 1, 3 and 6 month then yearly.
Radiograph to assess root development
Prognosis; usually good, but necrosis in 3-6% of cases

16. SUBLUXATION
Diagnosis; tooth is mobile. Bleeding at the
marginal gingival, tender to percussion
Radiology; the PDL space is widened.
Treatment; stabilize and relieve from occlusion. For
comfort use flexible splint(<2wks) if apex is fully
formed and extremely tender
Prognosis;
mature teeth with closed apices are at risk of
pulpal necrosis hence, close monitoring is required

17. Lateral luxation
Displacement of the tooth in a direction other than axially, accompanied by a comminution or fracture of the
alveolar socket is usually accompanied by comminution or fracture of the alveolar socket.
In first 48 hrs. the tooth and alveolar bone can typically be
manipulated (usually with force) into proper position and
splintedto adjacent stable teeth for 2-8 weeks.
If treatment is delayed more than 48 hrs. , it is difficult to
reposition the tooth manually, orthodontic intervention maybe
necessary.

18. Intrusive luxation
(central dislocation) is displacement of the tooth into the alveolar
bone with comminution or fracture of the alveolar socket.
In the primary dentition, the permanent successor develops lingual to the
primary incisor..
For permanent teeth the recommended treatment includes:
-allowed to erupt if the tooth is immature.
-Immediate surgical repositioning of the tooth
-Splinting to the adjacent teeth.
-Low-force orthodontic repositioning of immature
and mature teeth for 3 to 4 weeks to allow remodeling
of the bone and periodontal fibers.

19. •is partial displacement of the tooth out of the alveolar
socket clinically appear longer and mobile
•Treatment should be as soon as possible within the first
few hours after injury. The tooth that is partially displaced
out of the alveolar socket should be manipulated into
proper position and should be splinted with a non-rigid
material for 1 to 2 weeks to allow some physiologic
movement of the involved tooth so that ankylosismay be
prevented
EXTRUSIVE LUXATION

20. AVULSION
•complete displacement of a tooth out of the alveolar socket. is an urgent
situation requiring immediate action..

21. FIRST AID FOR AVULSED TOOTH
1.Do not touch the root of the tooth. Handle the tooth
by the crown only.
2.Rinse the tooth off only if there is dirt covering it. Do
not scrub the tooth.
3.Attempt to reimplantthe tooth into the socket with
gentle pressure, and hold it in position.
4.If unable to reimplantthe tooth, place it in a protective
transport solution, such as Hank's solution, milk or
salineThetooth should never be allowed to dry.

22. INJURIES TO THE SUPPORTING BONE
•Fracture of a alveolar socket walls; confined to facial or lingual wall.

23. INJURIES TO THE GINGIVA AND
ORAL MUCOSA
•copious irrigation for gingival wound is
necessary
•suturing may be difficult due to the friability
of tissue
•suitable antiseptic mouthwash should be
prescribed in the postoperative period.