Management of Dental Trauma

8/8/2019 Management of Dental Trauma

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MANAGEMENT OF DENTAL TRAUMA


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ASSESSMENT

History

Clinical examination

Radiograph

Additional tests


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Primary Dentition

Treatment is dictated by the concern for the

safety of the permanent dentition. If displaced tooth has encroached upon

permanent tooth germ extraction indicated.

Inform parents about possible pulpal

complications, appearance of sinus tract,

color change


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Also caution parents of permanent teeth

complications including: Enamel hypoplasia

Hypocalcification

Crown/root dilaceration Disruption in eruption.


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Permanent Teeth

Treatment is dictated by the concern for

vitality of the periodontal ligament and pulp. Periodical review is mandatory.

Initiation of endodontic treatment is indicated

in cases of spontaneous pain, abnormal

response to pulp test, lack of continued root

formation


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Splint

Used to stabilise a tooth following traumatic

injury Flexible splinting assists in periodontal

healing.

Characteristics of ideal splin :

Easily fabricated in the mouth Passive unless orthodontic forces are

intended


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Allows physiologic mobility (except for root

fractures Non-irritating to soft tissues

Does not interfere with occlusion

Allows endodontic access Easily cleansed

Easily removed


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Instruction to patient

Avoid biting on splint tooth

Maintain meticulous oral hygiene Call immediately if splint breaks / loosens

Use chx / antibiotics as prescribed.


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Guidelines

Infraction: incomplete fracture of the enamel

without loss of tooth structure. Treatment objective: maintain structural

integrity and pulpal vitality.


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Crown fracture-uncomplicated:

An enamel fracture or enamel-dentinefracture that does not involve the pulp.

Small fractures can be smoothed.

Larger fractures the lost tooth structure canbe restored.


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Crown fracture complicated:

An enamel dentine fracture with pulp exposure. Primary of teeth pulpal treatment alternatives are

pulpotomy, pulpectomy, extraction.

Permanent teeth pulpal treatment include, direct pulp

capping, partial pulpotomy, pulpectomy. Prognosis depends injury to PL, age of the pulp

exposure, entent of dentine exposed, stage of root

development.


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Crown root fracture:

Enamel, dentine and cementum fracture withor without pulp exposure.

Clinically may reveal a mobile coronalfragment attached to the gingiva with or

without exposure. Root fractures only demonstrated

rdiographically.


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Primary teeth if cannot restore extract

Permanent teeth remove coronal fragmentfollowed by supragingival restoration or

necessary gingivectomy, ororthodontic

extrution to prepare for restoration.

Pulp treatment pulp capping, pulpotomy and

rct.


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Root fractures:

Dentin and cementum fracture involving pulp Clinically reveal a mobile coronal fragment

attached to gingiva that may be displaced.

Radiogaphically may reveal 1 or more

radiolucent lines

Primary teeth extraction of coronal portion.


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Permanent teeth: reposition and stabilise the

coronal fragment. Location of root fracture in permanent teeth

affects survival after injury.

Root fractures occuring in the cervial third or

apical third can be treated succefully by

stabilisaion of repositioned fragment.


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Concussion:

Injury to the tooth suporting structureswithout abnormal loosening or displacement

of the tooth.

PL absorbs injury and is inflammed.

Signs include ttp, without mobility or

displacement.


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Nil abnormality radiographically.


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Management of Dental Trauma

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