Mx trauma secondary dentition

  1. treatment protocols of trauma in the secondary dentition
    • diagnose and document
    • protect cementum
    • reduce alveolar fractures and reposition luxated teeth
    • manage soft tissues
    • splint
    • protect pulp and dentine
    • restore fractured teeth
  2. Protecting the pulp by
    • seal dentine - immature teeth have large dentinal tubules
    • direct pulp capping
    • cvek pulpotomy
    • pulpotomy - pulpotomy site must be apical to dentine fracture
    • *vital pulp will give apical closure, root length, root strength
  3. cvek pulpotomy (apexogenesis) - incomplete root apex with vital pulp
    • removal of contaminated pulp tissue
    • non-setting CaOH or Ledermix cement dressing placed directly onto uncontaminated vital tissue
    • STEPS:
    • LA
    • RD - mandatory
    • pulp is washed with saline until haemorrhage stops - any clot should be gently rinsed away
    • place non-setting CaOH over pulp remnant
    • cover with setting CaOH
    • *essential that CaOH is placed over vital tissue and not over a blood clot
    • (alternatively use ledermix)
    • GIC base placed over dressings
    • restore with composite resin
    • success 80-96%
  4. Formocresol vital pulpotomy
    • pre op radiograph
    • LA and RD
    • remove caries and create endo access cavity
    • excavation of coronal pulp, remove coronal pulp contents with new, s/s round 6 or 8 bur or clean spoon excavator
    • haemorrhage control - cotton pellets under pressure- 5mins
    • when ceased/slight ooze, place formocresol cotton wool over pulp stumps and cover with additional dry pellet
    • remove after 4 minutes - if haemostasis achieved, fill pulp chamber with IRM
    • tooth may be restored immediately with amalgam or GI or SSC
  5. Permanent dentition- lateral luxation mx
    • gently reposition tooth
    • stabilize tooth with flexible splint for 2 wks
    • alveolar fracture - rigid splint for 4 weeks
    • manage any soft tissue trauma
  6. Permanent dentition - intrusive luxation
    • teeth with immature root devpt should be allowed to erupt spontaneously
    • if no movement noted after 3 wks - rapid ortho repositioning
    • complete root devpt - repositioned asap (ortho or surgically)
    • flexible splint for 2wks
    • rigid splint for 4 weeks if bony fracture
    • manage soft tissue injuries
  7. Permanent dentition- extrusive luxation
    • reposition teeth
    • stabilize with flexible splint for 2 weeks
    • if alveolar fracture 4 weeks
    • manage any soft tissue trauma
  8. Root fracture
    • reposition coronal portion asap
    • check position radiographically
    • stabilize the tooth
    • flexible splint for 4 weeks
    • if root fracture is near cervical region, splint for up to 4 mo
  9. Permanent dentition - avulsion - emergency mx
    • replant tooth immediately
    • hold tooth by crown
    • rinse tooth with normal sline if dirty
    • stabilise in position - temporary e.g. orahesive/luxatemp
    • arrange for appropriate dental treatment
  10. Permanent dentition Avulsion mx
    • stabilize tooth with flexible splint for up to 2 eeks
    • manage any soft tissue injuries
    • administer systemic antibiotics for 7days
    • tetracycline is first choice if patient is over 12yo (100mg/day)
    • phenoxymethyl penicillin (penV) alternative
    • check tetanus status
    • initiate root canal treatment 7-10days after replantation and before splint removal if tooth has a closed apex
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Mx trauma secondary dentition
mx trauma secondary dentition