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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
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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
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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%
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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
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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
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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
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Permanent dentition- extrusive luxation
- reposition teeth
- stabilize with flexible splint for 2 weeks
- if alveolar fracture 4 weeks
- manage any soft tissue trauma
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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
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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
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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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