Traumatic tooth injuries

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Traumatic Tooth Injuries : 

Prepared by Dr.Mohamed Gaber B.D.S and Diploma in oral surgery University of alexandria Al-Jandal phcc. Traumatic Tooth Injuries


Complicated Crown Fracture : 

Complicated Crown Fracture

Diagnosis:Description: It Is Crown Fracture Involving Enamel, Dentine And Pulp ExposureVisual Signs: Visual Loss Of Hard Dental Tissues(enamel&dentine)with Exposure Of The Pulp : 

Diagnosis:Description: It Is Crown Fracture Involving Enamel, Dentine And Pulp ExposureVisual Signs: Visual Loss Of Hard Dental Tissues(enamel&dentine)with Exposure Of The Pulp

Percussion Test: No Tenderness, If The Tooth Is Tender This Evaluate Tooth For Luxation Or Root FractureMobility Test: There Is Normal Mobility : 

Percussion Test: No Tenderness, If The Tooth Is Tender This Evaluate Tooth For Luxation Or Root FractureMobility Test: There Is Normal Mobility

Sensibility Test: Usually Positive, This Test Is VIP In Assessing The Risk Of Future Healing Complications, Lack Of Response To The Examination Indicates An Increased Risk Of Future Pulp Necrosis . : 

Sensibility Test: Usually Positive, This Test Is VIP In Assessing The Risk Of Future Healing Complications, Lack Of Response To The Examination Indicates An Increased Risk Of Future Pulp Necrosis .

Radiographic Examination:Radiographs Recommended Are Periapical,occlusal&eccentric Exposure To Rule Out Displacement,pesence Of Luxation Or Root Fracture. : 

Radiographic Examination:Radiographs Recommended Are Periapical,occlusal&eccentric Exposure To Rule Out Displacement,pesence Of Luxation Or Root Fracture.

Slide 9: 

In The Radiographic Images The Loss Of Tooth Substance Is Visible.Also Radiographs For Lip&cheek Laceration VIP To Search Tooth Fragments And Foreign Bodies.

Slide 10: 

PERIODONTAL CHANGES LOSS OF TOOTH SUBSTANCE

Treatment:Age And Cooperation Of The Patient Influence The Treatment Plan Wether It’s Primary, Mixed, Or Secondary Dentition,Also Location And Extent Of Injury. : 

Treatment:Age And Cooperation Of The Patient Influence The Treatment Plan Wether It’s Primary, Mixed, Or Secondary Dentition,Also Location And Extent Of Injury.

Slide 12: 

The Aim Of The Treatment:Is To Preserve The Functional State Of Teeth, Bone And Gingiva.

Slide 13: 

N.B. The Main Factor In Determining Prognosis After Any Form Of Pulp Exposure Is Minimizing The Bacterial Invasion Of The Pulp.

There Are Four Factors Contribute The Management Of Complicated Crown Fracture:1- The Length Of Time Elapsed Since The Injury Occur.2-the Size Of The Pulp Exposure.3- The Condition Of The Pulp (Vital Or Non Vital).4- Stage Of Root Development. : 

There Are Four Factors Contribute The Management Of Complicated Crown Fracture:1- The Length Of Time Elapsed Since The Injury Occur.2-the Size Of The Pulp Exposure.3- The Condition Of The Pulp (Vital Or Non Vital).4- Stage Of Root Development.

Complicated Crown Fracture With Vital Pulp : 

Complicated Crown Fracture With Vital Pulp Tooth With Open Apex: The Prognosis Is Best If The Fracture Is Treated Within The First Two Hours. Direct Pulp Capping Is Indicated For Small Pin Point Exposure Occurring At Pulp Horn And Not An Axial Pulpal Line Angle.

Slide 16: 

If The Tooth With Open Apex And Small Pulp Exposure (1- 1.5 Mm) And Seen Within 24 Hours Its Directly Pulp Capped With Calcium Hydroxide. If The Exposure Is Larger Or Small Over 24 Hours , Calcium Hydroxide Pulpotomy Is Needed.

This Procedure Has Very High Success Rate And It’s Designed To Allow Tooth With Open Apex To Complete Root Development. : 

This Procedure Has Very High Success Rate And It’s Designed To Allow Tooth With Open Apex To Complete Root Development.

Slide 18: 

Tooth With Closed Apex:Direct Pulp Cap Should Be Performed With Small Exposure , And Patient Seen Within 24 Hours. If The Exposure Is Larger Than 1.5 Mm, Or Time Elapsed Is Larger Than 24 Hours, Root Canal Treatment Is Performed.

Slide 19: 

PULP CAPPING

Slide 20: 

PARTIAL PULPOTOMY

Slide 21: 

Fractured Crown With Pulp Exposure In An Eight-year-old Girl. Pulpotomy Using MTA For Pulpal Protection. One-year Follow-up; Note Continued Root Formation. Two-year Recall Showing Further Root Development.

Complicated Crown Fracture With Non-vital Pulp : 

Complicated Crown Fracture With Non-vital Pulp Tooth With Closed Apex, Root Canal Treatment Is Performed. In Immature Apex, Apexification Is Performed To Form Calcific Seal At Apex Prior To Condensing Gutta Burcha.

Crown Root Fracture : 

Crown Root Fracture Without pulp exposure With pulp exposure

Crown Root Fracture Without Pulp Involvement : 

Crown Root Fracture Without Pulp Involvement

Diagnosis Description: A Fracture Involving Enamel, Dentin And Cementum With Loss Of Tooth Structure, But Not Involving The Pulp. : 

Diagnosis Description: A Fracture Involving Enamel, Dentin And Cementum With Loss Of Tooth Structure, But Not Involving The Pulp.

Visual Signs: Crown Fracture Extending Below Gingival Margin. : 

Visual Signs: Crown Fracture Extending Below Gingival Margin.

Percussion Test: Tender Mobility Test : Coronal Fragment Mobile. Sensibility Pulp Test : Usually Positive For Apical Fragment. : 

Percussion Test: Tender Mobility Test : Coronal Fragment Mobile. Sensibility Pulp Test : Usually Positive For Apical Fragment.

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Radiographs Recommended: Periapical, Occlusal And Eccentric Exposures. They Are Recommended In Order To Detect Fracture Lines In The Root.

Radiographic Findings: Apical Extension Of Fracture Usually Not Visible. : 

Radiographic Findings: Apical Extension Of Fracture Usually Not Visible.

Crown Root Fracture With Pulp Involvement : 

Crown Root Fracture With Pulp Involvement

DiagnosisDescription: A Fracture Involving Enamel, Dentin, And Cementum With Loss Of Tooth Structure, And Involving The Pulp. : 

DiagnosisDescription: A Fracture Involving Enamel, Dentin, And Cementum With Loss Of Tooth Structure, And Involving The Pulp.

Visual Signs:Crown Fracture Extending Below Gingival Margin. : 

Visual Signs:Crown Fracture Extending Below Gingival Margin.

Percussion Test: Tender. Mobility Test: Coronal Fragment Mobile. Sensibility Test: Usually Positive For Apical Fragment. : 

Percussion Test: Tender. Mobility Test: Coronal Fragment Mobile. Sensibility Test: Usually Positive For Apical Fragment.

Slide 35: 

Radiographic Findings : Apical Extension Of Fracture Usually Not Visible.

1-fragment removal 2-fragment removal&gingivectomy 3-orthodontic extrusion 4-surgical extrusion 5-decoronation 6-extraction : 

1-fragment removal 2-fragment removal&gingivectomy 3-orthodontic extrusion 4-surgical extrusion 5-decoronation 6-extraction Treatment Emergency Defenitive Temporary stabilization of a loose segment to adjacent teeth till definitive treatment plan is made

1-fragment Removal Only : 

1-fragment Removal Only It Is Removal Of A Superficial Coronal Crown-root Fragment And Subsequent Restoration Of Exposed Dentin Above The Gingival Level. Indications: Superficial Fractures (Chisel-type Fractures),in Case Of Crown Root Fracture Without Pulp Involvement. Advantages: Easy To Perform. Definitive Restoration Can Be Completed Soon After Injury. Disadvantages: Long-term Prognosis Has Not Been Established.

Follow Up: By Clinical And Radiographic Controls After 6-8 Weeks And 1 Year. : 

Follow Up: By Clinical And Radiographic Controls After 6-8 Weeks And 1 Year. Fragment removal Clean with water Allow G. to reattach to exposed to dentin Disinfect with sodium hypochloride apply GI. or composite cements to exposed dentine Restore with composite

2-fragment Removal With Gingivectomy : 

2-fragment Removal With Gingivectomy Removal Of Segment Of The Fractured Fragment With Subsequent Endodontic Treatment And Restoration With A Post-retained Crown. This Procedure Should Be Preceded By A Gingivectomy And Sometimes Ostectomy With Osteoplasty. Indication: Fractures Where Denudation Of The Fracture Site Does Not Compromise Esthetics (I.E. Fractures With Palatal Extension). Advantages: Relatively Easy Procedure. Restoration Can Be Completed Soon After Injury. Disadvantages: The Restored Tooth May Migrate Labially Due To formation of a pseudo-pocket palatally.

Follow Up : Clinical And Radiographic Controls After 6-8 Weeks And 1 Year. : 

Follow Up : Clinical And Radiographic Controls After 6-8 Weeks And 1 Year. Fragment removal Pulpotomy or pulp extirapation GIC application Gingivectomy and/or ostectomy. restore with composite resin or post retained crown.

3- Orthodontic Extrusion Of Apical Fragment : 

3- Orthodontic Extrusion Of Apical Fragment Removal Of The Segment Of The Fractured Fragment With Subsequent Endodontic Treatment And Orthodontic Extrusion Of The Remaining Root With Sufficient Length After Extrusion To Support A Post-retained Crown. Indication: All Types Of Fractures, Assuming That Reasonable Root Length Can Be Achieved After Extrusion. Advantages: Stable Position Of The Restored Tooth. Optimal Gingival Health. Disadvantages: Time Consuming Procedure With Late Completion Of final restoration.

Follow Up:Splint Removal, Clinical And Radiographic Control After 4 Weeks.--Clinical And Radiographic Control After 6-8 Weeks, 6 Months, 1 Year An Yearly For 5 Years.-Tooth Restoration Implying Pulp Extirapation , Root Canal Filing And Post Retained Crown After Labial Gingivectomy. : 

Follow Up:Splint Removal, Clinical And Radiographic Control After 4 Weeks.--Clinical And Radiographic Control After 6-8 Weeks, 6 Months, 1 Year An Yearly For 5 Years.-Tooth Restoration Implying Pulp Extirapation , Root Canal Filing And Post Retained Crown After Labial Gingivectomy. Adapt steel arch wire Leave acid for 20 sec. Rinse with water Dry enamel with compressed air Place wire coil on arch wire & fixate arch wire with resin. Fixate bracket with resin Fixate elastic around the arch wire &bracket for traction Verify normal position clinical & radiographic

4-surgical Extrusion : 

4-surgical Extrusion Removal Of The Fractured Fragment With Subsequent Repositioning Of The Root In A More Coronal Position. Indication: All Types Of Fractures (Except Crown-root Fractures In Young Teeth With Open Apices Where Vitality Should Be Preserved) Assuming That Reasonable Root Length Can Be Achieved. Advantages: Rapid Procedure. Stable Position Of The Tooth. The Method Allows Inspection Of The Root For Additional Fracture. Disadvantages: Limited Risk For Root Resorption And Marginal Breakdown Of The Periodontium.

Follow up:-RCT initiated 3-4 weeks later.-splint removal & clinical &radiographic control after 4 weeks. Then, after 6-8 months, 1 year &yearly for 5 years. : 

Follow up:-RCT initiated 3-4 weeks later.-splint removal & clinical &radiographic control after 4 weeks. Then, after 6-8 months, 1 year &yearly for 5 years. Extract & reposition apical fragment with forceps Clean with water Perform pulp extirpation & seal root canal Apply resin splint for 4 weeks. RCT initiated 3-4 weeks later. Support tooth with finger while removing splint

5-decoronation : 

5-decoronation An Implant Solution Is Planned, The Root Fragment May Be Left In Situ After Coronectomy In Order To Avoid Alveolar Resorption Maintaining The Volume Of The Alveolar Process For Later Optimal Implant Installation. Indication: Can Be Used In Cases Where The Root Cannot Support A Post-retained Crown Restoration. Advantages: Preserves The Alveolar Process. Disadvantages: Postpones Definitive Restoration.

Slide 47: 

Raise full buccal mucoperiosteal flap Remove crown and root surface with rotary instruments just apical to alveolar bone crest Extirpate root canal and allow blood coagulum Allow tension free primary wound closure

Post-decoronation Restorative Treatment Options : 

Post-decoronation Restorative Treatment Options Patient’s Crown Bonded to Lingual of Adjacent Teeth Fixed Space Maintainerin the Mixed Dentition Natural Tooth or Acrylic Tooth Attached to Orthodontic Archwire Resin Bonded Bridge Acrylic Based Removable Partial Denture

6-extraction : 

6-extraction Extraction With Immediate Or Delayed Implant-retained Crown Restoration Or A Conventional Bridge. Indication: Extraction In Cases Of Extensive Deep Crown-root Fractures. Disadvantages: Tooth Loss. Reduced Alveolar Bone Height And Width Space Loss With Migration Of Adjacent Teeth Probable Need For Bone Grafting

Slide 50: 

thank you