DENTAL TRAUMATIC INJURIES

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Predisposing Factors


	> 90% of All Injuries
		Protrusion of Anterior Teeth
		Poor Lip Coverage

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Mouthguards


	Girls as Well as Boys
	Off - the - Shelf Vs. Individualized
	Colors
	Neurological Protection

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Legal Considerations


	Detailed Records
	Standardized Forms
	Consistant Information
	Professional Responsibility

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Medical Issues


	Never Treat a Stranger
	Neurological Assessment
	Above All Else, Do No Harm

Inappropriate Treatments


	Endo in Hand
	Snip Root Tip
	Scrub Root Surface
	Soak in Fluoride

Head Injury


	Medical Emergency
	Priorities
		Patient before dental!

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Neurological Assessment


	Aware X 3 ?
	Loss of Consciousness?
	Nausea or Vomiting?
	P E R R L A ?
	Drowsy ?
	Blurred Vision?
	Highway Patrol...

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Other Medical Issues


	Current Meds?
	Other Pathology?
	Tetanus Status ( DPT)
		10 years...

Antibiotic Necessity


	Bacterial Endocarditis Prophylaxis
	Soft Tissue “Through and Through”
	Avulsion: Prevent Root Resorption
	Dentoalveolar Infections Later

Trauma Treatment Priorities


	No Further Damage...
	Save the Tooth
	Save the Vitality
	Compromised PDL - Crush Sequellae

Types of Injuries


	Concussion
	Fracture
	Luxation
	Intrusion
	Extrusion
	Avulsion
	Root Fracture

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Fracture Classifications


	A Picture is Worth A Thousand Words
	Class I, II, and III

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Locate Fragment


	ANYONE SEE IT?
	IN THE LACERATION?
	RADIOGRAPHIC LOCATION
	AVOID PROBING IF POSSIBLE

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Endodontic Considerations


Direct Pulp Cap
	1 of 2 reasonable applications
	Mechanical (surgical) exposure
Larger Exposure - Pulpotomy
	Primary - Formocresol
	Permanent - Calcium Hydroxide
	Partial Pulpotomy?
Necrotic
	Complete pulpectomy
	Obturation
		Interim
		Permanent
Apexification
	Permanent Dentition
	Ca(OH)2
	GP Final

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Radiographic Needs


Periapical Views
	Two Required
Lateral Radiograph
	Primary Anterior Intrusions
Panorex
	Suspect Major Bony Fractures
		Subcondylar
		Mandibular
		LaFort Types

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Concussive Sequellae


	Fracture Dissipates Energy
		Diminished Pulpal Shock
	Adjacent Teeth
		Future Prognosis
	Warning to Patient / Parents

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Luxation Injuries


	Reposition
		Crossbite
	Potential for Root Resorption
	Stabilization

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Adequate Isolation


	Rubber Dam
		no clamp
		premaxilla
		contiguous holes
	Cotton Rolls and Saliva Ejector
	Dri-Angles

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Splints: Appropriate Use


	Easy to Apply
	Hygienic
		Patient can maintain
	Adequate Stabilization
	Ease of Removal
		for doctor
		for patient

Splinting Times


	Luxations 7-10 Days
	Avulsions 7-10 Days
	Root Fractures 3 months
	All Are Estimates; Frequent Revision
			Andreasen & J of Trauma

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Intrusive Injuries


	Status of Periodontal Ligament
	Status of Alveolar Bone
	Status of Pulp
	Reposition???
	Orthodontic Repositioning

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Primary Versus Permanent


	Different Pulpal Prognosis
	Recovery Likelihood
	Dangers of Sequellae

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Primary Anterior Intrusion


	Into Follicle?
	Apex Through Cortical Plate?
	Reasonable Expectation of Re-eruption?

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Apical Penetration of Cortical Plate


	Reposition?
	Extract?
	Pulpectomy...

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Primary Anterior Intrusions


	Re-eruption Probability
		6-12 months = 50%?
		Ankylosis....Extract Stat!
	Pulpectomy Necessary?

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Replantation Protocol


	On Site
	15 Minute Window … MAX!
	Clean Gross Debris
	Hold in Position
	Seek Dental Care
	If MUST Transport > Milk

Contraindicated


	Endondontics in Hand
	Scrape/Scrub Root Surface
	Soak in 10% SnF
		Unless exarticulated > 1 Hour
	Snip Root Tip

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Dental Replantation Protocol


	Check for Full Replantation
	Occlusion
	Stabilize
	Follow-up
		Short-term
		Long-term

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Root Resorption


	Replacement
		Ankylosis
	Inflammatory
		Disappearance of root
	Calcium Hydroxide Temporary Obturation

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Apexogenesis and Resorption Prevention


	Calcium Hydroxide Obturation
		3-10 Day window
	Instrumentation and Complete Cleansing Critical
	Replace at 3 and 6 months
	If No Contradicting Signs/Symptoms - Final Fill
	Long Term Observation

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Replantation Research


	Doxycycline soak
	Hank’s Balanced Salt Solution
	Shortened or No Splint Times

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Root Fracture


	Prognosis Location Dependent
		The More Apical the Better
	Long Bone Model of Repair
		Longer Splint Time
	Endodontics?
		Complete?
		Partial Coronal Fragment
	Long Term Observation

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Sequellae to Trauma


To the Involved Teeth
	External Resorption
	Internal Resorption
	Ankylosis
	Loss of Vitality
		Root Dilaceration, Canal Dystyrophic Calcification
To Succedaneous Teeth
	Damage to Follicle
		Timing Critical
		Hypoplasias, Demineralization,etc.
	Root Dilaceration
	Loss of Tooth

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Replacement Options


	Short Term:
		Removable: “Kiddie” Partial
		Fixed: Orthodontic Band Retained
	Long Term
		Etch Retained Bridge
		FPD
	Eventual: Implant or FPD