TRAUMATIC INJURIES OF THE TOOTH Traumas that affect the hard tissues and cause pulpal and periodontal lesions are of great relevance to present day dentistry, because of their frequency, the functional and esthetic disturbances that accompany them and the rapidity with which these problems must be treated. Fracture: is understood to be the cracking or breaking of a tooth that has been subjected to a force or impact greater than its resistance. Even though endodontic techniques used by the specialist can resolve the pulpal complications caused by the fractured teeth, the fundamental aspect of prevention must be understood and practiced by the general dentist who will have a complete understanding of the value of rapid action to save the vitality of the pulp. CLASSIFICATION OF FRACTURES A) ELLIS CLASSIFICATION Class I
– Simple crown fracture with little or no dentine affected.
Class II
– Extensive crown fracture with considerable loss of dentin, but with the pulp not affected.
1
Class III
– Extensive crown fracture with considerable loss of dentin and pulp exposure.
Class IV
– A tooth devitalized by trauma with or without loss of tooth structure.
Class V
– Tooth lost as a result of trauma.
Class VI
– Root fracture with or without the loss of crown fracture.
Class VII
– Displacement of the tooth with neither root nor crown fracture.
Class VIII – Complete crown fracture and its replacement. Class IX
– Traumatic injuries of primary teeth.
B) W.H.O. CLASSIFICATION The World Health Organization adopted the following classification in 1978 with a code number corresponding to the international classification of disease: 873.60 Enamel fracture. 873.61 Crown fracture involving enamel / dentin without pulp exposure. 873.62 Crown fracture with pulp exposure. 873.63 Root fracture. 873.64 Crown root fracture. 873.66 Luxation. 873.67 Intrusion or extrusion.
2
873.68 Avulsion. 873.69 Other injuries such as soft tissues.
C) BY ANDREASEN 1) Classification of trauma in injury of hard tissues and pulp. This is based on W.H.O. classification. 873.60 Incomplete fracture. 873.61 Uncomplicated crown fracture. 873.62 Complicated crown fracture. 873.64 Uncomplicated crown and root fracture. 873.64 Complicated crown and root fracture. 873.63 Root fracture.
2) Injuries to the periodontal tissues: 873.66 Concussion. 873.66 Subluxation (loosening). 873.67 Intrusive luxation (central dislocation). 873.67 Extrusive luxation (peripheral dislocation, partial avulsion). 873.66 Lateral luxation. 873.68 Exarticulation (Avulsed tooth).
3
3) Injuries to the supporting bone: Mandible No. 802.20, maxilla No. 8.2.40 – comminution of alveolar socket. Mandible No. 802.20, Maxilla No. 802.40 – Failure of alveolar socket wall. Mandible No. 802.20, Maxilla No. 802.40 – Fracture of alveolar process. Mandible No. 802.21, Maxilla No. 802.42 – Fracture of mandible / maxilla. 4) Injuries to Gingiva/ Oral mucosa: 873.69 Laceration of gingiva/oral mucosa. 920.X0 Contusion of gingiva/oral mucosa. 910.00 Abrasion of gingiva or oral mucosa.
D) BASRANI CLASSIFICATION 1) Crown fractures. a) Fracture of enamel. b) Fracture of enamel and dentin. i.
Without pulp exposure.
ii.
With pulp exposure. 4
2) Root fractures. 3) Crown root fractures. E) BY ULFOHN His classification is based on clinical endodontics and does not reveal the extent of fracture or amount of dentin exposed. He based his classification on 3 aspects: i)
Clinical state of the pulp.
ii)
Pulp and dentin as one organ.
iii)
Determination of treatment.
Crown fractures: a) Of enamel. b) With indirect pulp exposure through dentine. c) With direct pulp exposure. F) BY HEITHERSAY AND MORILE They classified subgingival fractures based on the level of tooth fracture in relation to various horizontal planes of periodontium. Class I ďƒ Fracture line does not extend below the level of attached gingiva. Class II ďƒ Fracture line below the level of attached gingiva but not below the level of alveolar crest. 5
Class III Fracture line extends below the level of alveolar crest. Class IV Fracture line is within the coronal third of root, but below the level of alveolar crest. ETIOLOGY: 1) First year of life – Although infrequent injuries at this age may occur due to fall from a baby carriage. 2) Before school age – Incidence of dental injuries reaches its peak. Occurs due to falls, collisions and bumps. 3) Small children – Child abuse, as seen in battered child syndrome, Playground accidents, bicycle accidents. 4) Teen age – Sports such as hockey, football, basketball, wrestling and Horse riding. 5) Late teens – Automobile accidents. 6) Older age group – Rights (related to alcohol abuse), wife abuse. 7) Mentally retarded patients – due to lack of motor coordination. 8) Epileptic patients – Mainly due to fall during seizures. 9) Drug addicts - From violent with clenching.
6
10)Dentinogenesis imperfecta – Root fracture due to reduce hardness of dentin. PREDISPOSING FACTORS: -
Increased overjet with protrusion of upper incisors and insufficient lip closure are significant predisposing factors to traumatic dental injuries.
MECHANISMS OF DENTAL INJURY: The exact mechanisms of dental injuries are unknown, and without experimental evidence. Injuries can be Direct itself
Occurs
when
tooth
is
struck
e.g.
Indirect -
fully closed against the upper,
playground equipment. -
Lower dental arch is in a fight/fall.
run in anterior region.
-
Crown or crown root fractures in the premolar and molar region / jaw fractures.
7
FACTORS THAT CHARACTERIZE THE IMPACT AND EXTENT OF INJURY 1) Energy of impact: -
This factor includes both mass and velocity.
-
Low velocity blows causes more damage to surrounding tissues rather than tooth.
-
High velocity impacts – crown fractures are not associated with damage to the supporting structure.
2) Resiliency of impact force: When the blow to the tooth absorbed by surrounding tissues and less forces act on the tooth luxation results rather than a fracture of tooth. 3) Shape of impacting object: -
Sharp object – Clean crown fracture with minimal displacement because energy is spread rapidly over a limited area.
-
Blunt impact – area of resistance in crown portion is increased, impact is transmitted to apical portion causing luxation or root fractures. 8
4) Direction of impacting force: -
Impact can meet the tooth at different angles. Most often tilting the tooth facially perpendicular to long axis of the root.
-
Depending on different angles, different fracture lines are seen.
Due to frontal impacts four categories of fracture appear: -
Horizontal crown fracture.
-
Horizontal fracture at the neck of tooth.
-
Oblique crown root fracture.
-
Oblique root fractures.
EPIDEMIOLOGY 1.
Prevalence of dental injuries: -
Primary dentition – 11-30%.
-
Permanent dentition – 5-29%.
2. Sex and Age distribution: Sex – Boys affected almost twice as often as girls. Age – Peak incidence at 2-4 and 8-10 years of age. 3. Location of injuries: -
Most commonly involved are maxillary central incisors.
9
-
Least involved are mandibular central and maxillary lateral incisors.
4. Type of dental injuries: -
Permanent dentition Uncomplicated crown fractures mostly.
-
Primary dentition Luxation mostly.
Seasonal variations: -
Prevalence increases during winter months.
Diagnosis: The following modified principles of “PRINZ” fulfill the necessary requisites for obtaining a correct diagnosis of the pulp, whatever the cause. A.
Subjective symptoms: 1.
Case history: Thorough history about the occurrence of injury is necessary.
2.
Pain:
Intensity,
duration,
specificity,
cause,
spontaneity, localization, radiation. B.
Objective symptoms: 1.
Exploration: Consistency (dentin: hard-soft) depth, dentinal sensitivity, pulp exposure.
10
Inspection: Tooth structure, adjacent soft tissues. 2.
Colour: Localized spots, diffuse area of white, gray, brown.
3.
Transillumination.
4.
Pulp vitality tests - Thermal - Electrical
5.
Radiograph – Pulp canal, periapical region, root fracture.
6.
Percussion – Degree of periapical involvement.
Palpation : Changes in form, size, consistency and mobility of teeth. CROWN FRACTURES: 1) FRACTURES OF ENAMEL: These are fractures of the crown of the tooth involving only the enamel which may be accompanied by a crack that affects the dentin. This can be classified into three: Horizontal – Line of fracture perpendicular to long axis of the tooth. Oblique – Inclined to long axis. Vertical – Parallel to long axis.
11
According to Ingle: This involves chips and cracks confined to the enamel, did not cross DEJ but terminate at it. Also known as “crown infractions” by Andreasen. Diagnosis: -
Transillumination.
-
Dyes.
-
Vitality. Both immediately and after 6-8 weeks – concussion to apical neuro vascular bundle. Mainly involve children and majority of cases go unnoticed.
Treatment: 1) Smoothening of rough edges. 2) Composite resin using acid-etch technique. Prognosis: Good Sequlae: -
Pulp necrosis.
-
Internal resorption.
-
Calcification.
-
Trauma to primary may result in malformation of permanent successors.
12
2) CROWN FRACTURE INVOLVING ENAMEL AND DENTIN WITHOUT PULP EXPOSURE.
Description: Also known as “uncomplicated crown fractures” by Andreasen and Class II by “Ellis”. 1.
Anterior teeth (more common).
Site: -
Incisal proximal corners.
-
Incisal edges.
-
Lingual chisel type fractures. Posterior teeth cusps.
2. Incidence:
The enamel / dentin fracture is very common accounting for about one third of dental injuries. Diagnosis: -
As the tooth fracture involves dentin, dentinal tubules are exposed through which harmful bacteria and other substances have a direct pathway to pulp.
13
-
Thus along with the extent and degree of fracture, pulp vitality should be checked.
-
Electric pulp test is more reliable than a cold thermal test for vitality. If non-vital appropriate endodontic therapy should be provided.
Percussion Tenderness on percussion should be check. Mobility These two dictate the periodontal ligament status. Treatment Emergency / immediate follow up Objective of treating a tooth without pulp exposure is three fold: 1. Elimination of discomfort. 2. Preservation of vital pulp. 3. Restoration of fractured crown. Emergency 1.
Primary goal of treatment is to protect the pulp. Most effective method is placement of a protective
material over exposed dentin to allow the pulp to form a protective barrier e.g. Ca(OH)2 placement (Dycal).
14
2.
The fracture site must be covered with a restoration material such as acid-etch composite restoration.
The advantages are: a) No additional tooth structure is removed. b) Protects the dressing material. c) Provides for function and esthetics. Precautions: -
Do not cut the tooth structure.
-
Tooth should be relieved from occlusion.
-
Take a radiograph.
Permanent: -
This begins at 6-8 weeks after the injury.
-
Acid-etch – composite is the treatment of choice.
-
Because of the extent of fracture and because of esthetics reason – crown may be required.
3) CROWN FRACTURE WITH PULP EXPOSURE: -
Crown fracture involving enamel, dentin and pulp are called “complicated crown fractures” by Andreasen and Class 3 fractures by Ellis.
15
-
Degree of pulp exposure varies from a pinpoint exposure to a total unroofing of coronal pulp.
-
Pulp exposure complicates the treatment as healing and repair are harmed.
-
Traumatic exposure of the pulp lacerates the tissues and exposes the pulp to the oral environment.
-
Initial reaction is hemorrhage followed by an inflammatory response which is either distructive (necrotic) or prolifeative (polyp) reaction.
Incidence: -
Crown fracture are less than those not involving the pulp.
-
Range ďƒ 2-13%.
Diagnosis: The condition of the exposed pulp will affect the treatment choice and must be carefully evaluated. This depends on four factors: 1. Length of time the pulp has been exposed. 2. Maturity of tooth – Apex formed or not formed. -
Check Radiographically. 16
3. Age of the patient. 4. Extent of crown fracture – dictates pulp treatment along with maturity. Treatment: -
Depends on maturity of the tooth can be divided into two:
1.
Treatment of pulp exposure with incomplete root formation. a)
Pulp cap with Ca(OH)2 if treatment performed within 3-4 hours after injury.
b)
Pulpotomy
- Massive pulp exposure.
- Exposure > 3-4 hours. Aim: To maintain the vitality and allow root completion. After root completion, perform root canal filling. c)
If pulp is necrotic, apexification is done to induce apical closure (use Ca(OH)2). After root completion fill canal with gutta-percha as permanent filling.
Treatment of pulp exposure with completely formed roots: a) Pulpectomy – if pulp is necrotic. b) Root resection.
17
4) ROOT FRACTURE: This type of injury is limited to fractures involving the roots only. Cementum, dentin, pulp. Incidence: -
These are relatively uncommon. Occurring in 7% or less of injuries of permanent teeth.
-
Maxillary central incisors predominately in age group of 1120 years.
Diagnosis: a)
Clinical findings: (Horizontal Fracture) -
Slight extrusion of tooth.
-
May be displaced lingually (coronal segment).
-
Mobility of tooth.
-
Tenderness on palpation over the root.
b) Radiographs -
Fracture line seen on radiograph is oblique.
18
-
Root fracture is only visible only if the central beam is directed within a maximum of 15-20° deviation from the plane.
-
Root fractures occasionally escape detection on radiograph taken immediately after injury, while later clearly reveal the fracture. This is due to development of either hemorrhage or granulation tissue.
-
The fracture occurs most often in the age or middle third of the root and only namely in the coronal 1/3rd.
Radiographic and histologic observation in humans show that the healing events after root fractures occur in one of way: a)
Healing in calcified tissue.
b)
Interposition of connective tissue.
c)
Interposition of bone and connective tissue.
d)
Interposition of granulation tissue.
Classification of Root Fractures: A.
Based on direction of fracture line with long axis of tooth: -
Horizontal – fracture perpendicular to long axis of tooth.
-
Oblique – fracture is at an angle to long axis.
-
Vertical – fracture parallel to long axis.
19
B. Based on location: -
Cervical third.
-
Middle third.
-
Apical third.
C.
According to number of fracture lines: -
Simple – only one fracture line dividing root into two fragments.
-
Multiple – when root is divided into more than 2 fragments.
-
Comminuted – multiple fracture lines.
D.
According to extension of line of fracture: -
Partial – Fracture involves a portion of root.
-
Total – entire root is involved with fracture line.
E.
Position of root fragments: -
Without displacement – segments face each other.
-
With displacement – when fracture segments are not aligned.
20
Treatment Horizontal fracture treatment -
When a horizontal / a diagonal fracture of the root occurs immobilize the tooth by splinting it to adjacent teeth to keep it at rest.
-
Depending on the location of fracture the treatment varies considerably.
-
When a fracture occur in the middle or coronal third the prognosis is less favourable because of difficulty of immobilizing the tooth.
-
Repair does not occur due to constant movement of the tooth as well as exposure of pulp to oral environment (coronal fracture).
1) a)
Anesthetize the tooth.
b)
Tease off the broken coronal part from the residual periodontal attachment on the lingual.
c)
Endodontic treatment should be completed in one visit.
21
d)
Natural crown can be recemented on the tooth root with the aid of a temporary post and composite resin.
e)
Splint the tooth to adjacent teeth.
f)
Relieve tooth from occlusion.
g)
Recall patient after 3-4 weeks, evaluate the tooth, if asymptomatic tooth can be restored with a jacket crown.
2) If the apical fragment is sufficiently long supported by the surrounding periodontium and can be satisfactorily retained, intentional orthodontic extrusion (eruption) of the apical root is done to conserve existing alveolar bone and to expose sufficient root surface above the alveolar crest to enable one to construct post core crown with tapered margins around the erupted root surface. 3) If tooth is too loose, it should be extracted. Apical third treatment: -
A tooth whose root is fractured in its apical third has an excellent prognosis because the pulp in the apical fragment usually remains vital and tooth may remain firm in its socket.
-
If mobile, ligate the tooth.
22
-
With the pulp being vital in the root and the tooth is stable with or without ligation no additional treatment is required.
-
If pulp becomes non-vital or undergoes necrosis with time, the endodontic treatment should be done till the fracture fragment (i.e. coronal to the fracture).
-
If tooth fails to recover and symptoms persist the apical fragment can be removed surgically.
Vertical fracture: -
Vertical fracture is not as amenable to conservative endodontic treatment as horizontal fracture.
Diagnosis: -
Diagnosis is difficult to establish by radiograph, percussion or other means.
a)
Symptoms: -
Patient C/o sensitivity.
-
Patient may / may not be able to locate the affected tooth.
23
b) Electric pulp test -
Tooth may react normally to EPT or may become hypersensitive.
c) Radiograph -
In cases of hair line fracture no visible changes on radiograph.
d) Occlusal pressure test: -
When asked to bite / chew on a cotton applicator or a rubber polishing wheel patient gets sharp pain.
Causes: -
Condensation of gutta-percha.
-
Cementation of inlay in endodontically treated tooth.
-
Cementation of a post.
-
Excessive enlargement instruments.
-
Traumatic occlusion.
of
RC
with
engine-driven
Treatment: -
If a fracture passes through its furcation the prognosis may be favourable, provided the tooth can be hemisected e.g. BL fracture of mandibular molar. 24
-
Endodontic therapy followed by hemisection and full coverage restoration of mesial and distal segments usually suffice.
-
When a longitudinal fracture of an anterior tooth occurs prognosis is hopeless.
-
The successful termination of root fracture depends on the location of fracture, on the proximity of the fracture surfaces, on whether the fracture is comminuted and on the ability to mobilize the fragments.
CROWN ROOT FRACTURES: -
These are the fractures that occur simultaneously by in the crown and the root, affecting the enamel dentin and the cementum.
-
The pulp may or may not be involved in the fracture.
-
Fracture may be:
Vertical
Acc to the position
Oblique -
In majority of cases, the direction of the fracture is from buccal to lingual.
25
Etiology: -
Teeth with extensive plastic restoration.
-
Teeth undergone endodontic treatment and did not have a definitive restoration placed.
-
Teeth with incorrect intraradicular anchorage / screws, post.
-
Teeth damaged due to:
- Bruxism. - Bad habits. - Blows
-
Crown root fracture constitute 5% of traumatized teeth.
Classification: According to extent of fracture line. 1)
Total – fractured line is complete and coronal fragment is held only by the PDL.
2)
Partial – Incomplete fracture line. According to the proximity to the pulp chamber: 1) Without pulp exposure. 2) With pulp exposure.
26
Symptoms: -
Spontaneous pain that increases on mastication.
-
Temperature change causes pain.
-
Marked mobility on exploration and palpation, depending on
Signs:
whether the fracture line is partial / complete. -
May not be any color change.
Diagnosis: 1) Occlusal pressure : Ask the patient to bite on an orange-wood stick, the patient will experience pain on biting. In some instances it is possible to visualize the separation of fractured parts. 2) Radiographic examination: -
Fracture may not be visible Radiographically because the fractured segments are not displaced.
Treatment: 1) Fracture without pulp exposure (emergency treatment). 2) Anesthesia. 3) Removal of the fractured segment. 4) Protection of the remaining dentin. 5) Temporary restoration. 27
Follow up treatment: -
If a pulp appears normal clinically and Radiographically a definitive restoration is placed.
2) Fracture with pulp exposure (emergency treatment). a)
Anesthesia.
b)
Removal of the fractured segment.
c)
Pulp protection, extirpation of the pulp, or treatment of necrotic pulp.
d)
Temporary restoration.
Follow up treatment: a) Gingivectomy and or alveoloplasty when indicated. b) Appropriate treatment. c) Definitive treatment. Prognosis: When the fracture line is not very deep, the prognosis is favorable.
28
LUXATION: Definition: According to Grossman is the displacement or dislocation of a tooth from its socket. Classification: I] Partial – tooth is partially displaced from its socket. Total – in which tooth is completely avulsed from its socket. W.H.O. Classification of Luxation a) i)
873.66 Concussion – tooth is sensitive to percussion but is not displaced.
ii)
Subluxation – tooth has abnormal mobility but is not displaced.
iii) Luxation – tooth is loose and tooth is displaced. b)
873.67 i)
Intrusion – indicates displacement of the tooth into its socket accompanied by fracture of the alveolar socket.
29
ii)
Extrusion – partial displacement of a tooth out of its socket. Luxation injuries comprise of 15-40% of dental traumas.
Aetiology: -
Fall injuries.
-
Fight injuries.
Clinical Findings: Partial luxation: -
Soft tissue become swollen and are covered with blood.
-
Tooth may appear loose especially if extruded.
-
PDL is torn in several places usually.
-
Fracture is not commonly seen (according to Grossman) as forces which causes luxation are directed parallel with the long axis of teeth rather than at right angles.
-
According to Andreasen – two or more teeth are luxated simultaneously and show concomitant crown or root fractures.
-
Diffuse ache in the affected area with little discomfort.
30
-
Tooth may feel numb shortly after the blow.
-
If intrusion occurs, only a small portion of crown may be visible because of swelling of the tissues.
-
Intrusion seen more in primary teeth.
Diagnosis: -
Diagnosis is based on case history, clinical examination, radiographic examination and vitality test.
Radiographic findings: -
The width of the periodontal space is increased on radiographs of extrusive luxations, while it is partially or totally disappears in intrusive luxations.
Treatment: INTRUSION: -
An intruded tooth requires no immediate treatment (unless it is a primary tooth that can affect the permanent tooth bud) because the tooth will slowly erupt.
31
-
Emergency treatment is usually accomplished by applying cold, to alleviate the swelling and pain and by stopping any bleeding.
-
If eruption of intruded tooth is slow, tooth can be actively erupted and properly positioned with the use of orthodontic appliance (for a period of 6-8 weeks). If vital endodontic therapy is not required. When pulp becomes non-vital endodontic therapy is carried out, this vitality of intruded tooth should be checked frequently.
EXTRUSION: -
Extruded tooth should be forced back into the socket as soon as possible.
-
Tooth is forced back – under anesthesia with gentle finger pressure or pressure can be exerted with a wooden tongue blade placed against the incisal surfaces of the adjacent teeth to force them back.
-
Splint the tooth using: Acid-etch resin technique. Orthodontic bond/brackets and resin splint.
32
-
Ground tooth out of occlusion to prevent additional trauma.
-
Depending on the degree of impact pulp may be vital or nonvital. (Vital – as the vascular supply to the pulp is not always severed or even impared).
-
If pulp becomes non-vital / necrotic endodontic treatment must be done.
-
Splints are removed after a period of 2-3 weeks.
CONCUSSION AND SUBLUXATION: -
Treatment is confined to occlusal grinding of opposing teeth, supplemental with respected vitality and radiographics evaluation of tooth during follow up period.
-
Immobilize the tooth in cases of marked mobility.
Treatment: 1) At site of injury: a)
Wash the tooth in running water without brushing or cleaning it, and examine it to be certain that the tooth is intact.
33
b)
Have the patient rinse tooth, replace tooth in its socket using gentle, steady finger pressure. If the patient is cooperative and able, have the patient gently close the teeth together to force the tooth back into its original position.
c)
If the patient / parent cannot replace the tooth in the socket carry it in a suitable transporting media.
d)
Take the patient to the dentist.
2) Treatment in dental office: a) If the tooth is in its socket ligate, stabilize and disocclude the implanted tooth. If the tooth is out of its socket or is improperly positioned, replant the tooth properly before ligation. b) Take a radiograph to verify the position of the tooth in its socket and to examine it for any root or alveolar bone fracture check adjacent teeth for possible fracture. c) Do not attempt endodontic treatment at this time unless the tooth requires venting (drainage).
34
d) In this case open and perform emergency root canal therapy and place a sedative dressing. Endodontic treatment should be completed at a later date. Factors affecting the success of replantation: 1) Extra oral time: Universal agreement exists – shorter the extra oral time the better the prognosis for retention of replanted tooth.
-
90% of replanted teeth with extraoral time of within 30 minutes showed no resorption of roots.
2) Storage media and transportation of avulsed tooth: -
To prevent further damage to the PDL tooth should be replanted at site of injury.
-
When replantation is delayed tooth should be stored in a physiologic medium to prevent further injury to PDL.
-
Under no circumstances the tooth should be allowed to dry, as it causes clinical necrosis.
-
Do not wipe the tooth rinse it under water.
Methods used are:
35
1) Saliva - Best storage media, patients mouth. - Readily available. 2) Milk - Not readily available. - Expensive 3) Physiologic saline -
Not readily available
-
Does not impair periodontal healing.
4) Hank’s balanced salt solution (Krusen and Person) Composition: -
Na, Ca, Mg chloride.
-
Glucose.
-
Mg SO4
-
Sodium phosphate. 85-90% success rate
5) Special cell culture medium like viaspan and dentosafe. 6) Management of the socket: -
The less manipulation of the socket the better prognosis for the replanted tooth.
-
Use light irrigation and gentle aspirations to remove any blood clot present in the socket, to permit replantation.
36
-
Do not curette or vent the socket.
37
7) Management of the root surface: -
To preserve the vitality of the root surface cells, do not handle, scrape, brush, or remove any of the root surface.
-
If the root appears clean, replant as it is.
-
If the root surface is dirty, rinse it clean with tap water.
8) When to perform endodontic treatment: The guidelines suggest that endodontic treatment should be initiated within 7 to 14 days of replantation and when the tooth is in its socket. 9) Splinting: Leaving the splint in place for 7-10 days if no bony fractures are present or longer if necessary, and ask the patient not to bite on the splinted teeth; prescribe soft diet. 10)Adjunctive drug therapy: Refer the patient for a tetanus consultation within the first 48 hours, and prescribe antibiotics only if indicated.
38
Instructions to the patient: 1) Soft diet. 2) Brush with soft brush gently. 3) Use of chlorhexidine mouth wash (0.1%) for 7 days. 4) Regular follow up to be maintained. Complication : -
Root resorption.
-
Ankylosis.
PREVENTION OF TRAUMATIC INJURIES A)
Preventive measures in sports 1) Face mask. 2) Mouth protectors. a) Stock variety. b) Pre-formed. c) Custom made.
A)
Preventive measure during anesthetic procedure: a) Mouth protectors. Prevention of oral trauma in the comatose – Tongue stent.
39
CONCLUSION Bicycle and automobile accidents, home and play ground injuries have all taken their toll in fractured crowns and roots non-vital pulps and avulsed or dislocated teeth. These dental injuries meant a life of discomfort and disfigurement as no replacement can equal function and esthetics of intact dental structures. Considering the multiplicity of etiologic factors, one can easily understand why preventive measures are difficult to institute. However, certain accident-prone individuals can be protected. For example mouth guards have proven effective in the prevention of dental injuries due to contact sports and during anesthetic procedures.
40
References 1) Endodontic practice by Louis I. Grossman XIth edition. 2) Endodontic by John Ide Ingle IIIrd edition. 3) Pathways of the pulp by Stephen Cohen – VIth edition. 4) Fractures of the teeth by Enrique Basrani. 5) Traumatic injuries of the teeth – J.O. Andreasen IInd edition.
41
CONTENTS INTRODUCTION CLASSIFICATION ETIOLOGY MECHANISM OF TRAUMATIC INJURIES EPIDEMIOLOGY DIAGNOSIS INJURIES OF TOOTH IN DETAIL PREVENTION OF INJURIES CONCLUSION
42