DENTAL TRAUMA
- Introduction :
A dentoalveolar trauma involves several tissues and structures. (The consequences of a trauma, establishing a treatment plan and assessing its prognosis). partial or total loss of dental tissues resulting in serious aesthetic and functional damage for their victims. The treatment of dental trauma requires a multidisciplinary approach.
- Etiologies:
Determining factors:
Falls (learning to walk, ride a bike, etc.)
Collisions
Sports practice, particularly contact sports (e.g. boxing, rugby, judo, basketball, etc.);
Road accidents;
Assaults and violence
Inappropriate use of teeth (e.g. biting into something too hard);
Domestic accidents and work accidents: very low prevalence.
Predisposing or aggravating factors:
Occluso-functional factors:
Namely, dental malpositions and in particular the existence of an overhang with protrusion, in particular overhangs greater than or equal to 5 mm. Which exposes the teeth of the incisor-canine block.
Thus, labial incontinence and the absence of natural protection by the lips exposes the maxillary incisors more to fractures and dislocations.
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Social and environmental conditions: deprived or overpopulated areas with low economic levels have more severe dental trauma than others.
Gender: Boys are more prone to dental trauma than girls.
This is generally explained by aggressive games, practices and riskier behaviors in boys than in girls from a certain age.
Risky behaviors or behavioral disorders, particularly in children, with medical problems predisposing to falls such as epilepsy, visual or hearing defects, etc.
Psychological states, such as stressed and emotional people,….
Trauma can also occur during or following dental care (e.g. coronal fracture due to impact with a dental instrument (rotary, forceps, etc.).
- Mechanisms of dental traumatic injuries:
Dental trauma can result from direct or indirect trauma.
Direct trauma: Occurs when the tooth itself receives the shock, the blunt agent being for example the ground, a chair, etc. Direct trauma concerns the anterior teeth and particularly the maxillary incisors.
Indirect trauma: Is the result of a violent shock of the mandibular arch against the maxillary arch, for example, following a blow to the lower part of the chin. The dental injuries that result are coronal or coronal-radicular fractures of the premolars and molars. This type of trauma is also the cause of condylar or symphysis bone fractures.
4-Classification of dental trauma:
THE WHO CLASSIFICATION (1969) MODIFIED BY JOANDREASEN:
. Trauma to dental hard tissues and pulp:
1. Coronary lesions: cracks.
2. Simple coronal fractures: involving enamel or enamel and some dentin.
3. Complicated coronal fractures: with pulp involvement.
4. Simple coronal-radicular fractures: without pulp involvement.
5. Complicated coronal-radicular fractures: with pulp involvement.
6. Root fractures.
2. Trauma to periodontal tissues:
1. Concussion.
2. Subluxation.
3. Extrusion.
4. Lateral dislocations.
5. Intrusion.
6. Expulsion
3. Alveolar bone lesions:
1. Comminuted alveolar lesions: fracture with numerous alveolar fragments.
2. Fracture of the alveolar wall.
3. Fracture of the alveolar process.
4. Fracture of the maxilla or mandible.
4. Lesions of the gum or oral mucosa:
1. Laceration.
2. Concussion.
3. Loss of substance.
VANEK’S CLASSIFICATION (1980):
Class 1: Coronal fracture.
Class 2: Coronal fracture without pulp exposure.
Class 3: Coronal fracture with pulp exposure.
Class 4: Complete coronal fracture.
Class 5: Oblique coronal-radicular fracture.
Class 6: Root fracture.
Class 7: Dislocation.
Class 8: Avulsion.
5-Examination of the trauma patient:
It is essential to understand and immediately assess the damage to dental tissues and
Surroundings (pulp tissue, periodontal ligament, alveolar bone) during trauma.
This is why the patient’s anamnesis, the information provided by clinical and radiographic examinations are fundamental. When the patient consults late, it is then necessary to take into account the impact that the time component can have on the prognosis.
5-1: Anamnesis:
The anamnesis is essential. It must specify the circumstances of the trauma, guide the clinical examination and direct the therapeutic choice. First of all, the civil status must be noted: name, age, sex and contact details including address and telephone number.
Question 1: How did the trauma occur?
Depending on the type of trauma, certain areas need to be examined more closely. For example, a direct blow to the chin can cause not only an incisor fracture, but also have repercussions on the cusp area and the temporomandibular joint.
Question 2: Where did the shock occur?
The response makes it possible to assess the risks of contamination (in the case of expulsions) and to possibly initiate antibiotic therapy and/or tetanus vaccination.
Question 3: When did the trauma occur?
This question introduces the time factor. It is a decisive element that significantly influences the implementation of certain therapies such as pulp therapies, repositioning after dislocation, reimplantation.
It is also necessary to determine whether there has been a loss of consciousness? Does the patient suffer from amnesia? Has he vomited? Does he suffer from headaches? Positive answers to one or more of these questions may lead to the suspicion of head trauma. In these conditions, he will have to be referred to a hospital, the dental injuries then taking second place.
A questionnaire is used to assess the existence of medical history (blood disorders, cardiovascular disorders, epilepsy, diabetes and/or allergies). These may contraindicate certain therapeutic maneuvers, guide in the choice of anesthetic and specify the prescription or not of the most appropriate antibiotic therapy.
It is also necessary to ask about the nature of the dental pain (are the teeth spontaneously painful?). Are the teeth sensitive to thermal variations, sweet or acidic foods? An affirmative answer may lead to a search for dentin or pulp exposure.
And then is chewing painful? Does the occlusion seem normal? Positive answers to these questions may raise concerns about lateral dislocation, extrusion, alveolar fracture or even jaw fracture.
Exoral examination:
Inspection : Wounds on the face, lips and chin are inspected to determine whether or not stitches are required.
Teenage girl with multiple facial wounds
Palpation:
Palpation of the bony edges (nose, suborbital mass, symphysis, mandibular angle) suggests, in case of pain, the possibility of bone fractures. Hematomas are also sought. A limitation, deviation or deflection of the mouth opening may indicate a condylar fracture or meniscal displacement.
Endo-oral examination:
a) Soft tissue examination
Examine all the labial, lingual, gingival, jugal mucosa, etc.
*looking for: bruises, hematomas, wounds, bleeding and the existence of a foreign body
Hard tissue examination:
Direct impact coronal fractures can result in dentinal damage and possible exposure of pulp tissue.
In the case of indirect shocks, it is necessary to look for the presence or absence of coronal-radicular fractures at the level of the molar sector.
Enamel cracks are visualized by transillumination, holding the light beam perpendicular to the vestibular mucosa at the level of the attached gingiva.
Clinically, the change in color is assessed in relation to adjacent and/or contralateral teeth. A change in color observed immediately after trauma may disappear later and should not lead to a hasty decision to depulp. Conversely, the appearance during subsequent sessions of discoloration, particularly yellow or gray, indicates calcification or pulp necrosis.
DENTAL TRAUMA
Three tests must be carried out:
Mobility
Percussion
Thermal sensitivity
* Axial mobility indicates apical section of the neurovascular bundle
* Mobility in a horizontal direction indicates either an alveolar fracture (if the mobility of one tooth causes the mobility of adjacent teeth) or a root fracture.
Percussion is performed in the vertical and horizontal direction using the mirror handle in adults and the finger in children. It allows sensitivity and sound to be assessed.
Tenderness to axial percussion reveals damage to the periodontal ligament and/or the pulp vascular network.
A metallic sound during horizontal percussion indicates lateral intrusion or dislocation.
A dull sound indicates subluxation or extrusion.
The assessment of thermal sensitivity is done:
Either with dichlorofluoromethane, applied to the tooth using a cotton ball
Either by means of warmed gutta-percha.
They allow to judge the state of the pulp after the trauma. These tests can be supplemented by electrical tests.
X-ray examination:
An essential complement to the clinical examination, it provides more information on the stage of root development, on the presence or absence of root fractures and on the involvement of periodontal structures. All teeth in the traumatized region must be X-rayed, even if no traumatic lesion is visible on clinical examination (possibility of root fractures).
Taking photographs:
Photographing is recommended because it complements the documentation of the trauma and can be used later for other treatments, as well as forensic forms, clinical research, and teaching.
Forensic aspect and medical certificate:
This is a basic element for any possible legal problem. All findings must be recorded. It is necessary to note any particular fact and to take intra and extra oral photographs for a complete report.
6-Coronary fractures:
6-1) Coronal fractures without pulp exposure
The cracks:
Frequent but often overlooked, cracks appear as fissures in the enamel without crossing the enamel-dentin junction. There is no loss of substance. They are caused by a direct shock to the enamel.
Diagnosis:
Highlighted by transillumination, these cracks are often associated with other trauma, particularly dislocation, which must be investigated.
Clinical signs are non-existent. The patient sometimes complains of a slight sensitivity to cold.
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Treatment :
The therapy consists of abstention or the application of a sealant at the level of the crack line to prevent external colorants (caffeine, theine, etc.) from causing dyschromia.
Prediction:
It is excellent, this trauma does not cause serious pulp consequences.
Enamel fractures:
Diagnosis:
Enamel loss is most often located at the mesial or distal angle of the traumatized tooth.
The cold test is positive, and the percussion test is slightly painful.
Treatment :
When enamel loss is minimal, treatment consists of coronoplasty of the enamel edges with a diamond bur mounted on a turbine and under constant irrigation. This procedure may be followed by a fluoridation session.
In other cases, it is necessary to perform the reconstruction of the tooth using a light-curing composite.
Pulp vitality monitoring will be carried out one month later, then at 3 months and then every 6 months.
Prediction:
It is excellent, the risks of pulp necrosis are very minimal.
Coronal enamel-dentin fractures:
Diagnosis:
A more or less extensive loss of substance is observed. These fractures generally affect one or two teeth. They may be associated with ligament damage (subluxation or extrusion).
Proportional to the severity of the trauma, the clinical signs are manifested by:
– Dentin hyperesthesia (pain when cold, acid and sugar, etc.)
Pain when chewing
Radiographic examination allows the relationship between the pulp and the fracture line to be assessed.
Treatment :
Definitive treatment aims to achieve the following objectives:
Seal exposed dentinal tubules tightly
Restore aesthetics and function
The restoration will be done with bonded composite, respecting the operating protocol.
Post-operative follow-up:
The composite restoration provides excellent sealing and must be monitored annually over time.
Coronal fractures with pulp exposure:
These traumas result in varying degrees of pulp exposure. The treatment decision depends on:
About the size of the exhibition
The time elapsed between the time of the trauma and the visit to the office.
From the stage of root evolution.
Diagnosis:
The fracture line may be horizontal or oblique, may graze or cut the pulp. The pulp appears as a bloody mass at the level of the denuded surface, the peripheral fragment may be mobile and its mobility triggers pain.
The tooth is much more sensitive to cold than to heat.
Axial and transverse percussions are positive.
Signs of acute pulpitis are noted which set in immediately
There are two possible scenarios: mature teeth or immature teeth.
Treatment :
Mature teeth:
If the exposure is minimal and recent, direct pulp capping may be considered. However, the prognosis is less favorable and these techniques should be considered as emergency treatment.
If the pulp exposure is more extensive or older and if root anchorage is necessary for reconstruction, conventional gutta-percha endodontic treatment is the technique of choice.
7-Corono-radicular fractures:
From an epidemiological point of view, they represent approximately 5% in permanent dentition and 2% in temporary dentition. All dental tissues are affected: enamel, dentin, cementum and most often the pulp.
They can be classified into two categories according to the involvement of the pulp tissue:
* Simple FCR: without pulp involvement (rare)
* Complicated FCR: with pulp involvement
Diagnosis:
Most often, the fracture line is oblique, going from the incisal edge of the vestibular surface to the cervical edge of the buccal surface.
It is sometimes longitudinal along the long axis of the tooth or off-center mesially or distally.
The clinical symptoms are not very important (the coronal fragment is maintained by the periodontal fibers in its original position), in fact only chewing mobilizes the fragments, the pain is not spontaneous but functional.
Radiological diagnosis:
It is preferable to use several incidences and in particular off-center shots using mesial and distal angles of 20° compared to the first shot centered on the tooth.
Treatment
Treatment :
Simple FCRs:
Superficial fracture line:
The goal of treatment is to maintain the pulp vitality of the tooth and preserve the health of the marginal periodontium.
– Remove the fragment.
– Polish the tooth.
– Recommend perfect hygiene.
– Prescribe chlorhexidine mouthwashes for 1 week.
– Then, restoration of the tooth using a photopolymerizing composite
Deeper fracture line:
With the possibility of obtaining a supragingival limit after gingivoplasty and/or osteotomy.
It is necessary to achieve gingival healing and dentin repair.
– Clear the fracture line by gingivoplasty and/or osteotomy.
– Polish the dentin surface.
– Place a calcium hydroxide on the dentinal part which can be covered by a glass ionomer or a temporary crown (the limit of which must be supragingival).
– 2 or 3 weeks later, gingival healing is achieved and the tooth is reconstituted, using the aforementioned bonding techniques: composite or fragment.
DENTAL TRAUMA
Complicated FCR:
In such cases, it is necessary to treat the pulp problem, the periodontal problem individually and to carry out, in the best possible conditions, a prosthetic restoration which requires biological space (of approximately 2mm)
Endodontic phase:
Classic endodontic treatment is performed
Orthodontic phase:
Orthodontic traction is performed for 4 to 6 weeks. The tooth is extruded 0.5 mm more than necessary due to physiological re-ingression. After 3 months of retention, a restoration is performed.
Follow up :
Teeth will be checked at 2 months, 6 months and 1 year after the end of treatment
Prognosis: Depends on pulp, periodontal and prosthetic prognoses
8-Root fractures:
Root fractures are uncommon injuries. The most commonly affected teeth are the maxillary incisors.
Healing of root fractures is complex because the trauma involves the pulp tissue and surrounding tissues (periodontium and bone). However, endodontic treatment should not be systematically considered.
Clinical diagnosis:
The clinical expression of root fractures is diverse, the tooth may appear in normal position, extruded or laterally displaced. These fractures may be associated with other fractures (coronal fractures, alveolar table).
Mobility :
The degree of mobility depends on the severity of the trauma and the location of the fracture line. Mobility is even greater when the fracture line is located in the coronal third. In this case, the root fracture is highlighted during the radiographic examination.
Pulp sensitivity tests:
The test can be positive or negative. However, in the latter case, it is recommended to wait 3 weeks or even a month before starting endodontic treatment.
Percussion test:
This test may give a metallic sound indicating in this case that the root fracture is associated with a lateral dislocation of the coronal fragment. A dull sound indicates an extrusion of the coronal fragment.
Coronary dyschromia:
Dyschromia of the crown may appear. It then most frequently presents a pinkish tint due to pulp hemorrhage. This sign may be reversible and should not be considered as a systematic indication for immediate root canal treatment.
X-ray examination:
It is essential and can reveal a clinically unsuspected fracture of the apical third. It requires several images (1 occlusal supplemented by several retro-alveolar images under several incidences).
The fracture line is only radiovisible if the beam is directed between 15° and 20° relative to the fracture line.
Treatment :
The two essential factors are the degree of maturation of the apex and the location of the fracture line.
Fracture line at the apical third : This is the most favorable situation because in the majority of cases, neither mobility nor displacement of the fragments is observed. Abstention and surveillance are the rule.
However, in rare cases, there may be fracture of the external bone table. In this case the apical fragment must be surgically removed. For the coronal fragment, a retro obturation with MTA followed by a canal obturation with gutta-percha is the therapeutic solution currently recommended.
Fracture line in the middle third:
Depending on the displacement, the coronary fragment can remain alive, revascularize or necrotize.
Treatment consists of reducing the fracture:
Local anesthesia is necessary
The practitioner stands behind the patient
The reduction is done by pressing the left and right index fingers with identical pressure in the axial direction.
The reduction is assessed radiologically
Implementation of the restraint
An orthodontic wire is glued to the vestibular surface of the teeth using composite, and adjusted to the shape of the arch; this retention is left in place for 3 months.
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Fracture line at the coronal third:
If the fracture line communicates with the oral environment, the coronal fragment is removed, the apical fragment can be extruded orthodontically depending on its length. A prosthesis is then made after endodontic treatment. If the prognosis is unfavorable, the implant alternative is then considered.
Follow up :
The patient is reviewed for reassessment 3 weeks, 6 weeks, 3 months after the trauma. Follow-up visits reassess mobility, percussion, pulp sensitivity tests, crown color. Radiographic examination may highlight possible root resorptions or calcific pulp degeneration.
Prediction:
There are four types of biological responses in the presence of a root fracture according to Andreasen:
Healing by interposition of calcified tissue
Healing by interposition of fibrous tissue
Healing by bone interposition
Non-healing due to interposition of granulation tissue.
Healing :
Healing by interposition of hard tissue:
This type of healing is frequently found in the case of immature teeth and when the associated periodontal trauma is not very severe. The healing callus is then formed of tertiary dentin on the internal side and cementum on the external side. The two fragments are welded and form a single entity.
Healing by interposition of connective tissue:
DENTAL TRAUMA
Repair is observed by interposition of a new desmodontal space between the two fragments. The dentinal surfaces facing the fracture line can be covered with cementum.
Healing by interposition of connective tissue and bone tissue:
Bone interposition occurs when the space between the two fragments is wider, the fragments are then surrounded by cementum and a new periodontal ligament. The radiograph reveals a bony bridge separating the fragments while a normal periodontal ligament surrounds them.
DENTAL TRAUMA
Absence of healing due to interposition of granulation tissue:
In this situation, the pulp tissue of the coronal fragment is necrotic while that of the apical fragment remains vital. Pulp necrosis prevents the coalescence of the two fragments. Granulation tissue fills the fracture line and the periodontal ligament. A fistula may exist at the fracture line.
The X-ray shows an increase in the width of the fracture line and bone thinning on either side of the fracture line.
9-Periodontal trauma:
Concussion : is the shaking of the dental organ following a shock. This trauma is often caused by a frontal impact. The damage created to the periodontal ligament and pulp tissue is benign.
Diagnosis of concussion:
On clinical examination : the tooth shows no mobility and no abnormal displacement compared to the contralateral teeth. Bleeding and slight edema may exist in the periodontium, the percussion test may cause slight sensitivity and chewing may be slightly painful
No abnormalities were noted on X-ray examination.
Treatment :
Consists of abstention or adjustment of the occlusion if it is traumatic. The patient is recommended to take a soft diet for 2 weeks.
Follow up :
Pulp vitality is monitored for 1 to 2 months.
Prediction:
It is generally good
DENTAL TRAUMADENTAL TRAUMA
Subluxation : is caused by a stronger shock; some desmodontal fibers can then be broken, there is edema and bleeding in the periodontal ligament
Diagnosis of subluxation:
On clinical examination, abnormal mobility is observed in the vestibulolingual direction due to the rupture of certain periodontal fibers. Bleeding is visible at the gingival sulcus, the percussion test emits a dull sound and can be painful. The patient complains of having a “longer” tooth as well as discomfort when chewing. Pulp vitality tests are positive.
The X-ray examination shows no specificity.
Treatment :
It consists of adjusting the occlusion if it is traumatic, prescribing a soft diet for 8 days. Contention is not always necessary, except for the comfort of the patient, it should not exceed 2 weeks.
Prediction:
It is generally good
Extrusion:
An oblique impact displaces the tooth partially out of its socket. The apex is generally forced towards the vestibular alveolar wall, without fracture of this wall. Only a few palatal desmodontal fibers retain the tooth and prevent total avulsion. The periodontal ligament and the pulp are severely affected.
Diagnosis:
On clinical examination, the crown is intact but displaced out of its socket, most often in a lingual position, the tooth appears longer than the contralateral ones. It presents great mobility. The percussion test triggers a slight pain and a dull sound.
Careful X-ray examination gives the actual degree of displacement.
DENTAL TRAUMA
Treatment :
The key factor in healing an extrusion is the optimal and atraumatic repositioning of the tooth. By means of gentle digital pressure on the free edge of the tooth, the tooth is repositioned in its socket. In this way, the clot that has formed at the apex can be evacuated by sliding gently along the root. Contention (2 to 3 weeks).
Monitoring and prognosis:
Monitoring of pulp vitality is necessary for 3 weeks, 2 months, 6 months and then every 6 months for 4 years. The prognosis depends on the repositioning and the stage of root evolution.
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Lateral dislocations:
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Lateral luxation presents with displacement of the tooth in a direction other than axial as well as comminution and fracture of the alveolar wall. The laterally luxated tooth is displaced so that the coronal part is often tilted palatal/or lingually and the apical part is displaced vestibularly. In conjunction with the bone fracture and displacement, the periodontal ligament is partially injured.
These are traumas that cause significant damage to the periodontal ligament, pulp and alveolar bone.
Diagnosis:
The tooth appears laterally displaced and firmly locked in its new position. The crown is often forced into a lingual or palatal position and the occlusion is disturbed; there is often a clinically evident alveolar fracture. The tooth is immobile as if locked in its socket. Percussion test produces a metallic and sometimes painful sound.
On radiographic examination, the desmodontal space is thickened in the apical region, and a fracture of the vestibular bone lamina is noted.
Treatment :
It consists above all of repositioning the tooth in its initial alveolar position and containing it for the time necessary for healing.
Repositioning can be done using 3 techniques:
Digital repositioning: This is the gentlest method, the practitioner stands behind the patient, with the index finger of one hand he can palpate and feel the apex of the dislocated tooth. He leans with the index finger of the other hand on the palatal surface and with firm pressure, frees the tooth from its bony blockage; a clicking sound most often occurs.
Repositioning using a forceps: In this case the root is released from its bony blockage by slight extrusion and repositioned back in its initial position.
Orthodontic repositioning: Recommended when the patient consults late.
Monitoring and prognosis:
One week, one month, every three months for one year. The patient should be followed for a period of at least five years. This pathology is often accompanied by pulp necrosis and inflammatory resorptions
Intrusion:
This is the most severe form of dental displacement. The shock, most often axial, forces the tooth into its socket, generally leading to its perforation. The neurovascular system of the tooth suffers considerable damage which causes pulp necrosis generating inflammatory resorptions. The desmodontal fibers are crushed.
Diagnosis:
The clinical examination reveals a difference in height between the free edge of the traumatized tooth and the contralateral one; the tooth appears to be stuck in its socket.
Radiographic examination shows disappearance of the periodontal ligament at the apical region. The root is generally intact.
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Treatment :
It essentially depends on the stage of root development.
Immature teeth: Spontaneous re-eruption is usually observed, which may take several weeks. Pulp vitality should be checked at 3 weeks, 6 weeks, every 2 months up to 5 years. If the tooth does not re-erupt spontaneously, the tooth is extruded orthodontically.
Mature teeth: If the displacement is minimal, natural re-eruption can occur, pulp vitality is monitored and in case of necrosis, root canal treatment is performed. If the displacement is significant, repositioning of the tooth can be done by surgical or orthodontic means.
Follow-up and prognosis: Teeth are checked at 3 weeks, 6 weeks, 2 months, 6 months and then every 6 months for 5 years. Some teeth may show ankylosis 5 years later.
The prognosis depends on the condition of the pulp and the stage of root development.
Expulsion: This is a very common accident in immature permanent teeth due to their very short roots and ligamentous laxity. Repair of such trauma depends on pulp survival and healing of the
Periodontal ligament. The most determining factor is the extra-alveolar time.
The prognosis of treatment depends closely on the extra-alveolar time and the preservation environment.
– After 1 hour of dry storage, no periodontal cells can survive
– the pulp systematically becomes necrotic due to the rupture of the vascular-nervous bundle.
Under optimal conditions, the repair is carried out according to the following scheme:
– At the level of the periodontal ligament: After one week, we observe a revascularization of the periodontal ligament, a reattachment of the desmodontal fibers on the root and the formation of a new gingival attachment.
– At the pulp level: Revascularization begins 4 days after the trauma and progresses ½ mm per mm/day. Sensitivity tests may be positive only 2 months after the trauma
Diagnosis:
The clinical examination corresponds to an empty socket. If the tooth is found, the entire root must be checked. The radiographic examination confirms the expulsion, and may also reveal other associated fractures.
Treatment :
Purposes of processing :
This trauma requires emergency treatment, the desmodontal cells dry out and die within 30 minutes. There are two treatment options: Immediate reimplantation, delayed reimplantation.
Once the patient is in the office, the tooth is examined and cleaned with physiological serum; the root should not be scraped or dried with air. The socket is gently rinsed with physiological serum to eliminate the clot that is the source of ankylosis; do not curettage the socket.
First session:
1-If the extra-alveolar time is less than 60 minutes , and the apex is mature or immature, the tooth is gently replaced in the alveolus with light digital pressure. The X-ray checks for correct repositioning.
A restraint is placed for 2 weeks.
The necessary prescriptions are (oral hygiene, chlorhexidine mouthwash /10 days, ATB and painkiller coverage/4 days.
2nd session for mature tooth:
One week later, the root canal treatment is carried out with intermediate root canal filling with calcium hydroxide. The definitive root canal filling is carried out 1 month later.
Follow up :
Check-ups are done every 3 weeks, 6 weeks and then every year for 5 years.
2-If extra oral time exceeds 60 min , mature tooth and immature periodontal ligament cells are damaged there is no longer any urgency to reimplant the endodontic treatment is done extra oral
A 2% sodium fluoride solution for at least 5 min. Rinse the tooth with physiological saline.
A semi-rigid bonded retention for 4 to 6 weeks. If there is an associated alveolar fracture, reposition the fragment and the retention time will be extended. An occlusal check is performed.
Prediction:
It mainly depends on 3 factors:
Extra-alveolar time
The conservation environment
The stage of root development.
Complications of dentoalveolar trauma:
The complications of dentoalveolar trauma are multiple and can be of very variable severity.
10- Endodontic complications: Post-traumatic endodontic complications are of five types:
– pulp necrosis,
– apical edification stopped,
– intraductal calcifications,
– root resorptions
– root ankylosis
11-Conclusion:
Trauma is a real emergency in conservative dentistry and especially in pedodontics, requiring a precise diagnosis and reflection that allows us to opt for a therapy oriented towards the favorable evolution of the dento-alveolar structures concerned and towards the harmony of maxillofacial growth.
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Sensitive teeth react to hot, cold or sweet.
Sensitive teeth react to hot, cold or sweet.
Ceramic crowns perfectly imitate the appearance of natural teeth.
Regular dental care reduces the risk of serious problems.
Impacted teeth can cause pain and require intervention.
Antiseptic mouthwashes help reduce plaque.
Fractured teeth can be repaired with modern techniques.
A balanced diet promotes healthy teeth and gums.