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CDH trauma PDL injuries

Description

CDH Mind Map on CDH trauma PDL injuries, created by Zainab Patel on 13/01/2020.
Zainab Patel
Mind Map by Zainab Patel, updated more than 1 year ago
Zainab Patel
Created by Zainab Patel over 4 years ago
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Resource summary

CDH trauma PDL injuries
  1. Primary teeth
    1. PDL injuries (UNDER 3 TRAUMAS, be worried about central incisor)
      1. Concussion
        1. Subluxation
          1. Features
            1. Mobile
              1. TTP +ve
              2. Treatment
                1. None
              3. Extrusion
                1. Features
                  1. V Mobile
                    1. TTP +ve
                      1. Elongated on radiographs
                      2. Treatment
                        1. Minor extrusion <3mm
                          1. Reposition/ spontaneously align itself
                            1. Good co-operation
                              1. Reposition and flexible splint 2 weeks
                              2. Follow up
                                1. 1-2 wks, 6 wks, 6 month
                                  1. 1 YEAR, THEN 1 YEAR TILL SUCCESSOR
                                2. Severe extrusion >3mm
                                  1. XLA
                              3. Lateral luxation
                                1. Clinical features
                                  1. Non-mobile
                                    1. TTP
                                      1. Very displaced
                                        1. High metallic ankylotic sound
                                        2. Treatment
                                          1. Spontaneous repositioning if not in occlusion
                                            1. Repositioning
                                              1. XLA
                                            2. Intrusion
                                              1. Clinical features
                                                1. Not mobile
                                                  1. High metallic ankylotic sound
                                                  2. Treatment
                                                    1. Spontaneous re-eruption
                                                      1. If displaced towards labial plate
                                                        1. Follow up
                                                          1. 1 wk, 3-4 wk (R), 6-8 wk (R), 6mnths (R), 1 yr(R),
                                                            1. 1 YEAR, THEN 1 YEAR TILL SUCCESSOR
                                                              1. Check at 4 weeks and if it hasn't erupted then XLA
                                                            2. XLA
                                                              1. Follow up
                                                                1. 1 wk, 1yr
                                                          2. Alveolar fracture
                                                            1. Treatment
                                                              1. Flexible splint 4 weeks
                                                                1. Follow up
                                                                  1. 1 wk, 4wk (R), 6-8wk (R), 1yr (R)
                                                                    1. 1 YEAR, THEN 1 YEAR TILL SUCCESSOR
                                                                  2. GA often indicated so refer
                                                                2. Avulsion
                                                                  1. Review
                                                                    1. 1 YEAR, THEN 1 YEAR TILL SUCCESSOR
                                                                      1. 6mnth, 1 year
                                                                  2. DO NOT VITALITY TEST
                                                                  3. Permenant teeth
                                                                    1. PDL injuries (RESORPTION, LOSS OF VITALITY & TRANSIENT APICAL BREAKDOWN)
                                                                      1. Concussion
                                                                        1. Features
                                                                          1. TTP +ve
                                                                            1. Positive pulp
                                                                            2. Treatment
                                                                              1. General trauma advice
                                                                                1. Follow-up
                                                                                  1. 4wks, 6wks, 1 year
                                                                              2. Subluxation
                                                                                1. Features
                                                                                  1. TTP +ve
                                                                                    1. Mobile
                                                                                      1. Positive or negative pulp
                                                                                      2. Treatment
                                                                                        1. None usually
                                                                                          1. Flexible splint 2wk
                                                                                        2. Extrusion
                                                                                          1. Features
                                                                                            1. TTP +ve
                                                                                              1. V Mobile
                                                                                                1. Negative pulp
                                                                                                2. Treatment
                                                                                                  1. Reposition & splint 2 wks
                                                                                                    1. Types
                                                                                                      1. Flexible acrylic splint
                                                                                                        1. No wire needed
                                                                                                        2. Flexible wire splint
                                                                                                        3. Follow up
                                                                                                          1. 2 wk (R), 4 wk (R), 6-8 wk (R), 6mnths (R), 1 yr(R) & yearly for 5 yr (R)
                                                                                                      2. 5 year survival
                                                                                                        1. 95% open apex
                                                                                                          1. 45% closed apex
                                                                                                        2. Lateral luxation
                                                                                                          1. Features
                                                                                                            1. Non-mobile
                                                                                                              1. TTP +ve
                                                                                                                1. Visually displaced
                                                                                                                  1. Negative pulp
                                                                                                                    1. High metallic ankylotic sound
                                                                                                                    2. Treatment
                                                                                                                      1. Splint 4 weeks
                                                                                                                        1. If pulp is necrotic RCT
                                                                                                                          1. Reposition under LA fingers/ortho NO forceps
                                                                                                                          2. 5 year survival
                                                                                                                            1. Open apex
                                                                                                                              1. 95%
                                                                                                                              2. Closed apex
                                                                                                                                1. 25%
                                                                                                                            2. Intrusion
                                                                                                                              1. Clinical features
                                                                                                                                1. Not mobile
                                                                                                                                  1. Negative pulp
                                                                                                                                    1. High metallic ankylotic sound
                                                                                                                                    2. Treatment
                                                                                                                                      1. Open apex <3mm
                                                                                                                                        1. Spontaneous eruption
                                                                                                                                        2. Open Apex 3-6mm
                                                                                                                                          1. Orthodontic repositioning
                                                                                                                                            1. Flexible splint 2 weeks then check if there needs to be surgical (forceps) repositioning
                                                                                                                                              1. RCT 2-3 weeks later
                                                                                                                                            2. Completed root formation
                                                                                                                                              1. Surgical (foreceps) repositioning
                                                                                                                                                1. Flexible splint 4 weeks
                                                                                                                                                  1. RCT 2-3 weeks later
                                                                                                                                                2. Endo
                                                                                                                                                  1. Necrotic pulp
                                                                                                                                              2. Avulsion
                                                                                                                                                1. Treatment (clean saline, irrigate, replant, tetanus)
                                                                                                                                                  1. Open apex
                                                                                                                                                    1. Tooth already re-implanted
                                                                                                                                                      1. Flexible splint 2 wks
                                                                                                                                                        1. Tetracycline 2ds for 7 days
                                                                                                                                                        2. EADT <60 mins
                                                                                                                                                          1. Flexible splint 2 wks
                                                                                                                                                            1. Tetracycline 2ds for 7 days
                                                                                                                                                              1. Follow up
                                                                                                                                                                1. 2 wk (R), 4 wk (R), 3 month (R), 6mnths (R), 1 yr(R) & yearly for 5 yr (R)
                                                                                                                                                              2. EADT >60 mins
                                                                                                                                                                1. Poor prognosis
                                                                                                                                                                  1. Gonna need to RCT
                                                                                                                                                                  2. Flexible splint 4 wks
                                                                                                                                                                    1. Tetracycline 2ds for 7 days
                                                                                                                                                                  3. Closed apex
                                                                                                                                                                    1. Tooth already re-implanted
                                                                                                                                                                      1. Flexible splint 2 wks
                                                                                                                                                                        1. Tetracycline 2ds for 7 days
                                                                                                                                                                          1. RCT 7-10 days AFTER re-implantation & BEFORE splint removal
                                                                                                                                                                            1. If you do it earlier than this then the calcium hydroxide can increase chances of ankylosis
                                                                                                                                                                              1. calcium hydroxide as an intra-canal medicament for up to 1 month followed by root canal filling
                                                                                                                                                                            2. EADT <60 mins
                                                                                                                                                                              1. Flexible splint 2 wks
                                                                                                                                                                                1. Tetracycline 2ds for 7 days
                                                                                                                                                                                  1. RCT 7-10 days AFTER re-implantation & BEFORE splint removal
                                                                                                                                                                                  2. EADT >60 mins
                                                                                                                                                                                    1. Flexible splint 4 wks
                                                                                                                                                                                      1. Poor prognosis
                                                                                                                                                                                        1. Tetracycline 2ds for 7 days
                                                                                                                                                                                          1. RCT 7-10 days AFTER re-implantation & BEFORE splint removal
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