CDH trauma PDL injuries

CDH trauma PDL injuries

1. Primary teeth

   • PDL injuries (UNDER 3 TRAUMAS, be worried about central incisor)
     • Concussion
     • Subluxation
       • Features
         • Mobile
         • TTP +ve
       • Treatment
         • None
     • Extrusion
       • Features
         • V Mobile
         • TTP +ve
         • Elongated on radiographs
       • Treatment
         • Minor extrusion <3mm
           • Reposition/ spontaneously align itself
           • Good co-operation
             • Reposition and flexible splint 2 weeks
           • Follow up
             • 1-2 wks, 6 wks, 6 month
             • 1 YEAR, THEN 1 YEAR TILL SUCCESSOR
         • Severe extrusion >3mm
           • XLA
     • Lateral luxation
       • Clinical features
         • Non-mobile
         • TTP
         • Very displaced
         • High metallic ankylotic sound
       • Treatment
         • Spontaneous repositioning if not in occlusion
         • Repositioning
         • XLA
     • Intrusion
       • Clinical features
         • Not mobile
         • High metallic ankylotic sound
       • Treatment
         • Spontaneous re-eruption
           • If displaced towards labial plate
           • Follow up
             • 1 wk, 3-4 wk (R), 6-8 wk (R), 6mnths (R), 1 yr(R),
             • 1 YEAR, THEN 1 YEAR TILL SUCCESSOR
             • Check at 4 weeks and if it hasn't erupted then XLA
         • XLA
           • Follow up
             • 1 wk, 1yr
     • Alveolar fracture
       • Treatment
         • Flexible splint 4 weeks
           • Follow up
             • 1 wk, 4wk (R), 6-8wk (R), 1yr (R)
             • 1 YEAR, THEN 1 YEAR TILL SUCCESSOR
         • GA often indicated so refer
     • Avulsion
       • Review
         • 1 YEAR, THEN 1 YEAR TILL SUCCESSOR
         • 6mnth, 1 year
   • DO NOT VITALITY TEST

2. Permenant teeth

   • PDL injuries (RESORPTION, LOSS OF VITALITY & TRANSIENT APICAL BREAKDOWN)
     • Concussion
       • Features
         • TTP +ve
         • Positive pulp
       • Treatment
         • General trauma advice
         • Follow-up
           • 4wks, 6wks, 1 year
     • Subluxation
       • Features
         • TTP +ve
         • Mobile
         • Positive or negative pulp
       • Treatment
         • None usually
         • Flexible splint 2wk
     • Extrusion
       • Features
         • TTP +ve
         • V Mobile
         • Negative pulp
       • Treatment
         • Reposition & splint 2 wks
           • Types
             • Flexible acrylic splint
               • No wire needed
             • Flexible wire splint
           • Follow up
             • 2 wk (R), 4 wk (R), 6-8 wk (R), 6mnths (R), 1 yr(R) & yearly for 5 yr (R)
       • 5 year survival
         • 95% open apex
         • 45% closed apex
     • Lateral luxation
       • Features
         • Non-mobile
         • TTP +ve
         • Visually displaced
         • Negative pulp
         • High metallic ankylotic sound
       • Treatment
         • Splint 4 weeks
         • If pulp is necrotic RCT
         • Reposition under LA fingers/ortho NO forceps
       • 5 year survival
         • Open apex
           • 95%
         • Closed apex
           • 25%
     • Intrusion
       • Clinical features
         • Not mobile
         • Negative pulp
         • High metallic ankylotic sound
       • Treatment
         • Open apex <3mm
           • Spontaneous eruption
         • Open Apex 3-6mm
           • Orthodontic repositioning
             • Flexible splint 2 weeks then check if there needs to be surgical (forceps) repositioning
             • RCT 2-3 weeks later
         • Completed root formation
           • Surgical (foreceps) repositioning
             • Flexible splint 4 weeks
             • RCT 2-3 weeks later
         • Endo
           • Necrotic pulp
     • Avulsion
       • Treatment (clean saline, irrigate, replant, tetanus)
         • Open apex
           • Tooth already re-implanted
             • Flexible splint 2 wks
             • Tetracycline 2ds for 7 days
           • EADT <60 mins
             • Flexible splint 2 wks
             • Tetracycline 2ds for 7 days
             • Follow up
               • 2 wk (R), 4 wk (R), 3 month (R), 6mnths (R), 1 yr(R) & yearly for 5 yr (R)
           • EADT >60 mins
             • Poor prognosis
               • Gonna need to RCT
             • Flexible splint 4 wks
             • Tetracycline 2ds for 7 days
         • Closed apex
           • Tooth already re-implanted
             • Flexible splint 2 wks
             • Tetracycline 2ds for 7 days
             • RCT 7-10 days AFTER re-implantation & BEFORE splint removal
               • If you do it earlier than this then the calcium hydroxide can increase chances of ankylosis
               • calcium hydroxide as an intra-canal medicament for up to 1 month followed by root canal filling
           • EADT <60 mins
             • Flexible splint 2 wks
             • Tetracycline 2ds for 7 days
             • RCT 7-10 days AFTER re-implantation & BEFORE splint removal
           • EADT >60 mins
             • Flexible splint 4 wks
             • Poor prognosis
             • Tetracycline 2ds for 7 days
             • RCT 7-10 days AFTER re-implantation & BEFORE splint removal