CDH Trauma Pulp

CDH Trauma Pulp

Permenant teeth
1. Enamel-dentine-pulp fracture
  1. Treatment
    1. Open apex
      1. 0.5mm exposure and within 24 hours
        Direct pulp cap
        Material
        1a) Pulp cap with MTA or CA(OH)2
        1b) GIC
        1c) Composite
      2. Large exposure OR >24 hours
        Pulpotomy
        1a) Remove coronal pulp
        1b) Arrest bleeding
        1c) Apply MTA or Ca(OH)2 NOT ZOE
        1d) GIC
        1e) composite resin
      3. If pulpotomy doesn't work
        Pulpectomy
        Need to apexify (open apex), either using Ca(OH)2 OR MTA
        Can also use regenerative endo technique if open
        1a) clean out and extirpate
        1b) Triple antibiotic mixture in canal for 2 weeks
        1c) Small needle 2mm past WL to make apical tissues bleed into tooth
        1d) Get haemostats
        1e) Seal up GIC
    2. Closed apex
      1. Young people with closed apex >48hrs
        Pulpotomy
      2. Older patients with closed apex
        RCT
2. Uncomplicated crown-root fracture
  1. Treatment
    1. Emergency
      1. Stabilise loose segment to the adjacent teeth
    2. Remove the fragment & restore
      1. 1a) locate fracture line
      2. 1b) remove mobile fragment
      3. 1c) Disinfect & suture any lacerations
      4. 1d) GIC
      5. 1e) Composite resin
    3. Remove the fragment and restore with gingivectomy +- osteoplasty
    4. Remove the fragment & extrude orthodontically
3. Root fracture
  1. Treatment
    1. Coronal third/Cervical root fractures
      1. If the root fracture is near the cervical area of the tooth, stabilization is benificial for a longer period of time (up to 4 months).
      2. Endo?
      3. If displaced make sure you reposition before you splint
      4. If really bad (into gingival tissues)
        Extract whole tooth
        Extract coronal portion
        Extrude surgically with orthodontist & post crown
    2. Apical & mid-root fractures
      1. Endo?
      2. Non-mobile & non-displaced
        Soft diet, keep an eye on vitality
      3. Mobile
        Flexible splint for 4 weeks.
      4. If displaced make sure you reposition before you splint
  2. 20% get pulp necrosis
  3. Do endo if there is no vitality and PAP still after 3 months
    1. Cam do endo to the fracture line then allow the rest to resorb
4. Alveolar fractures
  1. Treatment
    1. 1a) Manual repositioning or repositioning using forceps of the displaced segment.
    2. 1b) Stabilize the segment with flexible splinting for 4 weeks.
5. Complicated crown-root fracture
  1. Treatment
    1. Emergency
      1. Stabalise to adjacent teeth
    2. Remove fragment and restore if supragingival
      1. With pulpotomy (immature apices) or pulpectomy
    3. Remove the fragment and restore with gingivectomy +/- osteoplasty + RCT and post
    4. Remove the fragment and extrude orthodontically + RCT and post
6. Enamel #
  1. Still take PA and USO
Primary teeth
1. Enamel #
  1. Smooth sharp edges
  2. No radiographs recommended
2. Enamel Dentine #
  1. No radiographs
  2. If small GIC layer
  3. If larger, GIC then composite
3. Enamel Dentine pulp #
  1. Treatment options
    1. Partial pulpotomy
    2. Extraction
    3. Direct pulp cap
4. Uncomplicated Crown root #
  1. Treatment options
    1. Fragment removal only
    2. XLA the tooth

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	Created by Zainab Patel over 4 years ago