CDH Trauma Pulp

Zainab Patel
Mind Map by Zainab Patel, updated 11 months ago
Zainab Patel
Created by Zainab Patel about 1 year ago
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Description

CDH Mind Map on CDH Trauma Pulp, created by Zainab Patel on 22/01/2020.

Resource summary

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