CDH trauma PDL injuries

Primary teeth
1. PDL injuries (UNDER 3 TRAUMAS, be worried about central incisor)
  1. Concussion
  2. Subluxation
    1. Features
      1. Mobile
      2. TTP +ve
    2. Treatment
      1. None
  3. Extrusion
    1. Features
      1. V Mobile
      2. TTP +ve
      3. Elongated on radiographs
    2. Treatment
      1. 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
      2. Severe extrusion >3mm
        XLA
  4. Lateral luxation
    1. Clinical features
      1. Non-mobile
      2. TTP
      3. Very displaced
      4. High metallic ankylotic sound
    2. Treatment
      1. Spontaneous repositioning if not in occlusion
      2. Repositioning
      3. XLA
  5. Intrusion
    1. Clinical features
      1. Not mobile
      2. High metallic ankylotic sound
    2. Treatment
      1. 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
      2. XLA
        Follow up
        1 wk, 1yr
  6. Alveolar fracture
    1. Treatment
      1. Flexible splint 4 weeks
        Follow up
        1 wk, 4wk (R), 6-8wk (R), 1yr (R)
        1 YEAR, THEN 1 YEAR TILL SUCCESSOR
      2. GA often indicated so refer
  7. Avulsion
    1. Review
      1. 1 YEAR, THEN 1 YEAR TILL SUCCESSOR
      2. 6mnth, 1 year
2. DO NOT VITALITY TEST
Permenant teeth
1. PDL injuries (RESORPTION, LOSS OF VITALITY & TRANSIENT APICAL BREAKDOWN)
  1. Concussion
    1. Features
      1. TTP +ve
      2. Positive pulp
    2. Treatment
      1. General trauma advice
      2. Follow-up
        4wks, 6wks, 1 year
  2. Subluxation
    1. Features
      1. TTP +ve
      2. Mobile
      3. Positive or negative pulp
    2. Treatment
      1. None usually
      2. Flexible splint 2wk
  3. Extrusion
    1. Features
      1. TTP +ve
      2. V Mobile
      3. Negative pulp
    2. Treatment
      1. 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)
    3. 5 year survival
      1. 95% open apex
      2. 45% closed apex
  4. Lateral luxation
    1. Features
      1. Non-mobile
      2. TTP +ve
      3. Visually displaced
      4. Negative pulp
      5. High metallic ankylotic sound
    2. Treatment
      1. Splint 4 weeks
      2. If pulp is necrotic RCT
      3. Reposition under LA fingers/ortho NO forceps
    3. 5 year survival
      1. Open apex
        95%
      2. Closed apex
        25%
  5. Intrusion
    1. Clinical features
      1. Not mobile
      2. Negative pulp
      3. High metallic ankylotic sound
    2. Treatment
      1. Open apex <3mm
        Spontaneous eruption
      2. 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
      3. Completed root formation
        Surgical (foreceps) repositioning
        Flexible splint 4 weeks
        RCT 2-3 weeks later
      4. Endo
        Necrotic pulp
  6. Avulsion
    1. Treatment (clean saline, irrigate, replant, tetanus)
      1. 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
      2. 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

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	Criado por Zainab Patel quase 7 anos atrás