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The Traumatic Injuries of Permanent Teeth And Complex Therapy PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "The traumatic injuries of permanent teeth and complex therapy” by Dr. Katalin Déri.

This medical PowerPoint presentation is about traumatic injuries to permanent teeth which can occur as a result of accidents, sports injuries, or physical altercations. The severity of these injuries can range from minor chips and cracks to more serious injuries such as root fractures, tooth displacement, and complete avulsion (knocked-out tooth).

The treatment for traumatic injuries to permanent teeth typically depends on the type and severity of the injury. Minor chips and cracks can often be repaired with cosmetic dental procedures such as bonding or veneers, while more serious injuries may require more complex treatments such as root canal therapy, dental implants, or orthodontic treatment.

Root canal therapy is often necessary when the pulp (nerve tissue) inside the tooth is damaged or infected as a result of a traumatic injury. During the procedure, the damaged or infected pulp is removed and replaced with a filling material. A dental crown is then placed over the tooth to protect it and restore its function.

Dental implants may be necessary when a tooth is completely knocked out or cannot be saved through other means. The implant is a small metal post that is inserted into the jawbone and acts as a replacement for the missing tooth root. After the implant has fused with the bone, a dental crown is attached to the post to restore the appearance and function of the tooth.

Orthodontic treatment may be necessary to correct tooth displacement or other issues caused by traumatic injuries. This can include braces or other appliances to reposition the teeth and correct any bite issues.

In some cases, a combination of these treatments may be necessary to fully restore the function and appearance of the affected teeth. It is important to seek prompt treatment for traumatic injuries to permanent teeth in order to minimize the risk of further damage and ensure the best possible outcome.

Tags : traumatic injuries to permanent teeth, Dentistry, dental medicine, oral medicine, dental medicine PowerPoint presentation

Published on : Jun 20, 2023 | Views : 2142 | Downloads : 1

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Slide 1-

The traumatic injuries of permanent teeth and complex therapy Dr. Katalin Déri Semmelweis Egyetem Department of Pedodontics and Orthodontics
Slide 2-

Risk Angle II/1 Predisposing factors: overjet protrusion of upper incisors insufficient lip closure
Slide 3-

Injuries Sport related - 1.5% -3.5%
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Injuries Playground - school
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Slide 8-

Injuries Fights
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Injuries Car accident
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Age distribution Therapeutic significance 8-13 years the highest incidence Peak at the age of 10
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Sex
Slide 12-

Incidence of injured teeth in %
Slide 13-

Anamnesis general anamnesis circumstances of injury black-out, amnesia, headache, nausea, vomit previous injuries : consequences, complications dental anamnesis
Slide 14-

Most important questions When? Time past between the injury and the treatment Where? Risk of infection How? Mechanism of the injury, polytrauma
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Slide 16-

Clinical examination Extraoral examination Intraoral examination Photo documentation X-ray
Slide 17-

Type of injuries Traumatic injuries involving: the permanent teeth the alveolar bone the soft tissues
Slide 18-

Classification of dental injuries(International Association of Dental Traumatology, 2001) Coronal fracture Coronal and root fracture Root fracture Fracture of processus alveolaris Luxations and avulsion (contusion, subluxation, lateral luxation, extrusion, intrusion, avulsion)
Slide 19-

Classification of dental injuriesPedodontics and Orthodontics textbook Luxatio totalis dentis permanentis Luxatio partialis dentis permanentis Intrusio Fractura coronae dentis permanentis Fractura radicis dentis permanentis
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Avulsion : complete displacement of a tooth Luxatio totalis dentis permanentis
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Luxatio partialis dentis permanentis loosening of the tooth or a partial displacement of the tooth out of its socket subluxation lateral luxation extrusion a. b. c.
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Luxatio partialis dentis permanentisDisplacement subluxation: sensitive to touch slightly mobile no displacement bleeding extrusion: axial (and lateral) displacement mobile clinical examination
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Luxatio partialis dentis permanentisDisplacement lateral luxation: lateral displacement locked in the alveolar bone no mobility not sensitive ankylotic signs
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Luxatio partialis dentis permanentis - luxatio lateralis
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3. Intrusion displacement of the tooth into the alveolar bone (axial dislocation)
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Fractura coronae dentis permanentis Types of coronal fracture Most frequent injury enamel only enamel and dentine enamel and dentine with the pulp exposed
Slide 27-

Fractura coronae dentis permanentis fracture without complication complicated fracture (with pulp exposition)
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Fractura radicis dentis permanentis Root fracture
Slide 29-

Fractura radicis dentis permanentis cervical third middle third apical third +1. axial fracture
Slide 30-

Complex therapy
Slide 31-

Treatment of the injuries: Avulsion1. Luxatio totalis dentis permanentis Actions out of surgery: Suitable storage: in wet agent physiological saline saliva milk Dentosafe-Zahnrettungsbox
Slide 32-

Treatment of the injuries: Avulsion Aim: replantation as soon as possible the ligaments and cells loose their vitality after 1 hour Preparation of the tooth and the alveolar socket Replantation Stabilization – using the neighboring teeth for splinting acrylic splint composite bonding with orthodontic archwire brackets Woundtreatment (debridement, suturing, hemorrhage control)
Slide 33-

Prognosis: max. 1 hour extra-alveolary Fixation: closed apex - 7-10 days open apex - 2 weeks (neurovascular reanastomosis) In mature tooth with closed apex, or in immature tooth with open apex but time elapsed > 30 min. In 1 week root canal treatment - Ca(OH)2 should be placed to prevent the initiation of inflammatory root resorption
Slide 34-

Treatment of the injuries: Avulsion1. Luxatio totalis dentis permanentis Instructions pulpy diet toothcleaning with soft toothbrush 0,1 % chlor-hexidine Supplementary therapy Antibiotic treatment Tetanus (immunization status?)
Slide 35-

Treatment of the injuries: Avulsion Luxatio totalis dentis permanentis If replantation is not possible ( e.g.: in the case of loss of the tooth ) Temporary solution: acrylic bridge orthodontic appliance (with an acrylic tooth) Final solution: orthodontic treatment implantation combined treatment
Slide 36-

Treatment of the injuries: Avulsion Luxatio totalis dentis permanentis Temporary solution
Slide 37-

Healing after replantation regeneration of the gingiva revascularisation of the ligaments renewal of the Sharpey ligaments open apex - revascularisation and reinnervation Cave: high bacterial contamination- healing is limited or impossible
Slide 38-

Treatment of the injuries: Displacement2. Luxatio partialis dentis permanentis Subluxation no need to splint for stabilization observation - x-rax (1 year) root canal treatment (pathological sign)
Slide 39-

Treatment of the injuries: Displacement2. Luxatio partialis dentis permanentis lateral luxation extrusion reponation ( following the injury ) fixation for 2-3 weeks later : orthodontic reposition root canal treatment ( in case of the tooth with closed apex )
Slide 40-

Treatment of the injuries: 3. Intrusion Open apex : there is a chance of spontaneous re-eruption Closed apex : surgical or orthodontic reposition splint root canal treatment
Slide 41-

Treatment of the injuries: 3. Intrusion orthodontic or surgical reposition
Slide 42-

Treatment of the injuries:Fractura coronae dentis permanentis The treatment of crown fracture depends on which third of the crown is injured
Slide 43-

Treatment of the injuries:Fractura coronae dentis permanentis Enamel injuries: Minor enamel fractures : polishing, fluoride solution ELMEX Larger enamel fractures (1-2mm or more): composite restoration
Slide 44-

Treatment of the injuries:Fractura coronae dentis permanentis Enamel – dentine injuries without pulp exposition - immature tooth Calcium hydroxide liner Temporary crown ( celluloid, acrylic ) – 1 year (GIC) – protective covering X – ray control Final restoration (closed apex) Enamel – dentine injuries without pulp exposition -mature tooth Final restoration
Slide 45-

Fractura coronae dentis permanentis temporary crown - incisal restoration
Slide 46-

Rebonding of fractured crown
Slide 47-

Treatment of the injuries:Fractura coronae dentis permanentis Pulp exposition Important: size of the pulp exposure time between the injury and the treatment root development
Slide 48-

Treatment of the coronal fracture in case of pulp exposition
Slide 49-

Direct pulpcapping - Ca(OH)2/ MTA Pulpotomy – partial or total elimination of coronal pulp tissue sterile round steel bur or excavator haemorrhage control Ca(OH)2/MTA + GIC /polikarboxilate cement Pulpectomy – elimination of all the pulp tissue - Ca(OH)2 Final root canal filling (closed apex) Regular re-call!!!
Slide 50-

Treatment of the injuries: Root fracture fracture in cervical third: Worst prognosis Elimination of coronal part root canal treatment orthodontic extrusion restoration Extraction + implantation fracture in middle third: Reposition of coronal part Splint ( 1-2 months ) Root canal filling Transradicular fixation can be an option (silver point)
Slide 51-

Fracture in apical third observation, In case of necrosis - Ca(OH)2, - Final root canal filling after healing If coronal part is dislocated - reposition and fixation for 1 month Treatment of the injuries: Root fracture
Slide 52-

Fractura radicis dentis permanentis Healing Soft tissue hard tissue granule tissue
Slide 53-

Possible consequences of traumatic injuries Peripheral (external) root resorption Trauma with damage to the periodontal structures, pulp may not become involved Macrophages , osteoclasts In cases of severe trauma, with some degree of displacement of the tooth Diagnosis – 1 week after injury
Slide 54-

Possible consequences of traumatic injuries Inflammatory root resorption Trauma with damage to the periodontal AND pulp tissues Bacterial toxines Rapid, progressive Intrusion, replantation Diagnosis – 2-4 weeks after the injury Severe cases – total root resorption in 1 month
Slide 55-

Possible consequences of traumatic injuries Ankylosis injury to the periodontal ligament and subsequent inflammation associated with invasion by osteoclastic cells cement resorption – repaired by bone regeneration mechanical lock / fusion between alveolar bone and root surface Diagnosis: Radiological : 2 months Clinical: 1month – typical ankylotic sound for percussion
Slide 56-

Possible consequences of traumatic injuries Pulpal necrosis signs: discoloration no response for vitality test sensitive for percussion periapical laesion if 2 of them presents - root canal treatment –Ca(OH)2
Slide 57-

Obliteration Calcific metamorphosis of the dental pulp ( progressive canal calcification / dystrophic calcification) Although the radiograph may give the illusion of complete obliteration, an extremely fine root canal and remnants of the pulp will persist yellowish opaque colour of the crown rct can be done if necessary Possible consequences of traumatic injuries
Slide 58-

Prevention Protectors Requirements: cover of the teeth, gingiva, alveolar bone do not influence the relation of jaws do not disturb breathing resistant and durable hygienic possible application on fixed orthodontic appliances
Slide 59-

Prevention Mouthguard: Confectional Prefabricated Individual
Slide 60-

Education!!!
Slide 61-

Warning - Child abuse!!!! Signs: time elapsed after the injury: weeks or months confused, frightened child parents and child don’t tell the same story anamnesis is not in accordance with the result of clinical examination recurring injuries
Slide 62-

Case report 20 years old boy Street fight oral surgery ambulance – ‘’dental splint’’ orthodontic clinic – 3 days after still very mobile upper front teeth
Slide 63-

Radiographs 13 root fracture in middle third 13, 12, 11, 21, 22, 23 extrusion, palatal dislocation all upper anterior teeth are very mobile except 13, all upper anterior teeth show vitality
Slide 64-

Treatment plan Slow reposition of dislocated teeth with fixed orthodontic appliance (1 year ) 13 rct ; transradicular fixation (silver point) /temporary/ Frequent control of all the upper anterior teeth first patological sign - rct After debonding – fix and removable retainer
Slide 65-

Treatment
Slide 66-

13 transradicular fixation(silver point and endomethason) after treatment 2 months later
Slide 67-

Pulpal necrosis of 22 Needle control RCF control Sign of root resorption
Slide 68-

Result of treatment
Slide 69-

Thank you for your kind attention!