1 / 50

Follow up in 4 weeks: Advise parents of possible injury / damage to permanent teeth

INTRUSION INJURIES : RECOMMENDATIONS. Primary Dentition. Root tip is displaced towards buccal cortical plate or vertical. All treatment is ideal and assumes patient has manageable behavior. Recommendations also assume radiographs ( periapical and lateral anterior taken where

warner
Download Presentation

Follow up in 4 weeks: Advise parents of possible injury / damage to permanent teeth

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. INTRUSION INJURIES: RECOMMENDATIONS Primary Dentition Root tip is displaced towards buccal cortical plate or vertical All treatment is ideal and assumes patient has manageable behavior. Recommendations also assume radiographs ( periapical and lateral anterior taken where appropriate). (REFERENCE: AAPD Handbook of Pediatric Dentistry) No Yes Extract if root tip is displaced into permanent tooth bud Allow 6 months for spontaneous re-eruption. Advise parents of potential damage to adult tooth Follow up in 4 weeks: Advise parents of possible injury / damage to permanent teeth

  2. Intrusive Luxation • Most common in upper primary incisors • Management: allow to re-erupt or extract

  3. Tooth Not Retrieved Post Trauma • Confirm Intrusion with Periapical • Monitor up to 6 months for re-eruption

  4. Intrusive LuxationPrimary Teeth • Consider antibiotic therapy - monitor for infection • Tetanus immunization current? • Extract if there are signs of swelling, spontaneous bleeding, abscess and fever Day of the Trauma 2 weeks Post Trauma

  5. Intrusive LuxationPrimary Teeth • One of the most dangerous injuries to the developing tooth bud • Management: Minimize damage by assessing displacement of permanent bud

  6. Ideally, a lateral film should be taken to confirm that intruded tooth has not displaced permanent tooth bud. If so, extraction recommended

  7. Lateral Anterior Radiograph for Intruded Primary Tooth • Angulation of intruded tooth • Occlusal or size 4 extraoral film next to child’s cheek and perpendicular to radiographic beam • Exposure time is doubled

  8. Intrusion Luxation: Re-eruption of Primary Tooth 2 months after injury 3 months after injury 1 year after injury

  9. ROOT FRACTURES : RECOMMENDATIONS Primary Dentition All treatment is ideal and assumes patient has manageable behavior. Recommendations also assume appropriate pre-operative radiographs. (Source: AAPD Handbook of Pediatric Dentistry) Fracture located in coronal 1/3 of root or segment is aspiration risk Yes Extract coronal segment. Leave apical segment if not visible/easily removed No Clinical and radiographic follow up in 4 weeks: Advise parents of possible injury / damage to permanent teeth. NO SPLINT IS INDICATED

  10. Root FracturesPrimary Teeth • Radiograph • Apical 1/3 - Most teeth maintain vitality and are minimally mobile - Apical fragment should resorb normally - Monitor with radiographs

  11. Root FracturesPrimary Teeth • Radiograph • Middle or Cervical 1/3 - Most teeth mobile. Extraction indicated - Gently attempt to retrieve apical fragment If not successful, monitor - Don’t disrupt permanent tooth bud

  12. Avulsion: Primary Teeth • Radiograph • Do not re-implant! • Space loss may not occur if primary canines are present • Permanent tooth eruption may be delayed due to scar tissue/bone

  13. Parents Question: Will the permanent teeth be damaged? • May not be able to be determined until the teeth erupt and can be evaluated clinically • The accident has happened - we can’t reverse it • Monitor clinically and radiographically

  14. Complications of Trauma • Permanent teeth malformation: • hypomineralization • hypoplasia • dilaceration • arrested development

  15. History of Intrusive LuxationPrimary Teeth • Hypomaturation/Hypomineralization #8

  16. History of Intrusion Luxation of Primary Tooth • Severe dilaceration of Root

  17. History of Avulsion #E :Prior to Eruption of Primary Canines • Space maintainer not possible for pre-coop tot with incisors only • Ortho/space regaining will be needed

  18. Acknowledgements • Photos and Diagrams taken from: • Textbook and Color Atlas of TraumaticInjuries to the Teeth, 4th edition: J.O. Andreasen (2007) • Pediatric Dentistry, 4th edition; Pinkham (2005) • Odontologia Para o Bebe’: Walter L.R.F. (1996) • University of Iowa, Department of Pediatric Dentistry

  19. Competency Exam Answer the following questions on your worksheets

  20. Case #1 “Anna” • Anna is a 4 y.o. girl who fell against the edge of a table about 2 hours ago • Her mother has given her children’s Tylenol and is at your office for evaluation • The upper incisors are tender, but non-mobile. • Her mother raises her lip to show you a 2 mm tear in the labial frenum area • Anna is cooperative

  21. Case #1: “Anna” • What other clinical procedures do you need to perform? List at least 3.

  22. “Anna’s” Pedo Occlusal • Is this radiograph within normal limits, or do you see any abnormalities or pathology?

  23. Case #1 “Anna” • What is your plan for treatment and followup care for Anna? • What are your care instructions for mother?

  24. Case #2: “Bart” • Bart is a 2 y.o. boy who fell against the edge of the bathtub about 1 hour ago • Mother felt his tooth “completely broke off at the gumline”, but could not find the piece • Clinically there are no additional findings

  25. “Bart” • What radiographs are indicated for Bart?

  26. Pedo Occlusal for “Bart” • Bart was not cooperative for further radiographs. What is your diagnosis based on this film?

  27. Case #2 “Bart” • What is your plan for treatment and followup care?

  28. Case #3: “Charlie” • Charlie is a healthy 3 y.o. boy who fell against the fireplace at home this morning • His father is with him • Clinical exam reveals enamel fracture #E and dentin fracture #F • No excessive mobility, no luxation • Occlusion is normal • Charlie is cooperative , but impatient and wiggly

  29. Charlie’s Clinical Appearance (photo is a representation of the injury, not an actual photo of this patient) • What radiographs would you order for Charlie?

  30. Pedo Occlusal for “Charlie”

  31. Case #3 “Charlie” • What is your plan for treatment and followup care for Charlie?

  32. Case #4 “Davonne” • Davonne is a 12 year old boy with a non-contributory Health History • He and his parents are at your office for comprehensive care. • The chief complaint is “discolored lower front teeth.”

  33. Davonne Clinical Photo

  34. Davonne • What most likely caused this discoloration? • What are treatment options?

  35. Competency Exam Answer Discussion

  36. Case #1 “Anna” • Anna is a 4 y.o. girl who fell against the edge of a table about 2 hours ago • Her mother has given her children’s Tylenol and is at your office for evaluation • The upper incisors are tender, but non-mobile. • Her mother raises her lip to show you a 2 mm tear in the labial frenum area • Anna is cooperative

  37. Case #1: “Anna” • What other clinical procedures do you need to perform? List at least 3. • Periapical radiograph (pedo occlusal) • Mobility check • Percussion check • Occlusion check • Complete hard and soft tissue assessment

  38. “Anna’s” Pedo Occlusal • Is this radiograph within normal limits, or do you see any abnormalities or pathology? Answer: Within Normal Limits

  39. Case #1 “Anna” • What is your plan for treatment and followup care for Anna? • Do not suture • Observe clinically and radiographically • What are your care instructions for mother? • OTC pain meds prn • Soft diet for about 1 week • Tooth may discolor, but this may reverse • Periodic reassessment needed

  40. Case #2: “Bart” • Bart is a 2 y.o. boy who fell against the edge of the bathtub about 1 hour ago • Mother felt his tooth “completely broke off at the gumline”, but could not find the piece • Clinically there are no additional findings

  41. “Bart” • What radiographs are indicated for Bart? • Periapical (pedo occlusal) • Lateral

  42. Pedo Occlusal for “Bart” • Bart was not cooperative for further radiographs. What is your diagnosis based on this film? • Intrusion. No fracture detected.

  43. Case #2 “Bart” • What is your plan for treatment and followup care? • Monitor for re-eruption • Consider antibiotic therapy and assess tetanus immunization • Explain signs and symptoms of infection. • Re-assess in 2 weeks

  44. Case #3: “Charlie” • Charlie is a healthy 3 y.o. boy who fell against the fireplace at home this morning • His father is with him • Clinical exam reveals enamel fracture #E and dentin fracture #F • No excessive mobility, no luxation • Occlusion is normal • Charlie is cooperative , but impatient and wiggly

  45. Charlie’s Clinical Appearance • What radiographs would you order for Charlie? • Periapical (pedo occlusal)

  46. Pedo Occlusal for “Charlie”

  47. Case #3 “Charlie” • What is your plan for treatment and followup care for Charlie? • Smooth #E • GI “Bandaid “ #F or composite if cooperation allows • Periodic clinical and radiographic followup

  48. Case #4 “Davonne” • Davonne is a 12 year old boy with a non-contributory Health History • He and his parents are at your office for comprehensive care. • The chief complaint is “discolored lower front teeth.”

  49. Davonne Clinical Photo

  50. Davonne • What most likely caused this discoloration? • History of primary tooth trauma/intrusion • What are treatment options? • No treatment • Cosmetic bonding

More Related