Endodontics
Course Review
Enoch Ng, DDS 2014
Dentoalveolar Trauma
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Bye age 14, 25% of kids will have an injury involving permanent teeth
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80% trauma for 7-15y/o kids is to incisors Mx and Mn
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Pulps of young permanent dentition is large – good blood supply, better repair potential
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May interrupt growth of immature teeth, resulting in thin weak teeth
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Goal – to maintain pulpal vitality
Consequences
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Structure of the tooth
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Surrounding PDL
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Vascular and nerve supply
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Surrounding bone
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Damage related to extent of displacement from original anatomic position
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Management can be multidisciplinary
Med History
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BP, pulse, temp, respiration
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Medical conditions, allergies
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Neurologic conditions – CNS eval, Glasgow coma scale
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Drug interactions
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Tetanus immunizations
Clinical Exam
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Soft tissue, facial skeletal
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Teeth and supporting structures
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Mobility
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Displacement
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Perio damage
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Pulpal injury
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Radiographic exam
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4 different radiographs, with attention to:
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Dimension of root canal space
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Degree of apical closure
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Proximity of fracture to pulp
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Proximity of fracture to alveolar crest
Dental Injuries
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Enamel infraction
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If necessary, etching and sealing with resin – prevent discoloration
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No recall necessary unless associated with other trauma
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Enamel fracture
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Bond fractured piece back onto tooth, or restore with composite
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3 radiographs (PA, occlusal, off angle) to rule out luxation injury or fracture
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Recall 6-8 weeks, 1 year
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Crown fracture without pulp involvement
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Bond fractured piece, provisional with GI, or permanent with composite resin
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3 radiographs (PA, occlusal, off angle) to rule out luxation injury or fracture
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Radiographs of lip/cheek lacerations – search for tooth fragments or foreign material
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Recall 6-8 weeks, 1 year
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Crown fracture with pulp involvement
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Immature tooth with open apex – preserve vital pulp to secure further root development
Pulp capping, partial pulpotomy, use Ca(OH)
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or white MTA
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Mature tooth with closed apex – NSRCT