Endodontics
Course Review
Enoch Ng, DDS 2014
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Crown root fracture
o
Prognosis depends on apical extent of fracture into attachment apparatus
Pick any of these possible treatments
Fragment removal (pulpotomy)
Fragment removal and gingivectomy
Orthodontic extrusion
Surgical extrusion
Decoronation
Extraction
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Root fracture
o
Reposition coronal segment of tooth
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Flexible split for 4 weeks – for cervical fractures, split for 4 months
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Soft diet for 1 week – good OH, soft bristle brush, chlorhexidine rinse
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Recall 6-8 weeks, 4 months, 6 months, 1 year (annually for 5 years)
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NSRCT of coronal segment if pulp necrosis occurs
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Horizontal Root Fracture
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More cervical = bad
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Pulpal necrosis 25% of the time
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Rigid split for 12 weeks, monitor pulp vitality
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Hard tissue induction at fracture site, then RCT of coronal segment
Techniques
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VPT (vital pulp therapy)
Pulp capping
Partial pulpotomy
Cervical pulpotomy
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Goal – preserve pulp tissue
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Cvek technique
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Remove inflamed tissue 2mm below exposure site with water cooled small diamond
Place Ca(OH)
2
liner, restore with acid-etch technique
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<24hrs – pulp capping – 80% success
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>24hrs – partial pulpotomy – 94-96% success
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>72hrs – cervical pulptomy – 75% success
Healing of Root Fractures
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Calcified tissue
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Connective tissue
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Bone and CT
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Non-union with GT
Dental Injuries
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Fracture of Alveolar Process
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Reposition and flexible splint for 4 weeks
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Monitor pulp vitality
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Recall 4 weeks, 6-8 weeks, 6 months, 1 year (annually for 5 years)
Remove splint at 4 weeks, take clinical and radiographic exam to check healing