Endodontics
Course Review
Enoch Ng, DDS 2014
-
Luxation
o
Concussion – injury to tooth without increased mobility or displacement, pain on percussion
No treatment, soft food for 1 week, good OH
Recall 4 weeks, 6-8 weeks, 1 year
o
Subluxation – no displacement, but increased mobility and bleeding of gingival sulcus
No treatment to flexible splint for 2 weeks, adjust occlusion
Soft food for 1 week, good OH
Recall 4 weeks, 6-8 weeks, 1 year
o
Lateral luxation – displacement non-axially with labial or lingual alveolar bone fracture
Reposition tooth AND displaced bone with finger pressure and forceps
Splint for 4 weeks (resin or wire composite)
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
o
Extrusion – axial displacement with intact alveolar bone socket
Reposition tooth, flexible split 2 weeks (resin or wire composite)
Soft food 1 week, good OH, splint removal after 2 weeks
Recall 4 weeks, 6-8 weeks, 1 year (annually for 5 years)
o
Intrusion – displacement of tooth into alveolar bone with fracture of alveolar bone
Primary or immature permanent tooth – spontaneous eruption
Orthodontic or surgical repositioning followed by RCT
o
Luxation Outcomes
Concussion – 2% PN
Subluxation – 12-20% PN
Lateral/extrusive – 50-75% PN
Intrusive – 96-100% PN
Pulp calcification – 20-25%
Root resorption – 5-15%
-
Avulsion – complete displacement of tooth out of socket, socket is empty or filled with coagulant
Complications – damage and drying of PDL, pulpal necrosis
Consider – time out of mouth, open apex, storage medium (HBSS, milk, saline, saliva, water)
o
Drying time of PDL > 2hrs – all cells are dead
Medical history, tetanus booster
Antibiotic therapy
o
<12y/o – Pen V 25-50mg/kg body weight QID for 7 days
o
>12y/o – 100mg doxycycline BID for 7 days
or
Pen V 500mg QID for 7 days
Root end development (open apex)
Root surface conditioning
o
Citric acid soaking – removes necrotic tissue
o
Doxycycline soaking – kills bacteria, promotes revascularization
o
2-4% NaF soaking – makes root resistant to resorption
o
Reposition tooth
o
Physiologic split for 2 weeks
0.015-0.030 ortho wire, resin bonded, 20-30# nylon fishing line
o
Remove pulp within 7-10 days, Ca(OH)
2
medicate canal
o
Obturate when no signs of resorption
o
Recall to monitor signs of resorption (surface, inflammatory, replacement)