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ePaper created 2016-11-22, 09:52:12 | version 1.38.0
| CE article traumatic dental injuries 18 roots 4 2016 teens or young teens in whom the teeth have not yet fully developed, and root development will cease without a vital pulp. Clinical examples Dental trauma can be roughly divided into two groups: fractures and luxation injuries. The frac- tures are then further divided by type: crown, crown-rootandrootfractures.Ifthepulpisexposed to the oral environment, it is called a complicated fracture; if not exposed, it is called an uncompli- cated fracture. Crown fractures The first thing to do in any crown or crown-root fracture is to look for the broken-off tooth fragment. With modern bonding technology it is possible to re- bond the fragment to the tooth, which is esthetically the best solution. Prior to reattaching the tooth frag- ment, the remaining dental thickness immediately coveringthepulpneedstobeassessedradiographically and clinically. If there is at least 0.5 mm of the dentin remaining,thereisnoneedtocoveritwithaprotective liner. If it is estimated that the remaining dentin is less than 0.5 mm, it is advisable to cover the deepest part, closesttothepulp,withacavityliner,andthendimple thefragmentaccordingly.8, 9 Ifthetoothfragmentwas keptdry,itshouldberehydratedindistilledwaterorsa- linefor30minutespriortoreattachment.Thisprocess willincreaseitsbondingstrength10 (Figs.1a–c). In a complicated fracture, the goal is to create a bacteria-tight seal to protect the pulp, after ensuring thatthepulpalwoundiscleanandallinflamedtissue removed.11, 12 Thetwobestcappingmaterialsavailable today are calcium hydroxide and mineral trioxide ag- gregate (MTA),13,14 but newer bioceramic materials are showing promise for this application. It is advis- able to create a 1-2 mm reservoir into the pulp with a high-speed diamond bur and copious water cooling, place the capping material, and then either reattach the tooth fragment or restore the crown with a com- posite resin material (Figs. 2a–c). Fig. 3d: A periapical radiograph of a root fracture a few hours after the injury. It was established that both fragments were in good approximation of each other. Splinting was done for two weeks. Fig. 3e: At the nine-month recall, internal root resorption was noted, but no defect in the PDL or adjacent bone, indicating a ‘normal’ healing process. Fig. 3f: Five-year recall, no endodontic treatment was needed. Follow-Up Procedures for Fractured Permanent Teeth and Alveolar Fractures TIME Crown Fracture Crown-Root Fracture Root Fracture Alveolar Fracture Uncomplicated Complicated Uncomplicated Complicated 4Weeks Splint removal*, clinical and radiographic control Splint removal and clinical and radiographic controls 6–8Weeks Clinical and radiographic control Clinical and radiographic control Clinical and radiographic control Clinical and radiographic control Clinical and radiographic control Clinical and radiographic control 4 Months Splint removal**,clinical and radiographic control Clinical and radiographic control 6 Months Clinical and radiographic control Clinical and radiographic control 1Year Clinical and radiographic control Clinical and radiographic control Clinical and radiographic control Clinical and radiographic control Clinical and radiographic control Clinical and radiographic control Yearly for 5Years Clinical and radiographic control Clinical and radiographic control *Splint removal in apical third and mid-root fractures; **Splint removal with a root fracture near the cervical area. Fig.3d Fig.3e Fig.3f Table 1 42016