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ePaper created 2016-11-22, 09:52:12 | version 1.38.0
traumatic dental injuries CE article | 19 roots 4 2016 Crown-root fractures One of the more challenging types of fracture to treat is the crown-root fracture because the fracture margin has to be exposed around the tooth/crown to properly restore the tooth. This can be accomplished by gingivectomy if the fracture line is in the sulcus. In more extreme cases, the tooth will have to be extruded with orthodontic forces or surgically repositioned. In the emergency session,ifthepulpisexposed,itneedstobeprotected in the same fashion as complicated crown fractures. If the pulp is not exposed, all accessible exposed den- tin areas should be covered for the patient’s comfort. Pulpal survival for all these fracture types is gener- ally good; however, endodontic treatment may be in- dicated later.15, 16 Therefore, it is of utmost importance that a recall schedule is followed and that the teeth involved in the trauma are tested every time. Tables 1 & 2 outline the recommended recall rates for most commondentalinjuries.Itisnotuncommonforthere to be no response to vitality tests for up to three months,andalackofresponsetovitalitytestsdoesnot always indicate that root canal treatment is needed— especially in young and immature teeth. Rather, it is advisable to look for at least one other sign of pulpal necrosis, such as vestibule swelling, periapical lesions and/ordramaticcolorchangeofthecrown.Ifnosigns exist, continue to monitor the patient at regular ap- pointments every three months, for up to one year. Root fractures The pulp is affected in all root fractures. However, if the fragments are approximated soon after the fracture, there is a good chance that no endodontic treatment is necessary, just observation. With good approximation, it is likely that the pulp will revascu- larize across the fracture regardless of the age of the patient17, 18 (Figs. 3a–f). A recent retrospective study included assessment of splinting type and time of root fracture. The study determined that, if the cervi- Fig.4a: In lateral luxation injuries of maxillary teeth,the apex is frequently pushed through the cortical plate facially. Figs.4b & c: To reposition the tooth, it has to be released prior to moving the crown forward. Follow-Up Procedures for Luxated Permanent Teeth TIME Concussion/Subluxation Extrusion Lateral Luxation Intrusion 2Weeks Splint removal (if applied for subluxation) Splint removal Clinical and radiographic examination Clinical and radiographic examination Clinical and radiographic examination Clinical and radiographic examination 4Weeks Clinical and radiographic examination Clinical and radiographic examination Splint removal Clinical and radiographic examination Splint removal Clinical and radiographic examination 6–8Weeks Clinical and radiographic examination Clinical and radiographic examination Clinical and radiographic examination Clinical and radiographic examination 6 Months Clinical and radiographic examination Clinical and radiographic examination Clinical and radiographic examination Clinical and radiographic examination 1Year Clinical and radiographic examination Clinical and radiographic examination Clinical and radiographic examination Clinical and radiographic examination 2–5Years Yearly up to 5 years Yearly up to 5 years Yearly up to 5 years Yearly up to 5 years Fig.4a Fig.4b Fig.4c Table 2 42016