Avulsion of permanent teeth（traumatic）
2022-06-20 10:17:48 0 举报AI智能生成
登录查看完整内容
2020年指南
作者其他创作
大纲/内容
0.5-16% of all dental injuries
Treatment: replantation
Introduction
severe caries or periodontal disease
uncooperative
severe cognitive impairment requiring sedation
severe medical conditions such as immunosuppression
severe cardiac conditions
situations when replantation is not indicated
permanent tooth！
pick it up by the crown
rinse it gently infont color=\"#b71c1c\
return it to its original position
Replantation
Keep the tooth/teeth in a storage medium：milk＞HBSS＞saliva (after spitting into a glass for instance)＞saline＞water
First aid at the place of accident
most likely viable: be replanted within 15min
may be viable: be kept in a storage medium + total day time <60min
likely to be non-viable: the total day time ≥60min
Assess the condition of the PDL cells by day time
Local anesthesia
Right place: Leave the tooth/teeth in place
Malposition: correct the position using slight digital pressure
Wrong socket or Rotated: reposition within 48h
Verify the position
Stabilize for 2 weeks or 4 weeks (alveolar or jawbone fracture)
Suture gingival lacerations
RCT within 2 weeks
Systemic antibiotics
Check tetanus status
Patient instructions
Follow up
Been replanted
Remove debris
Keep the tooth in a storage medium
Irrigate the socket with sterile saline
Reposition the fractured fragment
Remove the coagulum with a saline stream
Replant
后续步骤同上
Been kept in a storage medium + total day time <60min
Total day time ≥60 min: 同“保存于介质+干燥时间＜60min”
Closed apex
apexification
pulp revitalization/revascularization
RCT
Open apex: 将上述RCT换成Pulp revascularization，随访异常及时处理
Treatment guidelines
Infiltration anesthesia
Block/Regional anesthesia: severe injury cases
Anesthetics
prevent infection-related reactions
decrease the occurrence of inflammatory root resorption
patient's medical status or concomitant injuries
Why
Dosage: patient's age and weight
effectiveness on oral flora
low incidence of side effects
First choices: Amoxicillin or penicillin
Side effect: discoloration【Not for patients under 12 years of age】
Systemic antibiotics: recommended
Topical antibiotics: controversial
Tetanus: physician' evaluation
2 weeks: depending on the length and degree of maturation of the root
2 weeks→remove the splint and check the occlusion→1 additional week
4 weeks: alveolar or jawbone fracture
Short-term
stainless steel wire up to a diameter of 0.016” or 0.4 mm
nylon fishing line (0.13-0.25 mm)
Passive and flexible splints
avoid occlusal interference
enable palatal/lingual access for endodontic procedures
Labial surfaces
avoid plaque retention and secondary infection
easy cleaning
Away from the marginal gingiva and interproximal areas
Stabilization(splinting)
Avoid participation in contact sports.
Maintain a soft diet for up to 2 weeks
Brush their teeth with a soft toothbrush
Use a chlorhexidine (0.12%) mouth rinse twice a day for 2 weeks
Endodontic treatment within 2 weeks
Calcium hydroxide: 1 month
Corticosteroid or corticosteroid/antibiotic mixture: 6 weeks
Intracanal medicament before root canal filling
Closed apex
Spontaneous pulp space revascularization
Risk of infection-related (inflammatory) root resorption
pulp space revascularization/revitalization
Follow-up. If pulp necrosis and infection
Open apex
Endodontic considerations
Closed apex: font color=\"#b71c1c\
Infection-related (inflammatory) resorption: root/bone resorption
Radiographic absence of periodontal ligament space
Radiographic replacement of root structure by bone
A metallic sound to percussion
Ankylosis-related (replacement) resorption
Open apex: font color=\"#b71c1c\
Follow-up procedures: Clinical and radiographic examination
Outcomes
Periodontal healing
Pulp space healing (for open apex teeth)
Pain
Discoloration
Tooth loss
Quality of life
Esthetics (patient perception)
Trauma-related dental anxiety
Number of clinic visits
Injury-specific outcomes: Infra-occlusion
Core outcome set
Avulsion of permanent teeth
0 条评论
回复 删除
下一页
