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Follow up in 4 weeks: Advise parents of possible injury / damage to permanent teeth Allow 6 months for spontaneous re-eruption. Advise parents of potential.

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Presentation on theme: "Follow up in 4 weeks: Advise parents of possible injury / damage to permanent teeth Allow 6 months for spontaneous re-eruption. Advise parents of potential."— Presentation transcript:

1 Follow up in 4 weeks: Advise parents of possible injury / damage to permanent teeth Allow 6 months for spontaneous re-eruption. Advise parents of potential damage to adult tooth Primary Dentition Yes No INTRUSION INJURIES: RECOMMENDATIONS All treatment is ideal and assumes patient has manageable behavior. Recommendations also assume radiographs ( periapical and lateral anterior taken where appropriate). (REFERENCE: AAPD Handbook of Pediatric Dentistry) Extract if root tip is displaced into permanent tooth bud Root tip is displaced towards buccal cortical plate or vertical

2 Intrusive Luxation Most common in upper primary incisors Management: allow to re-erupt or extract

3 Tooth Not Retrieved Post Trauma Confirm Intrusion with Periapical Monitor up to 6 months for re-eruption

4 Intrusive Luxation Primary Teeth Consider antibiotic therapy - monitor for infection Tetanus immunization current? Extract if there are signs of swelling, spontaneous bleeding, abscess and fever Day of the Trauma 2 weeks Post Trauma

5 Intrusive Luxation Primary Teeth One of the most dangerous injuries to the developing tooth bud Management: Minimize damage by assessing displacement of permanent bud

6 Ideally, a lateral film should be taken to confirm that intruded tooth has not displaced permanent tooth bud. If so, extraction recommended

7 Lateral Anterior Radiograph for Intruded Primary Tooth Angulation of intruded tooth Occlusal or size 4 extraoral film next to childs cheek and perpendicular to radiographic beam Exposure time is doubled

8 2 months after injury 3 months after injury 1 year after injury Intrusion Luxation: Re-eruption of Primary Tooth

9 Clinical and radiographic follow up in 4 weeks: Advise parents of possible injury / damage to permanent teeth. NO SPLINT IS INDICATED Extract coronal segment. Leave apical segment if not visible/easily removed Primary Dentition No Yes ROOT FRACTURES : RECOMMENDATIONS All treatment is ideal and assumes patient has manageable behavior. Recommendations also assume appropriate pre-operative radiographs. (Source: AAPD Handbook of Pediatric Dentistry) Fracture located in coronal 1/3 of root or segment is aspiration risk

10 Root Fractures Primary Teeth Radiograph Apical 1/3 - Most teeth maintain vitality and are minimally mobile - Apical fragment should resorb normally - Monitor with radiographs

11 Root Fractures Primary Teeth Radiograph Middle or Cervical 1/3 - Most teeth mobile. Extraction indicated - Gently attempt to retrieve apical fragment If not successful, monitor - Dont disrupt permanent tooth bud

12 Avulsion: Primary Teeth Radiograph Do not re-implant! Space loss may not occur if primary canines are present Permanent tooth eruption may be delayed due to scar tissue/bone

13 Parents Question: Will the permanent teeth be damaged? May not be able to be determined until the teeth erupt and can be evaluated clinically The accident has happened - we cant reverse it Monitor clinically and radiographically

14 Complications of Trauma Permanent teeth malformation: hypomineralization hypoplasia dilaceration arrested development

15 History of Intrusive Luxation Primary Teeth Hypomaturation/Hypomineralization #8

16 History of Intrusion Luxation of Primary Tooth Severe dilaceration of Root

17 History of Avulsion #E : Prior to Eruption of Primary Canines Space maintainer not possible for pre-coop tot with incisors only Ortho/space regaining will be needed

18 Acknowledgements Photos and Diagrams taken from: Textbook and Color Atlas of Traumatic Injuries to the Teeth, 4 th edition: J.O. Andreasen (2007) Pediatric Dentistry, 4 th edition; Pinkham (2005) Odontologia Para o Bebe: Walter L.R.F. (1996) University of Iowa, Department of Pediatric Dentistry

19 Competency Exam Answer the following questions on your worksheets

20 Case #1 Anna Anna is a 4 y.o. girl who fell against the edge of a table about 2 hours ago Her mother has given her childrens Tylenol and is at your office for evaluation The upper incisors are tender, but non-mobile. Her mother raises her lip to show you a 2 mm tear in the labial frenum area Anna is cooperative

21 Case #1: Anna What other clinical procedures do you need to perform? List at least 3.

22 Annas Pedo Occlusal Is this radiograph within normal limits, or do you see any abnormalities or pathology?

23 Case #1 Anna What is your plan for treatment and followup care for Anna? What are your care instructions for mother?

24 Case #2: Bart Bart is a 2 y.o. boy who fell against the edge of the bathtub about 1 hour ago Mother felt his tooth completely broke off at the gumline, but could not find the piece Clinically there are no additional findings

25 Bart What radiographs are indicated for Bart?

26 Pedo Occlusal for Bart Bart was not cooperative for further radiographs. What is your diagnosis based on this film?

27 Case #2 Bart What is your plan for treatment and followup care?

28 Case #3: Charlie Charlie is a healthy 3 y.o. boy who fell against the fireplace at home this morning His father is with him Clinical exam reveals enamel fracture #E and dentin fracture #F No excessive mobility, no luxation Occlusion is normal Charlie is cooperative, but impatient and wiggly

29 Charlies Clinical Appearance ( photo is a representation of the injury, not an actual photo of this patient) What radiographs would you order for Charlie?

30 Pedo Occlusal for Charlie

31 Case #3 Charlie What is your plan for treatment and followup care for Charlie?

32 Case #4 Davonne Davonne is a 12 year old boy with a non- contributory Health History He and his parents are at your office for comprehensive care. The chief complaint is discolored lower front teeth.

33 Davonne Clinical Photo

34 Davonne What most likely caused this discoloration? What are treatment options?

35 Competency Exam Answer Discussion

36 Case #1 Anna Anna is a 4 y.o. girl who fell against the edge of a table about 2 hours ago Her mother has given her childrens Tylenol and is at your office for evaluation The upper incisors are tender, but non-mobile. Her mother raises her lip to show you a 2 mm tear in the labial frenum area Anna is cooperative

37 Case #1: Anna What other clinical procedures do you need to perform? List at least 3. Periapical radiograph (pedo occlusal) Mobility check Percussion check Occlusion check Complete hard and soft tissue assessment

38 Annas Pedo Occlusal Is this radiograph within normal limits, or do you see any abnormalities or pathology? Answer: Within Normal Limits

39 Case #1 Anna What is your plan for treatment and followup care for Anna? Do not suture Observe clinically and radiographically What are your care instructions for mother? OTC pain meds prn Soft diet for about 1 week Tooth may discolor, but this may reverse Periodic reassessment needed

40 Case #2: Bart Bart is a 2 y.o. boy who fell against the edge of the bathtub about 1 hour ago Mother felt his tooth completely broke off at the gumline, but could not find the piece Clinically there are no additional findings

41 Bart What radiographs are indicated for Bart? Periapical (pedo occlusal) Lateral

42 Pedo Occlusal for Bart Bart was not cooperative for further radiographs. What is your diagnosis based on this film? Intrusion. No fracture detected.

43 Case #2 Bart What is your plan for treatment and followup care? Monitor for re-eruption Consider antibiotic therapy and assess tetanus immunization Explain signs and symptoms of infection. Re-assess in 2 weeks

44 Case #3: Charlie Charlie is a healthy 3 y.o. boy who fell against the fireplace at home this morning His father is with him Clinical exam reveals enamel fracture #E and dentin fracture #F No excessive mobility, no luxation Occlusion is normal Charlie is cooperative, but impatient and wiggly

45 Charlies Clinical Appearance What radiographs would you order for Charlie? Periapical (pedo occlusal)

46 Pedo Occlusal for Charlie

47 Case #3 Charlie What is your plan for treatment and followup care for Charlie? Smooth #E GI Bandaid #F or composite if cooperation allows Periodic clinical and radiographic followup

48 Case #4 Davonne Davonne is a 12 year old boy with a non- contributory Health History He and his parents are at your office for comprehensive care. The chief complaint is discolored lower front teeth.

49 Davonne Clinical Photo

50 Davonne What most likely caused this discoloration? History of primary tooth trauma/intrusion What are treatment options? No treatment Cosmetic bonding


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