Dental trauma, treatments

For the selection of the treatment for dental trauma in the pediatric patient, we will assess, among other factors, the maturity of the patient and the time remaining for the replacement of the tooth damaged. Every patient who has suffered a dental traumaWhether he is an adult, child or adolescent, he must undergo a clinical examination and oral X-rays for the diagnosis and evaluation of the damage suffered.

Uncomplicated coronary fracture

The fracture involves enamel or enamel and dentin; the pulp is not exposed. Treatment in primary dentition as in permanent dentition will consist of smoothing the cutting angles at the edges of the enamel fracture and restoring the tooth with a filling (composite). If the tooth fragment is available, it can be used for rehabilitation using the adhesives and composite for material that we use for the fillings.

Complicated coronary fracture

The fracture involves enamel, dentin, and the pulp or nerve.

• Temporary dentition: when in the exposure of the pulp, the time elapsed since the injury and the external contamination are considered minimal, a treatment called pulp capping which consists of the application of a material called calcium hydroxide (classically used material) to seal this exposure. Later a reconstruction of the tooth will be made with a filling. In children with temporary teeth with immature and still developing roots, it is advantageous to preserve pulp or nerve vitality to facilitate root development. The techniques to take into account will be the nerve covering without tissue removal vascular-nervous (pulp) or partial pulpotomy elimination of the tissue contained within the pulp chamber, preserving the vascular-nervous tissue of root canals. This treatment is also of choice in children with fully formed roots. These treatments should always be considered before extraction or tooth extraction.

• Permanent dentition: in young patients with immature roots in the process of formation, it is advisable to preserve pulp vitality by pulp capping or partial pulpotomy. Treatments just mentioned for primary teeth. In adult patients, root canal or endodontic treatment (killing the nerve) may be the treatment of choice, although pulp capping or partial pulpotomy are also valid options. In extensive coronary fractures, a decision must be made whether a treatment other than extraction is feasible.

Crown-root fracture

The fracture involves enamel, dentin, and root structure; the pulp may or may not be exposed.

• Temporary dentition: extraction is the recommended treatment. Care must be taken to avoid trauma to germs on the underlying permanent teeth.
• Permanent dentitionTreatment recommendations are the same as for complicated fractures of the crown, pulp capping and partial pulpotomy in patients with immature permanent teeth or endodontic treatment in adults, and dental extraction as a last resort.

Root fracture

The coronary fragment is mobile and may be displaced.

• Temporary dentition: The fracture is usually located in the middle or apical third of the root. If the coronary fragment is displaced, extract only this portion of the tooth. The final root or apical fragment should be left to be physiologically reabsorbed.

• Permanent dentition: reposition, if displaced, the coronary segment as soon as possible. Stabilize the tooth with a flexible splint (bonding the tooth to the neighbors, with glass fibers or wire and composite) for 4 weeks. If the root fracture is close to the cervical or neck area of ​​the tooth, stabilization is beneficial for a longer period of time (up to 4 months). And track for a year.

Alveolar fracture

The fracture involves the alveolar bone. The segment containing the tooth is mobile and generally displaced. Interference is often noted, that is, a dental stop is perceived in lateral movements of the mouth. In both the primary and permanent dentition, any displaced fragments should be repositioned and splinted. Stabilize the segment for 4 weeks.

Supportive tissue injuries

Concussion and subluxations, in both situations no special treatment is required, it will be enough to keep the tooth at rest, preventing it from coming into contact with the opposite when closing the mouth or biting. If necessary, the tooth will be touched up by polishing the contact surface. Follow-up will be done by the dentist. They can also be splinted or stabilized for 2 weeks in the case of subluxations.

Extrusive Luxation

The tooth appears elongated and is excessively mobile.

• Temporary dentitionCareful reduction or leaving it to spontaneous alignment are considered acceptable treatment options. In severe extrusion on a fully developed primary tooth, extraction is the treatment of choice.

• Permanent dentition: reposition the tooth gently reinserting it into the socket. Stabilize the tooth with a flexible splint for 2 weeks. Subsequent evaluation of endodontic treatment if there is a lesion of the vascular-nervous tissue that can manifest itself with a change in the coloration of the tooth.

Lateral dislocation

The tooth is displaced, usually towards the inside of the mouth. It will often be immobile.

• Temporary dentition: If there is no occlusal interference, the tooth is allowed to reposition spontaneously. When there is occlusal interference, with the use of local anesthesia, the tooth can be gently repositioned by pressure from outside the mouth inwards. In severe displacement, when the crown is dislocated in a labial position, extraction is the treatment of choice. If there is minor occlusal interference, slight wear is indicated.

• Permanent dentition: reposition the tooth with forceps and gently reposition it to its original location. Stabilize the tooth with a flexible splint for 4 weeks. Observation of the vitality of the tooth (vascular-nervous tissue that has been injured in the dislocation). If there is significant involvement with necrosis, endodontic treatment should be applied.

Intrusion

The tooth is frequently displaced through the bone table away from the mouth, it may be impacting the dental germ of the successor in the event that it occurs in a temporary tooth. We talk about permanent dentition:

• Tooth with immature roots: allow spontaneous replenishment to occur. If no movement is observed within 3 weeks, rapid repositioning is recommended.
• Tooth with ripe roots: The tooth should be repositioned orthodontically or surgically as soon as possible. The pulp will probably be necrotic (dead), so endodontic treatment is necessary using a temporary filling with calcium hydroxide, which allows natural resorption of the temporary teeth.

Avulsion

The tooth is completely outside the socket. Radiographic examination is essential to verify that the missing tooth is not intruded. Reimplantation of avulsed primary teeth is not recommended.

Permanent teeth

The prognosis of tooth reimplantation is poor when it is done after an hour and will end with the loss of the tooth. Immediate reimplantation has a better prognosis, as the vitality or not of the vascular-nervous tissue may vary, but the tooth will remain in the mouth, producing ankylosis due to bone union of the tooth to the bone due to calcification of the periodontal ligament.

Reimplantation in less than an hour and with the tooth preserved in a humid environment has a prognosis between the two aforementioned situations. Being able to not produce the subsequent reabsorption of the root that results in the loss of the tooth.

Immediate reimplantation

• The tooth will be cleaned with serum and will be reimplanted in its place.
• It will be stabilized with splinting of the tooth.
• Tetanus vaccination will be administered, if not properly vaccinated.
• antibiotic treatment, analgesics and use of topical antiseptics such as chlorhexidine on gum lesions.
• Soft diet to avoid use or trauma to the injured tooth.

In the case of permanent teeth and mature roots, if the reimplantation is not immediate, the root canals and the pulp chamber of vascular-nervous tissue will be cleaned. waiting for a time that may be a year to complete endodontics with gutta-percha, a material that replaces the pulp tissue.

In the same situation but with permanent teeth with immature roots, it will be observed that the pulp tissue does not necrose, since this possibility exists. Otherwise, the same treatment will be carried out as in the case of permanent teeth with mature roots.