Avulsion of permanent teeth（traumatic）
2022-06-20 10:17:48 0 举报AI智能生成
2020年指南
作者其他创作
大纲/内容
Introduction
<font color="#b71c1c">0.5-16%</font> of all dental injuries
Treatment: <font color="#b71c1c">replantation</font>
First aid at the place of accident
Replantation
<font color="#b71c1c"><b>permanent</b></font> tooth！
pick it up by the <font color="#b71c1c">crown</font>
rinse it gently in<font color="#b71c1c"> milk, saline, patient's saliva</font>
return it to its <font color="#b71c1c">original position</font>
bite on gauze, a handkerchief or a napkin to<font color="#b71c1c"> hold it in place</font>
Keep the tooth/teeth in a storage medium：milk＞HBSS＞saliva (after spitting into a glass for instance)＞saline＞water
Treatment guidelines
Assess the condition of the PDL cells by day time
most likely viable: be <font color="#b71c1c">replanted </font>within <font color="#b71c1c">15min</font>
may be viable: be kept in a storage <font color="#b71c1c">medium </font>+ total day time <font color="#b71c1c"><60min</font>
likely to be non-viable: the total day time<font color="#b71c1c"> ≥60min</font>
Closed apex
Been replanted
Clean the injured area with water, saline, or chlorhexidine
Local anesthesia
Verify the position
Right place: Leave the tooth/teeth in place
Malposition: correct the position using slight digital pressure
Wrong socket or Rotated: reposition within 48h
Stabilize for <font color="#b71c1c">2 weeks</font> or <font color="#b71c1c">4 weeks </font>(alveolar or jawbone fracture)
Suture gingival lacerations
RCT within 2 weeks
Systemic antibiotics
Check tetanus status
Patient instructions
Follow up
Been kept in a storage medium + total day time <60min
Remove debris
Keep the tooth in a storage medium
Local anesthesia
Irrigate the socket with sterile saline
Reposition the fractured fragment
Remove the coagulum with a saline stream
Replant
Verify the position
后续步骤同上
Total day time ≥60 min: 同“保存于介质+干燥时间＜60min”
Open apex: 将上述RCT换成Pulp revascularization，随访异常及时处理
apexification
pulp revitalization/revascularization
RCT
Anesthetics
Infiltration anesthesia
Block/Regional anesthesia: severe injury cases
Systemic antibiotics: recommended
Why
prevent infection-related reactions
decrease the occurrence of inflammatory root resorption
patient's medical status or concomitant injuries
Dosage: patient's age and weight
First choices: Amoxicillin or penicillin
effectiveness on oral flora
low incidence of side effects
Others: Tetracycline, Specifically doxycycline
Effects: Antimicrobial, anti-inflammatory, anti-resorptive
<font color="#b71c1c">Side effect: discoloration【Not for patients under 12 years of age】</font>
Topical antibiotics: controversial
Tetanus: physician' evaluation
Stabilization(splinting)
Short-term
<font color="#b71c1c">2 weeks</font>: depending on the length and degree of maturation of the root
<font color="#b71c1c">2 weeks</font>→remove the splint and check the occlusion→1 additional week
<font color="#b71c1c">4 weeks</font>: alveolar or jawbone fracture
Passive and flexible splints
stainless steel wire up to a diameter of 0.016” or 0.4 mm
nylon fishing line (0.13-0.25 mm)
Labial surfaces
avoid occlusal interference
enable palatal/lingual access for endodontic procedures
Away from the marginal gingiva and interproximal areas
avoid plaque retention and secondary infection
easy cleaning
Patient instructions
Avoid participation in contact sports.
Maintain a soft diet for up to <font color="#b71c1c">2 weeks</font>
Brush their teeth with a <font color="#b71c1c">soft </font>toothbrush
Use a<font color="#b71c1c"> chlorhexidine (0.12%)</font> mouth rinse <font color="#b71c1c">twice a day for 2 weeks</font>
Endodontic considerations
Closed apex
Endodontic treatment within 2 weeks
Intracanal medicament before root canal filling
Calcium hydroxide: <font color="#b71c1c">1 month</font>
Corticosteroid or corticosteroid/antibiotic mixture: <font color="#b71c1c">6 weeks</font>
Open apex
Spontaneous pulp space revascularization
Risk of infection-related (inflammatory) root resorption
Follow-up. If pulp necrosis and infection
RCT
apexification
pulp space revascularization/revitalization
Follow-up procedures: Clinical and radiographic examination
Closed apex: <font color="#b71c1c">2, 4 weeks, 3, 6 months, 1, 2, 3, 4, 5 year at least</font>
Open apex: <font color="#b71c1c">2 weeks, 1, 2, 3, 6 months, 1, 2, 3, 4, 5 year at least</font>
Infection-related (inflammatory) resorption: root/bone resorption
Ankylosis-related (replacement) resorption
Radiographic absence of periodontal ligament space
Radiographic replacement of root structure by bone
A metallic sound to percussion
Outcomes
Core outcome set
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
0 条评论
下一页
