Trauma and nerve damage to teeth (Part I)

1. 1. • Enamel without loss of substance, infraction of crown or cracks
      • Enamel and dentin with loss of tooth substance but without pulpal involvement.
      • Enamel, dentin and pulp with loss of tooth substance and exposure of pulp.

1. 1. • Defined as microcrack in the thickness of the enamel
      • Quite common but not readily detectable
      • Illuminating crowns with indirect light causes cracks

1. 1. • Routine vitality testing
      • Sealing of cracks with adhesive systems

1. 1. • More common than complicated
      • Usually occur at mesioincisal or distoincisal corners of maxillary central incisors
      • Exposed dentin sensitivity to thermal, chemical and mechanical stimuli
      • Deep, pink blush of pulp may be appreciated through the thin remaining dentin wall

1. 1. • Composite build up
      • Coronal fragment reattachment

1. 1. • Bleeding from exposed pulp
      • Exposed pulp is sensitive to stimulation
      • Pulp testing is positive unless there is concomitant luxation injury
      • Depending on the absence or presence of a concomitant luxation injury the pulp will present with bright red, cyanotic or ischemic appearance

1. 1. • Vital pulp therapy
      • Direct pulp capping
      • Partial pulpotomy (Cvek Technique)
      • Cervical pulpotomy
      • Pulpectomy
      • Follow up

1. 1. • Maxillary central incisors most commonly affected
      • Coronal fragments are displaced lingually and slightly extruded
      • Degree of mobility of crown i.e. fracture plane to the apex, more stable is the tooth
      • Root may occur in association with alveolar process fractures
      • Temporary loss of sensitivity is seen which returns back to normal within 6 months

1. 1. • More apical and better than prognosis
      • Middle and apical, reduction to position and immobilization
      • Endodontic therapy when evidence of pulpal necrosis
      • Coronal 3^rd , Extraction

1. 1. • Fracture line is parallel to the long axis of the tooth and can extend from crown to the apex
      • May or may not involve the pulp chamber
      • Seen most often in mandibular molars

1. 1. • Low level dull pain-cracked tooth syndrome
      • Bite test: Pain on release of biting force
      • Transillumination
      • Staining with disclosing dye
      • Definitive diagnosis is made only on surgical exploration

1. 1. • Single-rooted teeth: extraction
      • Multirooted teeth: Hemisection with endodontic therapy and crown

1. 1. • Involve both crown and root
      • Usually involves pulp
      • Permanent teeth are more affected than deciduous teeth
      • Seen often in anterior teeth due to direct trauma

1. 1. • Anterior tooth: plane extends obliquely from the mid portion of the crown facially and extends below the gingival level palatable.
      • Displacement of segments are minimal
      • Bleeding from pulp
      • Pain on mastication

1. 1. • Removal of coronal fragment permits evaluation of extent
      • If pulp is not exposed: conservative treatment (Bonding tooth fragment or composite build up)
      • If small amount of root is lost with pulp exposure: crown lengthening + Endodontic therapy
      • If > 3-4 mm of clinical root is lost: removal of residual root

DISCLAIMER : “Views expressed above are the author's own.”

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