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Endo pt.3 (Trauma Mangement (Trauma Review (Sensinibility Testing (Can be…
Endo pt.3
Trauma Mangement
Long Sequelae
Conservative Mangement:
- 10 years old (closed apex, large pukp chambers, little secondary dentine)
- WHAT (happened), WHERE (did it happen), WHEN (did it happen)
- Puloptomy vs pulpectomy
- LONGTERM and MINUTE observations are essential for the dx of path or healing
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Trauma Review
Clinical
Colour change, tenderness to percussion/palpation, ST changes (gingival recession/sinus), mobility, sound, sensibility (overtime)
Radiographic
Pulp space, PDL space, Lamina dura, apical bone, root #, more than one radiograph (different angles)
Healing (Bone, Dentine Pulp)
- Reparative healing
- Regenerative healing (maybe in future)
= mostly healing is reparative (hard/ soft tissue healing w/ connective tissue)
Radx = scar, opaque barrier, receding pulp horn
Sensinibility Testing
Can be unreliable, subjective pain, false-negatives common
- young = EPT non-reliable as nerve plexus not developed
- old = COLD non-reliable as calcified dentine tubules less Newtonian flow
Common reactions of teeth to trauma
- Discolouration (bruising - haemorrhaging down the tubules)
- Pulp Canal Obliteration
- Pulpitis
- Pulp Infection / Necrosis
- Inflammatory Resorption- Internal/External
- Replacement Resorption (Ankylosis)
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Pulp Canal Obliteration
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No visible pulp space and YELLOW discolouration
75% symptom-free, sensibility tests unreliable
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Materials
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Antiobiotic Treatment
Amoxicillin500mg q8h/Augmentin 625mg TDS
PenicillinV 500mg QID
OR
Metronidozole 400mgTID, 4 days
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Evidence for: Metronidazole and Amoxicillin being the most effective rx for treating dental abcesses
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Endodontic Re-Tx
Non-Surgical ReTx
How?
- Heat
- Mechanical (H-Files or Rotary files)
- Chemical Solvents (Chloroform)
- Paper Points (wicking)
GP removal depends on:
- Root canal shape - orifice diameter
- Length and quality of rootfilling
- coronal access
Why?
- Clinical signs/symptoms
- Radiographic signs of persistent / new disease
- When Exo is not a good option
Surgical ReTx
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Why?
- Things that are preventing us from therapeutic access – ie cast posts and cores
- Extruded materials (excess messy GP, cellulose, transported infected debris)
- True cysts
- Broken Instruments
Correct Diagnosis:
Perisistent periapical diesease
(endo - interradicular bacteria, extraradicular bacteria, foregin bodies, cysts)
(pros - leaky restorations, perforations, fractures)
Healing
Most lesions heal within 2 years, over fills require a longer obs period
Healed
No clinical signs of disease + no radx evidence of disease
(normal PDL, lamina dura around thr root)
EndoTx Older Patients
Different priorities to younger patients:
--> Short term goals often most important ie eating and speaking ect
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Diabetes and Endo
Evidence linkingT2 DM with higher prevalence of AP, asymptomatic lesions, larger lesions and reduced healing
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RCT improves quality of life (pain, psychological, social disability, function & nutrition), cost barrier to care and dissatisfaction but compares well to replacement (Moiseiwitsch et al 2002, Liu et al 2014)