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Treatment for Trauma (PERIO (Extrusion (Immediate presentation (Reposition…

- - - - Reposition with minimal force to reduce apical lock
      - Splint 3-4wks
      - Monitor
    - - Rely on spontaneous or ortho repositioning OR accept crown position and recontour to suit
      - Splint?
  - - - Reposition with slow apical pressure // Splint for 2-3wks
    - - Rely on spontaneous alignment or orthodontically realign
        
        Splint?
  - - - If time out of mouth is <1hr and apical foramen is >1mm then there's a good chance the pulp will revascularise
      - Replant and apply functonal splint for 2wks
      - Review vitality, watch for apex to close radiographically and check for pathology
        
        If not revascularising by 3 months then commence RCT
    - - Stored in appropriate medium for <1hr
        
        Hold tooth by crown, rinse in saline if dirty -> LA -> Replace tooth with minimal pressure
        
        Functional splint for <2wks
        
        1 month root fill
        
        At 7 days start RCT - dress with CaOH for 1 month
      - Out of mouth for >1hr or stored in inappropriate medium
        
        Prep and fill RC system out of mouth
        
        (Soak in 2% NaF for 20min to reduce replacement resorption)
        
        Remove dead PDL cells with gauze
        
        Re-position and splint tooth for 4 weeks
      - Replanted at scene
        
        Splint for <2 weeks
        
        At 7 days start RCT - dress with CaOH for 1 month
        
        Root fill at 1 month
    - - Primary teeth should not be replanted at risk of damaging the permanent successor
    - - CHX should be recommended for 1-2wks
      - Tetanus booster should be arranged if needed
  - - - Release from lock and allow to re-erupt or orthodontically extrude
      - Monitor vitality
    - - RCT during this time
      - Monitor long term
      - Orthodontically extrude over 3-4wks
- - - - Direct pulp cap
        
        ONLY for early presentation with no other injury
        
        Must isolate and clean with hypochlorite -> Haemostasis -> MTA or CaOH cap -> Restore -> Monitor vitality
      - Pulpotomy
        
        Used when there is an extended time post trauma or reduced vascularity from PDL/perio trauma
        
        Cvek Pulpotomy = Isolate & clean with hypochlorite -> remove 2mm into pulp w/high speed -> Haemostasis -> MTA -> GIC atop that -> Restore -> Monitor vitality & radiographs
      - Pulpectomy & Root fill
        
        Can be done in same visit
    - - Seal tubules
        
        Will need suitable cap e.g. CaOH
      - Restore - Ideally with fragment
        
        Otherwise composite and crown
  - - - Create long Junctional epithelium
    - - These are only indicated if a third or less of the root is involved
        
        Once complete -> RESTORE OR REPLACE
    - - Will need a splint to stabilise and subsequent RCT
    - - Indicated for vertical root fracture, unfavorable CR ratio or financial difficulties
  - - - Need to ensure this is a fracture and not just extrusion
      - Those fractures in the coronal third may require crown lengthening surgery, ortho extrusion or exo
      - For fractures in the apical third, the apical portion is almost always fine and does not require Tx
      - The coronal portion however, can have vascular supply compromised due to luxation injury Hence depending on healing may require RCT
      - HEALING
        
        Connective tissue
        
        FCT has healed across area // Monitor
        
        Increased mobility // Positive vitality test // Obvious fracture radiographically
        
        Granulation tissue
        
        Coronal portion is infected -> Site has not healing and granulation tissue is forming
        
        RCT of coronal portion
        
        Disinfect the frature and dress with CaOH for 1wk -> Then root root to the frac line with at least 3-4mm of MTA. The rest GIC or comp
        
        Hard tissue
        
        Bone or cementum have healed across the fracture area // Monitor
        
        Normal mobility // Positive vitality // Slight fracture line radiographically
    - - Hopeless -> EXO