2. CONTENTS
1. CLASS IV ELLIS FRACTURE
2. TREATMENT OF TRAUMATIC
INJURIES TO TEETH
3. FRACTURE WITH PULP
INVOLVEMENT
4. CROWN FRACTURES
5. CONCLUSION
6. REFERENCE
3. CLASS IV ELLIS FRATURE
The
traumatized
teeth that
becomes non
vital with or
without loss of
crown
structure.
4. EMERGENCY:
INITIAL CONTACT:
• Often these emergencies are
communicated by parent to the dentist
on the phone .
• The dentist should take the following
steps:
• The clinician should try to alleviate the
anxiety.
5. If there is an avulsed tooth,following
instructions need to be given:
i. Insert the sink drain plug to avoid tooth
loss.
ii. Gently insert the tooth into the socket by
holding the crown and not disturbing the
root area.
iii. If the replacement is nit possible keep it
under the tongue and lip and go to dentist
fast.
iv. Tooth can also be kept in the milk while
coming.
6. PARENT MANAGEMENT: Dentoalveolar injury
can appear alarming to the parent.
o A little blood mixed in saliva can give a impression of
copious haemorrhage & clotting of the blood on the
lips may suggest extensive laceration .
o When a child arrives at the clinic the accompanying
parent may be in a hysterical or extremely nervous
condition & this complicates the situation.
o A quick examination will reveal the extent of injury &
the results should be communicated to the parents to
alleviate their concern.
8. In cases of pulpal exposures following can be
done:
• 1. Pulpectomy
• 2. Apexification
• 3. Extraction
FRACTURE WITH PULP
INVOLVEMENT
9. • Pulpectomy in
apexified permanent
teeth is conventional
root
canal(endodontic)
treatment for
exposed, infected,
and/or necrotic teeth
to eliminate pulpal
and periradicular
infection.
PULPECTOMY(CONVENTIONAL ROOT CANAL
TREATMENT)
10. • In all cases, the entire roof of pulp
chamber is removed to gain access to the
canals and eliminate all coronal pulp
tissue.
• Following debridement, disinfection and
shaping of root canal system, obturation of
the entire root canal is accomplished with
a biologically acceptable, non-resorable
filling material.
14. Final preparation
• After thoroughly
cleaning and
shaping the canals,
canals are dried
prior to filling the
roots.
15. Obturating (filling)
the root canals
• Finally, the canals
are sealed with 2
components:-
1. A sealer that sets
over time
2. Gutta percha
• This serves as the
permanent root
canal filling
16. Root canal treatment
completed
• Upon treatment of the
root canal treatment, a
temporary filling is
placed over the sealed
canals that has two
parts :-
1. Cotton pellets soaked
in antibacterial solution
2. A solid temporary filling
on top
17. • A final restoration
(usually a crown) is
placed and
follow-ups are done.
18. 2.APEXIFICATION:
• Is defined as a method of inducing closure by
the formation of osteo-cementum or similar
hard tissue or continued apical development of
the roots of an incompletely formed tooth in
which pulp is no longer vital.
19. • Immature permanent tooth which became
non-vital have a blunderbuss or divergent root
apex that makes canal obturation by a non
surgical approach difficult or impossible.
1.Anaesthetise and isolate the tooth.
2.Prepare a conventional access &
extirpate the necrotic pulp
3.Instrument the canal, 0.5mm short of the
radio graphic apex.
4.Fill the canal with calcium hydroxide or
calcium hydroxide &camphorated
monochlorophenol.
20. 5.Seal the canal with zinc oxide eugenol/IRM.
6.Dressing should be changed in every 3 months
till apexification is achieved.
7.Later the canal can be obturated with
conventional endodontic treatment.
21. MULTIPLE VISIT APEXIFICATION
PROCEDURE WITH CALCIUM
HYDROXIDE
Anaesthesia, rubber dam isolation, and
access opening
Working length should be at least 2 mm
short of radio graphic apex of the tooth.
22. Circumferential enlargement is effected by
lateral pressure against the walls with a
large file.
Drying the canal with paper points
23. Ca(OH)2 is mixed wit sterile water or
anaesthetic solution to a thick consistency.
The paste is delivered into the canal with
an amalgam carrier and condensed with
finger pluggers.
24. The entire root canal is filled with
Ca(OH)2 paste, ensuring that the material
is in contact with the periapical tissues.
The access cavity is sealed with RMGIC
(Resin modified glass ionomer cement)
25. Patient called after 3 months
Radiographic evidence of calcific barrier at
or near the root apex
YES NO
OBTURATION USING
THERMOPLASTICIZED
TECHNIQUE
Ca(OH)2 dressing
is changed and
patient is recalled
every 3 months till
evidence of calcific
barrier is seen
27. Anaesthesia, rubber dam isolation, and
access opening
Working length should be at least 2 mm
short of radiographic apex of the tooth.
28. Circumferential enlargement is effected by
lateral pressure against the walls with a
large file.
Drying the canal with paper points
29. MTA is mixed in a 3:1 ratio with sterile
distilled water to a wet sand consistency.
The paste is delivered into the canal with a
MTA carrier and condensed with prefitted
pluggers.
30. The material is condensed into a 3-4mm
apical plug.
Moist cotton pellet is placed over the MTA
Patient is recalled after 48 hours and the
set of MTA is verified and obturation is
done using a thermoplasticized technique.
32. EXTRACTION
• If either of the pulpectomy or
apexification is not performed then
extraction of the tooth is done.
33. CROWN FRACTURES:
1. ENAMEL INVOLVEMENT:
Fracture only confined to enamel is rare.A
radiograph is necessary to determine the
extent of the injury.
o Smoothening of fractured enamel & fluoride
application to strenghthen the surface layer
is usually the treatment of choice.
o As an alternative , the acid etch technique
may be used effectively to restore the
smallest amount of enamel fracture with
good esthetic result.
34.
35. 2.Crown infarctions:
o Very common but often overlooked these fractures
appear as lines in the enamel substance , which do
not cross the dentio-enamel junction.
o Infarctions are caused by direct impact on enamel.
o These injuries do not require definitive treatment.
o Sealing the infarction line with unfilled resin following
an acid etch technique may prevent stains e.g
(tobacco, food, wine , tea ,coffee etc)
36.
37. o Since no guarantee exists that the infarction
line will stop short of dentin or pulp,vitality
testing to document the status of pulpal tissue
is recommended for all teeth with infarction
lines.
o The results of vitality testing for tooth or teeth
with infarction should be compared to that of
adjacent or contralateral control teeth.
o Healthy tooth with infarction will respond
positively to vitality testing .
38. ENAMEL AND DENTIN
INVOLVEMENT:
o Radiograph and vitality tests are adviced to
determine the full extent of injury.
Prognosis of the tooth depends on the following
factors:
• The amount of time the dentin has been
exposed(less than 24hrs has good prognosis)
• The remaining thickness of the dentin
between the fractured tooth surface and pulp.
• The stage of development of the pulp.
39.
40. • A protective layer of calcium hydroxide or glass
ionomer must be applied at the earliest to seal
the exposed dentinal tubules. The crown form
may then be restored with an acid etch
composite resin or a temprorary crown.
• An orthodontic band can be used as a
temprorary matrix for retention of the dressing
covering the exposed dentin.
41. 4. Reattachment of fracture
segment:
• The restorative techniques requires etching the
enamel with 35%phosphoric acid gel(30sec).
• Rinsing with water(20sec).
• Drying with air(5sec).
• Conditioning of the dentin and bonding of the
dentin(intraoral or extraoral fragments)with any of the
adhesive material systems; gluma(gluma bayer AG,
FRG) or scotch bond 2.
• The strength of the restored crown- fractured tooth
using any of the listed systems is 50%of the strength
of intact teeth.
42. • The restored crown-
fractured tooth has a
tendency to re-fracture
with subsequent
traumatic accidents.
• This problem may be
overcome by placing cast
ceramic laminate veneers
on crown fractured teeth
rather than using dental
adhesive material
systems.
• Laminate veneers provide
identical strength to those
of intact teeth.
