chapter five

Dental non-caries
disease
7 Traumatic dental
injuries

 Concussion of the teeth

 Dislocation of the teeth
 Fracture of the teeth
 Concussion of the teeth

 Mild force
 Slight injury of periodontal ligament
 No teeth displacement or fracture
 Clinical features

 Feeling of elongation
 normal or slight mobility
 sensitive to tooth percussion
 gingival bleeding
 Treatment

 Allow the tooth to rest as

much as possible for 1-2 w
 Monitor pulpal status
watch for tooth color changes
 Prognosis is good
Dislocation of the teeth

 Lateral luxation
 Extrusive luxation
 Intrusive luxation
 Avulsion
 Clinical features
 Displacement and mobility of the teeth
 Sensitivity to biting or chewing
 Sensitivity to percussion, pressure or palpation
 Gingival laceration and alveolar process fracture
 Complication of tooth luxation

 Pulp necrosis
 pulp calcification
 Root resorption
 Alveolar process resorption
Lateral luxation:
Displacement of tooth labially, lingually,

distally, or mesially
Severe pain, Very sensitive to
percussion
Treatment:
Repositioning and stabilization of the
tooth
for 2 to 6 weeks
Root canal therapy is necessary mostly
Lateral luxation accompanying
by fracture of alveolar socket
Extrusive luxation:
Tooth Displacement axially in a coronal
direction
Severe tooth mobility
Likely to be continually traumatized by
contact
with opposing tooth
Treatment:
Repositioning and stabilization for 4 to 8
weeks
Root canal therapy
Extrusive luxation
Intrusive luxation:
Tooth was pushed into the socket, resulting in
firm, almost ankylosed tooth
Treatment:
Immature teeth: little or no treatment
Mature teeth: repositioning immediately,
by orthodontic appliances or surgical exposure
Root canal therapy will be necessary
Intruded tooth
Tooth avulsion:
Complete displacement out of the socket
Treatment success is directly related to the
extra-
alveolar time before replanation
The sooner an avulsed tooth is replanted,
the better the prognosis
Guidelines for avulsions:
Rinse the tooth in cold running water
Do not scrub the tooth
Replace the tooth in the socket
Bring the patient to the hospital right
away
to complete the treatment of
replantation
Evaluate the need for stabilization
The optimal time for root canal therapy:
about 3 to 4 weeks after replantation
(Exception Immature teeth with wide open apical
foramen
have the potential for pulp
revascularization)
 Resorption is the most frequent
sequela
Inflammatory resorption:
• radiographically visible as bowl-shaped
resorption
area of the root and associated with adjacent
radiolucencies
• involves both tooth structure and adjacent
bone
• replanted tooth without root canal therapy
often
show these resportive lesions
 There is apparent tooth loss
along
with adjacent bony destructure
 Root canal therapy can be
expected
to arrest inflammatory resorption
of
the replanted tooth
 Root canal therapy can be
performed
about 2 weeks postreplantation
 Tooth fracture
Enamel fracture
Crown fracture without pulp involvement
Crown fracture with pulp involvement
Root fracture
Crown-root fracture
Enamel fractures

Chips and cracks

confined to the enamel
Treatment and prognosis of enamel
fracture
 minor smoothing of rough edges
adding composite resin
pulp vitality tests, immediately and again in
6-8w
 Prognosis is very good
Crown fracture without pulp involvement

Enamel and dentin involvement

without pulp exposure
 Treatment and prognosis
Early treatment is important:
Evaluation of pulp status
Protection of the pulp by sealing the dentinal
tubules
The composite resin restoration
Follow-up:
Revaluation periodically to determine pulp status
Root canal therapy for teeth of pulp necrosis
 Crown fracture with pulp involvement

Crown fractures involving enamel,dentin and pulp

Treatment
Immature teeth: pulp capping
shallow pulpotomy
Mature teeth: pulp extirpation (pulpectomy)
root canal therapy
post/core and crown restoration
 Root fracture

Fractures involving the roots only

Generally transverse to oblique, diagonal
Single or multiple, complete or incomplete
Incompletely formed roots rarely fracture
 Treatment of root fracture

No mobility and the tooth is symptomless:

Fracture in the apical 1/3
No treatment is necessary sometimes
Root canal therapy for pulp necrosis
 Treatment of root fracture

Coronal fragment is mobile:

Fracture in the middle 1/3 or coronal 1/3
Repositioning the coronal segment
Splinting the tooth to adjacent teeth
The rigid stabilization last for at least 12
weeks
 Sequelae to root fractures

Healing with calcified tissue

Healing with interproximal connective tissue

Healing with interproximal bone and connective tissue
Interproximal inflammatory tissue without healing
Root fracture resulting in healing with calcified tissue
Root fracture resulting in
connective tissue between the
segments
Healing by interproximal bone
Root fracture resulting in interproximal inflammatory tissue
 Sequelae to root fractures

Root fractures occurring in the coronal 1/3 had a

poorer
prognosis than those that took place more apically
Location did not influence outcome
As long as appropriate reduction and fixation are
accomplished, healing can occur regardless of the
fracture location
Factors influencing repair:
The degree of dislocation and mobility
of
the coronal fragment
The stage of root development
The location of the fracture
The quality of treatment
Crown-root fracture

Enamel, dentin, and cementum are involved

The pulp is also involved at most time
 Crown-root fracture

Complaints of pain
The fragments are generally easy to
move
Bleeding form periodontal ligament
or
pulp often fills the fracture line
The pulp is often exposed
Treatment of crown-root fracture

Removal all loose fragments first

If the pulp is exposed:
----RCT and crown restoration
If the pulp is not exposed:
----dentinal protection by cast restoration
If the apical extent of fracture is within
4mm of
the gingival crevice:
----gingivectomy/alveolectomy to allow a
margin
for restoration
8 Chronic dental injuries

 Abrasion
 Bruxism
 Wedge-shaped defect
 Dentine hypersensitivity
Abrasion
Complication of abrasion

Dentine
hypersensitivity
Food impaction
Traumatic occlusion
Endodontic
disease
 Treatment of abrasion

Removal of etiological factors

Desensitization
Occlusal adjustment
Endodontic treatment
Other management to treat complication
 Bruxism
Abnormal movement of masticatory system
Etiological factors:
 Psychological factor
 Premature and/or lateral contact
 Systematic factors
 Occupational habit
Clinical feature of bruxism

 Abnormal movement of
masticatory
muscles and lower jaw
 Resulting in teeth attrition
 Periodontic disease
 TMJD, etc
 Treatment of
bruxism

 Removal of etiologic factors

 Occlusal matrix
 Occlusal adjustment
 Prosthetic treatment
 Treatment of complications
Wedge-Shaped Defect
 Etiology:
excessive toothbrushing,etc
 Clinical feature:
premolar; sensitivity
 Treatment:
Desensitization,filling or endodontic
treatment
Dentine
Hypersensitivity

Dentine hypersensitivity is a form of

hypersensitivity caused by the effect
of thermal, tactile, osmotic or
chemical stimuli on exposed dentine
Treatment of Dentine
Hypersensitivity

 drugs
 Restoration
 Laser
 etc
 test
1 What is the most common dental disease?

Please answer its important etiological

factors.

2 Please tell the differents between fused

teeth
and geminated teeth.

3 Please choose correct treatment for

1)Reversible pulpitis ( )
2)Irreversible pulpitis( )
3)apical periodontitis ( )
A. pulp capping B. Sedative
dressing