牙外伤 （nxpowerlite）课件

Traumatic Dental Injuries,ZHU Qi Wuhan University School of Stomatology,Classification for Injuries to the Oral Structure WHO,873.60 Enamel fracture 873.61 Crown fracture without pulp involvement 873.62 Crown fracture with pulp involvement 873.63 Root fracture 873.64 Crown-root fracture 873.66 Tooth luxation (dislocation) 873.67 Intrusion or extrusion 873.68 Avulsion 873.69 Other injuries,Etiology,Falling while playing and running: 16%25%,Automobile accidents:,Sports activities,Incidence,20%25% population suffered a dental injury,First two decades, from ages 8 to 12 years,Maxillary central incisor, lateral incisor, Mandibular incisors.,Examination ,History,Chief Complaint,History of Present Illness (injury),Medical History,Examination ,History of Present Illness (injury),When and Where did the injury happen?,How did the injury happen?,Have you had treatment elsewhere before coming here?,Have you had similar injuries before?,Have you noticed any other symptoms since injury?,What specific problems have you had with your teeth?,Examination ,Clinical Examination,Soft Tissues,Facial Bones,Teeth,Tooth Fracture,Mobility,Displacement,Injury to Periodontal ligament and Alveolus,Pulpal Trauma,Examination ,Radiographic Examination,Follow-up Evaluation,indispensable in the diagnosis and treatment. detection : dislocation, root fracture, jaw fracture,after 6 wks, 6 m, 12 m, yearly for several years,Definition: Incomplete fracture or crack of enamel without loss of tooth structure.,ENAMEL FRACTURE or CROWN INFRACTION,Diagnosis and Clinic Presentation Crack or craze line indirect light or transillumination,UNCOMPLICATED CROWN FRACTURE,Definition: Fracture of the enamel only or enamel and dentin without pulp exposure.,CROWN FRACTURE without PULP INVOLVEMENT or,Incidence: 1/3 of all dental injuries,Uncomplicated Crown Fracture I,Uncomplicated Crown Fracture II,Diagnosis and Clinic Presentation,Enamel fracture Enamel/dentin fracture,Treatment,Protect the pulp by sealing the dentinal tubules by direct application of calcium hydroxide, Dycal. Consideration given to function and esthetic, restoration with a bonded resin technique.,Uncomplicated crown fracture of the maxillary central incisor,CROWN FRACTURE with PULP INVOLVEMENT or,COMPLICATED CROWN FRACTURE,Definition: Crown fractures involving enamel, dentin, and pulp.,Incidence: 2% 13% of all dental injuries.,Crown fracture with pulp involvement,Treatment,Immature teeth: preserve pulps pulp capping, or pulpotomy,Mature teeth: pulp extirpation, root canal therapy, post/core and crown restoration.,Shallow pulpotomy,CROWN ROOT FRACTURE,Definition: Crown root fracture involving enamel, dentin, and cementum; pulp may or may not be involved.,Incidence: 5% of all dental injuries.,Crown root fracture,Crown root fracture of maxillary central incisor,Treatment,The same manner as crown fractures,A periodontal assessment is made,Extracted or not?,ROOT FRACTURE,Definition: Fracture of the cementum, dentin, and pulp.,Incidence: Less than 3% of all dental injuries.,Diagnosis and Clinic Presentation,Displacement of the coronal segment,X-ray examination is extremely important!,Root fracture,Treatment,Apical third: no treatment is necessary,Middle third: repositioning and splint,Coronal third: a poorer prognosis? communication exist,Treatment of root fracture,Healing Patterns,Healing with calcified tissue,Healing with interproximal connective tissue,Healing with interproximal bone and connective tissue,Interproximal inflammatory tissue without healing,Healing with calcified tissue,Healing with interproximal connective tissue,Healing with interproximal bone,Healing with interproximal bone,Interproximal inflammatory tissue,LUXATION INJURY,Definition:,Concussion: No displacement, normal mobility, sensitivity to percussion.,Subluxation: Sensitivity to percussion, increased mobility, no displacement.,Lateral Luxation: Displacement labially, lingually, distally, or mesially.,LUXATION INJURY,Definition:,Extrusive Luxation: Displacement in a coronal direction.,Intrusive Luxation: Displacement in an apical direction into the alveolus.,Incidence: the most common injury 30% 40% of all dental injuries.,Diagnosis,Common symptom: Sensitivity to biting or chewing,Other symptom: Mobility Dislocation bleeding,Treatment,Lateral and Extrusive Luxation: Repositioning into original position Splint with an acid-etched technique,Follow-up,Mature tooth: RCT after 3-weeks,Immature tooth: RCT or Not?,Treatment,Intrusive Luxation:,Mature tooth:,Immature tooth:,Reeruption, if not Orthodontic movement,be repositioned immediately RCT after 2 weeks,Prognosis,Pulp necrosis,Pulp canal obliteration,Root resorption,Lateral luxation,Lateral luxation,Extrusive luxation,Extrusive luxation,Intrusive luxation,Intrusive luxation,2 weeks,10 days,4 weeks,Primary intrusive luxation,Primary intrusive luxation,6 weeks later,6 month recall,Primary intrusive luxation,16-month recall,16-month recall,AVULSION,Definition: Complete displacement of the tooth out of the socket.,Incidence: 1% 16% of all dental injuries.,Treatment,Treatment success for avulsed teeth is directly related to the extra-alveolar time before replantation. The sooner an avulsed tooth is replanted, The better the prognosis.,Guideline 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 dental office right away to complete the treatment of replantation.,Selected Clinical Procedures,Splinting Technique,Splinting Technique,Recommende Splint Peri