（P161-189）儿童牙外伤讲稿-口腔专业课课件-儿童口腔

Speechscript“Dentaltraumainchildhoodandadolescence”Lecture:Jin-hua-wangviceprofessorTime:2013-11-14ThischapterincludetwosectionsSectionⅠ:generalintroductionSectionⅡ:diagnosisandtreatmentof

youngpermanentdentitiondentaltraumasectionⅢ:injuriestotheprimarydentitionSectionⅣ:dentalinjuriespreventionprefaceatraumawithaccompanyingfractureofapermanentincisorisatragicexperiencefortheyoungpatient,theoralandemotionalhealthoftheyoungpatientisinvolved,andthechild,sappearancemustberestoredtonormalassoonaspossibletorelieve,gnosisoftraumaticinjurieshasimprovedsignificantlyinthelast20years,thishasbeenlargelyduetoagreaterunderstandingandknowledgeofpulpalprocedures.soweshouldcreateconfidencetotreatthedentaltraumainchildhoodandadolescence.Contents Tograsp:clinicalclassification,diagnositicevidence,therapeuticprincipleandmethodofDentaltraumainchildhoodandadolescence.Tobefamiliar:PredilectionageandtypeofDentaltraumainchildhoodandadolescence.Tracingandrestorationevaluationoftraumaticteeth.Toknow:Incidenceofanteriorteethtrauma.SectionⅠ:generalintroduction1.1definition.1.2epidemiology.1.3classification.1.4historyandexamination.1.1definitionchildhoodandadolescenceteethsuffersharptrauma,especiallycausedental,pulp,periodontiumtraumaduetobeatingandcollisions.1.2epidemiologyTable1dentaltraumaprevalenceinchildhoodandadolescence.agePrevalenceBoysgirlsFiveyearsgroup31-40%16-30%Twelveyearsgroup12-33%4-19%Fromthistablewecansee,boysareaffectedalmosttwiceasoftenasgrilsinboththeprimaryandthepermanentdentitions.Table2dentaltraumaincidenceinchildhoodandadolescencedentaltraumaincidencePrimarydentitionPermanentdentitionpredilectionage1-2years7-9earsaccountratio50%50-70%Table3clinicalcomparisontothePrimarydentitionandPermanentdentitionclinicalcomparisontothePrimarydentitionandPermanentdentitionPrimarydentitiontraumaPermanentdentitiontraumaDisplacementiscommonToothfractureiscommonIntrusion,extrusion,displacementMuturationofroot:crownfractureorrootfractureImmuturationofroot:mobility,displacement,extrusionAccount80%inPrimarytraumaAccount40-60%inPermanenttrauma1.3classificationAndreasenclassification(focalpoint)Ellisclassification(self-study)Lihongyiclassification（self-study）Table4classificationofthedentaltrauma(Andreasenclassification)Injuriestotheharddentaltissuesandpulpenamelinfractionenamelfractureenamel-dentinfracturecrownfractureswithpulpinvolvinguncomplicatedcrown-rootfracturecomplicatedcrown-rootfracturerootfractureInjuriestotheperiodontaltissuesconcussionsubluxationextrusiveluxationlateralluxationintrusiveluxationavulsionInjuriestothesupportingbonecomminutionofalveolarsocketfractureofalveolarsocketwallfractureofalveolarprocessfracturesofmandibleormaxilla,jawfractureInjuriestothegingivalororalmucosalacerationofgingivaororalmucosacontusionofgingivaororalmucosaabrasionofgingivaororalmucosa1.4historyandexamination1.4.1dentalhistory1.whendidinjuryoccur?thetimeintervalbetweeninjuryandtreatmentsignificantlyinfluuencestheprognosisoftrauma.2.wheredidinjuryoccur?mayindicatetheneedfortetanusprophylaxis.3.howdidinjuryoccur?thenatureoftheaccidentcanyieldinformationonthetypeofinjuryexpected.4.concussion,headache,vomitingoramnesia?braindamagemustbeexcludedandreferraltoahospitalforfurtherinvestigationorganized.1.4.2clinicalexaminationInspectionFacialswelling,bruises,mandibularmovementormandibulardeviationonopeningorclosingthemouth,crownfracture,mobilityPalpationandpercussionsensitivetopercussion，displacement，cinch，rootfracture，alveolarfracrute，andsoon.Pulpalexamination(reactiontosensitivitytests)Thermaltests,coldtests，electricpuiptests,neithernegativenorpositiveresponsesshouldbetrustedimmediatelyaftertrauma.1.4.3radiographicexaminationDivision:periapical,occlusal,orthopantomogramcrownandrootfracture,andtheircondition.alveolarandjawbonesfracrute，andtheircondition.conditionoftheperiodontaltissue.conditionofadjacentteethanddentalgerm.conditionofrootformationandabsorption.relationshipbetweenprimaryteethandsucceedpermanentteeth.iftherearerootabsorptionandmodustotheoldtrauma.sectionⅡ:Diagnosisandtreatmentof

dentaltraumaIntheyoungpermanentdentitionenamelinfractionandcrownfracturecrown-rootfracturerootfracturetoothluxationinjuriestoothavulsionprognosisassessment1.1crownfracture：itwasthecommonestinthetoothfracture,itwaspredilectedinincisalangleandincisaledge.Itwasdividedintomerelyenamelfracture，enamelfracturewithdentinexposed，crownfracturewithpulpexposed.1.1.1clinicalsituation:itwaspredilectedinincisalangleandincisaledge,anddentindidn'texpose.Treatment:Nodisposal.Grindingandpolishing.torestoreinthenearfutureforthesmallareas.torestoreafterviewingforthelargeareas.1.1.2clinicalsituation:dentinexposed,andtheyweresensitivetothecaloricstimulation,itwasessentialtopulpprotection.Treatment:Tookindirectpulpcappingtoprotectpulp.mobilitynotobviously:directrepair.mobilityobviously:repairtemporarywithComplexresin，thentorestorepermanentlyaftermobilityvanishing.modulateocclusion.follow-upreviewperiodic1.1.3clinicalsituation:.crownfracturewithpulpexposed,theyweresensitivetothecaloricstimulation,andaffectedtotakefood.itcouldbeinfectedandpulphyperblastosisifitdidn'ttreat.Treatment:Takedirectpulpcapping(itwasdifficulttosuccess).Takepalpotomy(rootimmaturating).…Takeapexification(rootimmaturating). Takerootcanaltherapy(rootmaturating).2.1rootfracture:itoccurmostfrequentlyinthemiddleortheapicalthirdoftheroot.wecandiagnosebyradiographandvaryingprojectionangle.2.1.1Itcanbedividedintothreetypescoronalthirdrootfracture.middlethirdrootfracture.apicalthirdrootfracture.2.toothmobility dentalcrownlengthenslightlyarticulationtrauma2.resettobrokenendsoffracturedroot.splinttooth(2-3mouths).eliminateocclusiontrauma.2.1coronalthird:extractthecoronalfragmentandretaintheremainingrootbyextirpategingiveandstripalveolarbonepartly.iftherootwasimmature,wecanTakeapexification,keeptheteethinterspace,andTakerootcanaltherapywhentherootwasmature,iftherootwasmature,wetakerootcanaltherapydirectly,thendrawrootoutofalveolarcrest,,thisisrootcanal-orthodontictreatment,clinicalprognosiswasworsemiddlethird:replacementandsplinting,itcanbefixedfor2-3mouths,thenreviewconditionofbrokenendshealingandpulpvitalityrecovery.iftakeplacepulpnecrosis,wecanadoptrootcanaltherapywhenbrokenendshealing,otherwiseweplaceretentionpostinrootcanal.apicalthird:prognosisisbetterthanotherrootfracture,iftherootfractureisalmostimmobility,wecanletalone;iftherearemobilityobviously,wecanfixit;iftakeplaceroottippathologicalchangesorcalcify,wecancommitapiectomyandroottipreversefilling.3.1Crown-rootfracture:enamel,dentin,caementumfracturesimultaneouslywhenteethtraumatakeplace,itcanbedividedintotwotypes:simplecrown-rootfractureandcomplicatedcrown-rootfracture.3.1..1clinicalmanifestationHorizontalfractureandverticalfractureHorizontalfracture:itiscommoninclinical，displaymed-distaldirection，dentalcrownlabialsurfacedrooppartly，lingualsurfaceconnectedwithgingivesometimes.itmaybetakeongingiveandpulpstimulusaching.verticalfracture:thereisonlysinglebandfracturelineusually,anditisfewinclinical.3.emergencytreatment:fixedtemporary.simplecrown-rootfracture:cementalrepair.verticalfracture:stickinesstreatment.Systemicaltherapy:Reparationafterremovingdentalcrownfragment.Removedentalcrownfragmentandassistgingivectomyandremovealveolarbone.rootcanal-orthodonticcombinedtreatment.4.1itcanbedividedintofivetypesConcussionsubluxationintrusion.Extrusiveluxationlateralluxation4.2ConcussionandsubluxationToeffectperiodontaltissueandpulptissuechieflyaftertoothtrauma,buttoothtissueIntegrityordisplaytobeenamelfissureonly,therearenoscleroustissuesdefectandtoothluxation.clinicalmanifestation:periodontaltissueinjury

pulptissueinjury

dentaltissueinjuryperiodontaltissueinjury： toothachingpain.bitingunwell.percussionunwellorsensitivetopercussion.radiograph：noabnormalitiesorperiodontalspaceswiden.pulptissueinjury：Recent-term:congestion,bleed,Sensorydeprivation. long-term:calcificchangeofpulp,toothabsorption.traumatickystis,rootparaplasia.dentaltissueinjury：EnamelinfractiontreatmentEliminateocclusiontrauma（modulateocclusion）Diminishoravoidirritation（refrainfromcaloricstimulationandbiting）Infectionprevention(takeanti-inflammatory)Dealwithenamelsurfaceinfraction（applyfluorinevarnish）Follow-upreviewperiodic(maybeoneweek,thenonemonthandsoon)4.3toothintrusionwhenoutsideforcecontributedteeth，theteethwereinsertedalveolarbone.clinicalmanifestationItwasshorterthantheadjacentteeth,andnomobility.Wepayattentiontothedifferencebetweentheintrusiveteethandthejusteruptiveteeth.Percussion:intrusiveteethtakeonlowanddeeptone，butthejusteruptiveteethpresenthighmetaltone.Radiograph:theintrusiveteethtakeonimagevanishingofperiodontalspacesandlaminadura.butthejusteruptiveteethprecentnormalimageofperiodontalspacesandlaminadura.treatmentroottipimmaturation:re-eruptedspontaneously.butwhentheapicalshadowandtheapicalrootresorptionhappened,weshouldextirpatepulp,thenapplycalciumhydroxidetoobturatietherootcanal.roottipmaturation:orthodontichook,gnosisOnlyroottipimmatureteethcanbevitalpulp.Rootresorption:roottipimmatureteeth:58%.roottipmatureteeth:70%.4.4lateralluxationandpartextrusionlateralluxation:whenoutsideforcecontributedtheteeth,theteethtakeonliguladislocation,distoversionandmesioversion.partextrusion:whenoutsideforcecontributedteeth,theteethpresenttobeprolapsedoutoftoothsocketandlengthenobviously.clinicalmanifestationDivergefromlongaxisoftooth.Teethcantakeonprolongation.Therearearticulationtraumabetweenantagonization.Radiograph:periodontalspacesvanishedinroottipdisplaceside，butperiodontalspaceswideninoppositeside，alongwithalveolarbonebreakage.treatmentReplacementinlocalanesthesiaWholedentitionocclusalpad,etchingsplintingororthodonticbracketretained2-3weeks,iftheradiographtakeonperiodontalligamentedgeunsharpness,wecanprolongretainedtimetotwomouths.Maintaindentalhygienemodulateocclusionreviewtakeradiographiftheexternalrootresorptionhappened:roottipmaturation:employdentalpulpextirpation,thenapplycalciumhydroxidetocontrolinflammation,wheninflammationvanished,wecanmakepermanentcanalobturation.roottipimmaturation:applycalciumhydroxideorvitapextoinduceroottipcontinuedevelopment.5.1toothavulsionwhenoutsideforcecontributedtheteeth,theteethprolapsedoutofalveolarbonecompletely.clinicalmanifestationItiscommonestinsingleimmaturepermanenttooth.treatmentreserveteeth:physiologicalsalineormilkorsalivaandsoon.cleantroubleteeth:physiologicalsalinesyringe，gauzerubgently，refrainfromscrapingroot.Sanitatetoothsockethole:physiologicalsalinesyringetoothsockethole.implantteeth:minimalstrength，replaceperfectly.Splintteeth:Wholedentitionocclusalpad,etchingsplintingororthodonticbracketfixed2-3weeks,thendemolishdevice,otherwiseitcanpromoterootresorption.Thetroubleteethrefrainedfrombiting.makeuseofantibiotics：systemicadministrationaweek.Dealwithimplantationtoothpulp:roottipmaturation:employdentalpulpextirpation,thenapplycalciumhydroxidetoobturaterootcanal.roottipimmaturation:reviewregularandtakeradiograph.Recheckperiodicly：reviewweeklyduringamouth,mouthlyduringayear,three-sixmouthlyafterhalfayear.SectionⅢ:injuriestotheprimarydentition1.diagnosisTherearethesamemanifestationasthepermanentdentition.Radiographicexaminationissimilartothepermanentdentition.buttherearedifferentbetweenthem.Duringitsearlydevelopmentthepermanentincisorislocatedpalatallysideandincloseproximitywiththeapexoftheprimaryincisor.withanyinjurytoaprimarytooththereisriskofdamagetotheunderlyingpermanentsuccessor.Displaceprimarytooth:iftakeonrootshorten,itindicateroottipdisplacetothelabialside,itisawayfrompermanentteethdentalgerm,onthecontrary,theroottipdisplacetothepalatalside,soitmustbeextracted.2.primarydentitiontraumaproduceseffecttotheinheritedpermanentdentition2.1anomalyeruptiontothepermanenttoothdentalgerm.2.2anomalyformationtothedentalcrown. 2.3anomalyformationtothedentalroot.2.4severetraumatotheprimarytoothcanmakethedentalgermnecrosisorstopdevelopment,andsoon.3.treatmentDisposalprincipleoftraumaticaldisplacementisthesameastheimmaturepermanenttooth.Whentheintrusivedisplacementhappened,weshouldidentifythedirectionofdisplacement,thendeterminewhethertopullouttheavulsedtooth.Weshouldn'textrudetoreplacetheIntrusivedisplacement,anddidn'treimplanttothetotalextrusivetooth.Ifthechildtooyoungtocooperate,wecanextractthetooth..dentalarchchangingissmall,becausetheanter