Download Lecture Notes - Montana Study Club

April 10, 2015
Dave Matthews – Open Lecture – Hilton Garden Inn
Outline-Notes
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Strategies for Treating Traumatized Teeth in the Adolescent and Adult Dentition
o First person who tx patient is most important – least invasive, most conservative
treatment is usually the best
 Should avulsed be implanted in adolescent?
 Yes, but needs close monitoring for ankyloses (at least 6 months)
o If obviously ankylosed, better to extract early, during growth
and development (because ridge will not develop normally as it
should, with an ankylosed tooth in place)
 Sooner implantation occurs, less likely chance of ankyloses (best chance
is within 1 hour).
 Rinse tooth only if there is dirt on it, do not scrub
o Soaking in 1% doxycycline solution
o for 5min
o Soaking in 4% NaF for 20 min may be beneficial (Dave believes
that getting it back in the mouth ASAP is preferred)
 If teeth have been moved, do you best to reposition them
 If teeth are in the socket at time of trauma, avoid doing endo as long as
possible, unless they are symptomatic, or infected
 If tooth is ankylosed, what are some strategies
 Extract/ Graft
 Do Nothing/ Monitor
o If root resorption is occurring (without inflammation), this is
nature’s bone graft.
 Decorination (cut the crown off 1 mm below bone, and hollow out
inside to allow blood in – remove all GP if present) – this is usually not
recommended
o May not do anything, because the tooth is still ankylosed
 Bone usually will not grow coronal unless tooth is totally
resorbed
 Transplantation - *** Best*** over 90% successful
 (but very technique sensitive)
o Best done at age 11 – usually a lower premolar with root 2/3
developed)
 Can be done immediate or delayed
o Does not ankylose
o Alveolar process continues to develop
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Usually don’t require endo – if done properly, root will continue
to grow and mature (very important to not damage follicle)
 Full root development (outside ideal window) , often
will require endo due to loss of vitality
 If tooth not ankylosed, but not retainable long term
 Burial (sleeping a fractured root)
o A great option for bone preservation, until age is appropriate
for implant.
 Orthodontic site development
o Positioning all other teeth ideally, and allowing full eruption to
ensue
o Mesializing canines, laterals in to edentulated sites
Removal of pigmentation and amalgam tattoos
o Inside out removal
 Make pouch
 Harvest very large CT graft and place in pouch (to thicken up tissue)
 After healing of graft (4 months), make flap and grind amalgam out of inside of
tissue
o Coverage over outside with an FGG on outside. (Not done commonly now)
“Hopeless” teeth
o Strategies for managing vertical gingival issues
 Ortho extrusion may be the only option in some cases with significant bone loss
 Grafting considerations
 Extraction is sometimes the worst thing you can you, because there is no
predictable way to manage tissue
o Root resorption
 Even when it looks significantly progressed, they often last for many years with
no problems
Etiology and Treatment of Gingival recession
o Tooth Position
o Thin Periodontium
o Abrasion/Erosion
o Calculus
o Frenum Pull ? (Matthews does not think this is a major factor)
o Restoration/clasps
Implant margin stability/repair
Pontic site augmentation
Interdisciplinary treatments using ortho, perio, restorative
Rescue cases using pediculated connective tissue grafts
Discussion of cleaning implants with hygienists
Bone Level vs. tissue level implants