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April 10, 2015 Dave Matthews – Open Lecture – Hilton Garden Inn Outline-Notes 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 o 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