Surgical Stomatology

By Dr. Vishaal Bhat on Friday 28 December 2007 with 0 comments



The most common dental surgeries of children’s age is tooth extraction. It is performed under a surface or injection anesthesia. Temporary teeth with highly resorbed root may be extracted without an anesthesia. Among frequent surgico-conservative treatment of permanent teeth belongs root canal therapy that is practiced at teeth with radicular cysts or granuloma, eventually in case of the apification method failure. Injuries of temporary and permanent teeth represent a separate topic, described below. In case of temporary dentition, sub-luxations or luxations of teeth are quite often seen. Rather than hard teeth tissues, a tooth socket that is still highly elastic, is affected upon an impact.

Injuries of the temporary dentition periodontal ligament.

The slightest and prognosticativelly most favorable injury of the dental supporting apparatus is contusion. At this injury, a mushy food is recommended and the dental pulp vitality is checked periodically. In case of the pulp necrosis, therapy should be applied according to principles of restorative stomatology with respect to the stage of development of the root. Sub-luxation is a common temporary teeth injury. A slight sub-luxation requires the same therapy as contusion, more severe cases require repositioning of sub-luxated teeth followed by immobilization with a fixed splint. An increased care of the dental hygiene and a pulpy food are recommended. If the pulp of sub-luxated teeth looses its vitality, therapy should be applied according to principles of conserving stomatology. In case that injured teeth has to be extracted, a gap is replaced with a removable denture. Luxated temporary teeth must not be replanted. There is a danger of damaging permanent teeth germs; the younger a child, the higher the danger. A special kind of luxation is repulsion (intrusion, central luxation) which occurs after an impact at a longitudinal tooth axis and causes partial or total immersion of a tooth to the alveolar ridge. Upper incisor teeth are mostly prone to this type of injury while it is rare for teeth of the lower jaw. This condition does not require any therapy since intruded teeth usually erupt again during 2 - 4 weeks. Teeth should be extracted only if they are intruded into nasal cavity or if they could harm the permanent tooth buds. Resulting gap should be replaced removable dentures (space-maintainers). Fractures of temporary teeth crowns that do not expose the pulp chamber should be treated similarly as a corresponding injury of permanent dentition. If the pulp is exposed by an injury, a therapy is applied with respect to a stage of development of the tooth. Teeth with advanced root resorption should be extracted. In case of a fracture in the middle third of a root, teeth should be fixed by a splint. Fractures of the apical third of a root are mostly treated by grinding that just excludes an affected tooth from articulation.

Consequences of temporary teeth injuries.

A coloration may occur at affected teeth, their vitality may be preserved, however. More often, discoloration is a sign of the dental pulp necrosis. A rare consequence of an injury is the pulp chamber obliteration or internal root resorption. After heavy sub-luxations, an accelerated root resorption, a temporary tooth position change, eventually its delayed exfoliation, may often take place. Long lasting teeth mobility, post-accidental gingivitis, denudation of the cervix or root of a temporary tooth may be further consequences of an injury.

Consequences of permanent dentition injuries.

Bearing in mind that a permanent tooth development takes about ten years, during which formation and mineralization of the enamel, dentine, and cement takes place, a root is formed and teeth gradually erupt, permanent teeth change their positions relative to their temporary predecessors, we can not be surprised by a number of various possible defects of permanent dentition. Mechanism of an injury may lead to a permanent tooth crown fracture, to a tooth germ position change or its complete shattering. Permanent teeth defects are more prominent after their eruption. The crown or the root part of a tooth, its pulp, or sometimes the whole germ may be damaged. Defects of teeth eruption are not all that sporadic. Injuries of permanent teeth with completed root development should be treated the same way as in adult patients. At incompletely developed teeth, we have to consider a stage of the root development. Luxated teeth should be replanted in all cases where the gap needs to be preserved. If it would be more suitable to compensate for a lost tooth by an orthodontic movement, we do not perform replanting and the sub-luxated teeth should be extracted as well.

Category: Restorative Dentistry Notes

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