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90 comments:
There was a lot about the various Tx options for the different classes of fractures, but the thing that stuck out to me was the importance of performing a proper evaluation prior to 'fixing' the tooth - Hx of injury, assess other possible head trauma, EOE/IOE, vitality testing, hard/soft tissue injury, etc.
Sean Young #192
CVEK procedure works only if the fracture has been less than 2 days with small pulp exposure and no complication. It can actually help to form permanent teeth completely so that adequate treatment (ex endo) can be done later.
Sonia Lee #145
The best restoration for uncomplicated anterior tooth fractures is the celluloid crown form. For the most esthetic results 1mm of incisal light shade should be put in first, followed by the body color composite.
Orly Hendizadeh,#134
Use the Cvek Procedue: if the tooth is fractured and there is a pulp exposure that is small. Also the fracture must have occured within less than 48 hours.
Also I have learned that the Celluloid Crown form is the recommended crown form for restoring the fractured crown since it can stand a lot of pressure.
Karen Li #146
In the Cvek procedure, the small pulpal exposure is opened 1-2mm with a round bur, rinse with local anesthesia to establish a clot and fill with MTA or light-cured composite. Save a broken piece of tooth and bond it back on.
Jing Lee#144
I was really surprised to see that SSC's and basket crowns can be indicated for anterior teeth, and to actually see what it looked like on a patient just made my visualization of what it would look like a reality...poor kid, how is he going to grow up normal after that? I guess in pediatrics, esthetics is a nonfactor...?
Sean Nguyen, #160
Before placing composite in the maxillary anterior teeth make sure to take the shade before any kind of isolation is placed( rubber dam or cotton roll). Child abuse is the 2nd most common etiology of dental trauma in preschool child.
Heidi Gonzalez #526
The best way to restore a fractured tooth is using the tooth fragment which must be re-hydrate before re-attaching.
Claudia Rodriguez #531
There are 4 Ellis Classifications for fractures:
Class 1: Enamel fracture only.
Class II: Fracture involving enamel and dentin.
Class III and IV:
As Class II, with pulp exposure.
Regina Espinoza #126
Uncomplicated tooth fractures are more common than complicated fractures among school age kids because they have soft bone and their teeth are not fully erupted.
Tina Duong #125
Look for signs of Intracranial injury, like Nausea, vomiting, loss of conciousness.... after a dento-facial injury.
Difference between Ellis class 3 & 4 is that class 3 is a diagonal fracture while class 4 is horizontally across the tooth. Both cause pulp exposure.
Dilshad Abtin #524
Jonathan Do #121
When restoring uncomplicated fractures the celluloid crown form is considered one of the quickest and easiest ways to restore the tooth.
When a patient presents with a chipped tooth, review their general health first. Be sure they respond properly, aren't dizzy etc. and then proceed with fixing the tooth.
Ryan Plewe
#168
The Cvek procedure is indicated in a complicated crown fracture, which has a small exposure size and has occurred in less than 48 hours.
Joanne Kim #140
Uncomplicated tooth fractures are very common for school age kids because they have soft bone that will give and be more flexible than teenage bone and the teeth are not fully erupted.
Don't use CO2 snow on partially erupted incisors!
Steph Morphis #154
We use Andreasen classification, but still need to know Ellis classification because it may shows up in journal from time to time.
When restoring anteriors composite crowns, dont make it a flat plane, but create some grooves to make it more natural.
Eric Cheung #110
If a parent calls you saying that his or her child fractured his front tooth, have the parent find the fragment if possible and keep it hydrated in milk or water.
Emmy Le #142
It’s important to examine the entire head and neck area during trauma situations. Some problems can become exacerbated if these injuries are not detected and treated.
-Carol Kim (138)
It's interesting to learn that dental injuries cost us $8 million a year to treat.
Kim Pham #167
Fractured fragments of teeth can be reattached provided they are hydrated.The best medium to store it is milk.
Asha Sethu-Madhavan #532
Restoring with tooth fragment can be an effective tx when it is dine right.
Jeff Kim
139
This is the first that I recall learning how to classify tooth fractures. In class we were given a couple methods to do so.
Marc Thomas #182
If the trauma is complicated then it involves the pulp and the CVEK proceedure is indicated. From there on the way to treat the tooth is the same as uncomplicated, in which you place a GI liner and then a SS crown.
Shannon Lazarian #133
Before treating a traumatic tooth, we sould EOE IOE and treat the tooth depending the degree of fracture. Uncomplicated fx is not invloving pulp while complicated have pulp involvement.
Tiffany Hsu #529
Magic Minute
I thought that the most interesting thing that I learned was that you should not test recently errupted teeth with endo ice or icecubes because newly errupted teeth have very high water content and cold testing them will lead to craze lines in the teeth.
Michelle Duong #123
Considering using a celluloid crown when restoring an uncomplicated fracture on an anterior tooth.
It was interesting to hear about a Dr. X rebuilding a primary tooth using various shades and layers of composite to accomodate dentin and enamel color, and tooth morphology.
Ernest Lai #141
Emergency treatment options for an uncomplicated crown fracture include: orthodontic band, basket crown, stainless steel crown, and etch & seal.
Kevin Omoto
#163
IN order to maintain the viability of the tooth fragment / PDL cells it is best to leave a fragment of tooth in milk. Also, it is possible to re-insert the fragment of the tooth if it is done wthe proper technique
Neilesh Patel
#165
It is very important not to use CO2 snow on immature or partially erupted teeth because they have high water content and that may lead to craze lines in the tooth structure.
Bozhena Fisher #128
Most common fractures are uncomplicated ones (no pulpal involvment). # of complicated fractures are higher in teens and adults than younger children.
Stacy Yu #193
That a fractured tooth can be restored using the hydrated broken tooth fragment if found.
Steve Kim, #528
the best restoration for a chipped tth is using the chipped tooth fragment itself
Catherine Do #122
What i felt interesting and learned is you can use composite bone the broken fragments of tooth together and tooth still function.
Lei Zeng, #535
Parents should bring fragments of fractured teeth in a medium of milk (preferably) or water to the dentist for the restoration. If the tooth is dry, it should be re-hydrated before attaching it back.
Sanam Soroudi
#180
Although it was sad to have my magic moment at the time that I did, but I liked to learn of the ways that we can detect child abuse as a dentist. It stinks that little ones can get hurt by others, but it is pretty cool that we could potentially save their lives by stopping abuse.
I also learned that, unlike other facial fractures, nasal fractures are not too be palpated too much because they hurt like crazy. I thought that all fractures would hurt horribly...but this one was named in class as one of the most painful ones.
-Raquel Ulma #188
A deciduous tooth that is intruded will often re-erupt. You can also extract it, but leaving it alone (no treatment) is not a contraindication.
Paredes #164
Cvek procedure is utilized in cases of complicated tooth fractures when there is small pulpal exposure and within 48 hrs of traumatic episode. When restoring fractured incisors 2mm or more of bevel in the enamel is necessary to create esthetic restorations.
Edvin, #100
Fractured tooth fragment can be reattached provided it was being hydrated in milk (best medium).
Second most common reason of dental trauma in preschool kids is child abuse!!!
Alina Tiraspolskaya #183
The Cvek procedure (partial pulpotomy) can be performed for complicated injuries, but the trauma must have occurred less than 48 hrs ago and the pulp exposure must be small. The procedure includes opening the exposure with a small round bur to 1-2mm, establishing a clot with local anesthetic, washing, and filling prep with light cured calcium hydroxide or MTA. Note: protection with Dycal or GI base is no longer indicated for this procedure
-Jeanne Wong #195
In children:
1) watch out for amnesia, alertness, nausea and vomiting...may be signs of head trauma
2) there are 2 types of classification schemes for fracture: Ellis and Andreasen
3) celluloid crown form can be used to restore crown fractures
Jun Flores #130
Socket is the best place for tooth transportion, Cold milk for < 6 hours and saliva, saline or water: < ½ hour.
Soheil Yashari #191
fbest transportation medium for fragments of fractured teeth is saliva, milk or water or saline,rehydrate a tooth fragment before reattching .
poonam rai#530
When restoring anterior teeth, use a lighter shade of composite on the incisal edge, and fill the crown with a body shade.
Matthew Moadel #151
From Dr. D I learned that with school-age children the majority will have uncomplicated crown fractures, however preschool and younger the tooth will usually come out b/c the bone is so much softer.
Morris Poole #169
If you have a complicated crown fracture with a small pulpal exposure and it has been less than 48 hours since the trauma happened, the best material to use to cap the pulp is light color MTA.
Paul Hoang #135
Ellis classification of tooth fracture:
Class I: enamel only
class II: enamel + dentin
Class III + IV: Enamel + dentin + pulp exposure.
Naomi Nguyen
#158
The best restoration for a tooth fracture is the tooth itself so try to save it in milk or water to keep it hydrated.
Josh Cardwell #108
The CVEK procedure is performed within 48 hours of a fractured tooth with a small pulp exposure.
Shelton Chow #111
Ellis class III and class IV are tooth fractures involving the pulp in a horizontal or diagonal direction, respectively. And,
the best way to restore a broken tooth is to use the fractured off part. For this, DBA is placed on both surfaces to be reattached.
J.Oka #162
It is best to perform an EOE and IOE before restoring a fractured tooth on a child. Ask the parents if they have the broken fragment of tooth; if they don't, it might be wise to look in any soft tissue lesions before suturing them.
Cristen Dismuke #118
Natalie Nguyen #159:
For complicated crown fractures, use the Cvek procedure (partial pulpotomy). Its indications include a small exposure that is less than 48 hrs post-trauma. Use a small round bur or diamond to open cavity, establish clot, wash, then fill prep only with light-cured calcium hydroxide.
Fractured crown fragments can be hydrated & bonded back into place. The fracture line can be camouflaged with a feathered bevel, using a diamond bur, 1/2 way through the depth of enamel & matched enamel composite.
If you're really good, you can use your finger as a lingual matrix if the factured portion is lost.
Austin Tung #187
Tooth fractures can be classified by whether they involve enamel, enamel and dentin, or enamel, dentin and pulp.
Robert Busan #107
The CVEK procedure is used on fractured teeth with small pulp exposure.The fracture should have occured less than 48 hrs ago.
Amandeep Iqbal
#527
The Cvek procedure is indicated with new fractures and small exposures and allows for complete root formation.
[Colby Smith] #178
Is very important to select the shade of the composite before placing the rubber dam.
Celluloid crown are the best obtion for uncomplicated anterior crown fractures.
Following dentoalveolar trauma in a child, be sure to examine the head and neck area and take a complete history of symptoms to rule out the need for head injury txt.
Diana Craft
115
A rubber dam should be placed before any shade is picked for a anterior composite restoration.
Mihir Shah
175
child abuse is second most common cause of dental trauma in preschoolers. Transport chipped or avulsed teeth in milk.
Farshid Siami #177
CVEK procedure indication: 1.fracture has been less than 2 days
2.small pulp exposure
Jan Slapnicka
#533
I learned that there are 4 different Ellis classifications of teeth fractures. Class 1 is an enamel only fracture, class 2 includes enamel and dentin, and class 3 and 4 includes enamel, dentin, and a pulp exposure
Amy Dixon #120
Do not use CO2 snow for diagnosis on partially or newly erupted incisors because there is a fairly high water content that will freeze and result in craze lines throughout the tooth.
Richard Duong #124
In cases of fractured teeth, it is important to bring in a fractured off tooth fragment to possibly reattach it to the remaining tooth. The pt/parent should keep the tooth hydrated, preferably in milk
When restoring a fractured tooth, shade selection should be made prior to placing a rubber dam, or cotton-rolls, or anything that may have a negative effect on shad selection. Great results can be obtained using the piece of fractured tooth if possible. If the fractured piece hasn't been kept well-hydrated, re-hydrate it prior to bonding it.
Jared Martin #147
When doing pulp testing, make sure not to put Endo Ice on a newly erupted maxillary incisor because it can cause craze lines that will persist over the life of the tooth.
Will Traynor #186
The Cvek procedure is indicated in situations of small pulp exposures and less than 2 days.
Ernest Lai #141
in order to achieve a good color match with composite restorations, different shade composites need to be applied in layers to match the dentin and radiolucent enamel.
Pedram Sooferi
#179
1. I learned about Cvek procedure
2. The Andreasen clasification: non-complicated and complicated tooth fractures
3. Use the fractured piece and bond it to the remained tooth structure
Cornel Crasnean #525
For pulp exposures in kids, MTA works best...and if you're here at UCLA you can use as much as you want. In the real world, however, there are less expensive options that are also acceptable such as CaOH compounds.
Rick Shamo#176.
I was surprised to learn that chipped teeth can be restored by simply cementing the chipped frament back into place.
Avoid using Endo Ice when evaluating vitality--there is a strong risk of creating craze lines because of the higher water content of newly erupted teeth.
Jared Lee
#143
When presented with a case of dental trauma, you must first address the patient's overall health status, especially neurological symptoms which may not be immediately evident.
When presented with a case of dental trauma, you must first address the patient's overall health status, especially neurological symptoms which may not be immediately evident.
#173
Brandon Seto
The Cvek Procedue is used when the fracture is extensive and there is a pulp exposure that is 1-2mm, make sure to re-hydrate the broken down peice as well.
Sanaz Hamzehpour #132
The celluloid crown form is best for anterior crown restorations.
Fractured pieces of teeth can be bonded back in place instead of placing an entirely new restoration.
CO2 on immature teeth can create craze lines.
Chris Claus
113
Using tooth fragments and attaching them can be very esthetic as well as fabricating a tooth's crown from scratch.
Nick Quach #170
It was interesting to know that if you keep the chipped/ cracked tooth hydrated eg milk that it could be reattched.
Azadeh-Ahmadi Ardakani #101
I learned about the ellis classification system and that broken fragments of tooth structure can be recemented when the fracture is uncomplicated.
Alex Molayem #152
A chipped tooth can be restored with its own fragment. I have actually seen this done at the UCLA CDC.
Varo Boyajyan #106
When a pedo patient presents with a broken tooth/teeth, if you think it's restorable follow these steps --> hydrate the fragments, acid etch fragments and tooth, place a hybrid layer and bonding agent, position the fragment and cure it. Then use a football diamond and bevel the fracture line 1/2 into enamel. Finally place enamel shade composite and polish it.
-Dave Tajima #181
To achieve the most natural and esthetic look for the anterior celluliod crowns, put in the light incial shade first, then the composite. chen 109
If a tooth is chipped, look around for the fragment because it can be bonded back to the tooth. When done correctly, you shouldn't be able to see the fracture line.
Broc Mushet #156
You can restore a fractured tooth with the natural chipped portion, but make sure a tooth is stored well. The absolute best medium is saliva, BUT it's tooth risky the patient might swallow it, so go with milk.
Jake Cragun #117
Immature teeth, or those that are not fully erupted, have high water content. This could subsequently lead to the development of craze lines upon application of CO2 snow. Therefore, it is contraindicated to use CO2 snow on these teeth.
Dissanayake #119
The best restoration for uncomplicated anterior tooth fracture is celluloid crown form. It is important to select the shade before you isolate with the rubber dam. It was interesting to note that also, you can use stainless steel crown in the anterior as well.
Azadeh Ahmadi-Ardakani #101
It is important to rehydrate a tooth fragment before attempting to reattach it.
Trish Barsanti
#105
When a tooth has been fractured, a method of preserving the fractured piece is to place it in water or milk, with the best medium being milk. This way, they can be reattached most effectively – since the best treatment for a fractured tooth is to restore it with itself.
Enayat Astani #308
In order to use the CVEK procedure...the trauma must have occured at most 48 hrs prior.
Niki Zarabian #194
For the most esthetic tooth colored temporary crowns, place ~1mm of incisal shade acrilic/composite before filling the remainder of the celluloid crown form with body colored acrilic/composite.
Sydon Arroyo #102
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