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Treatment of patients with dislocation of the tooth
03-09-2009
When incomplete dislocation of the tooth under conduction anesthesia should be carefully reponirovat it. At the same time his fingers have not only dislocated the tooth, but necessarily on neighboring and alveolar bone. It is necessary to prevent accidental breakdowns it in the opposite direction. The pressure on the tooth should be developed gradually and moderately, to not further damage the neurovascular bundle at the site of its entry in the apical hole. Proper conduct of repositioning can be defined by the absence of contact with the antagonist only reponiruemogo of the tooth. If it is determined, it is necessary to bring the injured tooth of occlusion. Reponirovat tooth more difficult, if the date of injury has been more than 2 days. The return of the tooth in the correct position prevents organizing blood clot in alevole. In this situation, you should first make a neat little lyuksatsiyu subsequent to reposition the tooth by the above method. In the case of treatment the patient for help in a few weeks, when the tooth is stronger in the wrong position, move it is only possible with the use of orthodontic appliances.
After repositioning spend immobilization dislocated tooth. It is better to use the bus Kappa from fast-hardening plastic. In the bus must include not less than two healthy teeth on each side of the dislocated tooth. Cutting-edge dislocated tooth exempt from plastic, that he felt no extra pressure. In addition, it allows you to control the viability of the pulp in the dynamics of the method elektroondontometrii. Shin impose a term not less than 5-6 weeks. The use of metal staples smooth tire-less preferable, as wire ligature when it is tightened, pushes the tooth out of the hole.
Before splinting in the first days after reposition and fixation of the tooth should be checked electrically pulp. Then it is done repeatedly in the process of treatment. Lowering or even absence of electrically not only during the first days, but weeks after the injury is not evidence of irreversible changes in the pulp of the tooth. Restoring normal life of the pulp may be in a few months. According to V. Gimzhauskene (1968), in 59,2% of the electrically restored to normal in 16.9% and remained low at 23.9% declined more or not determined. The author of the study were repeated over 5 months to 5 years after injury.
When clinical signs of the death of its pulp is removed, and the canal of the tooth sealed by conventional methods. Otherwise, can develop severe periodontitis, subperiosteal abscess, fistula is often formed. Acute process in periodontal usually subsides and becomes chronic. In the case broke off a wall of the alveoli dislocated tooth and its subsequent sequestration occurs and progresses to periodontal inflammation, which may ultimately lead to precipitation of the tooth.
Perhaps the root of the coalescence of the injured tooth with a wall of the alveoli. After partial dislocation can not exclude external root resorption, which is not progressing. Severity is determined by its degree of displacement of the root of the tooth. The greater the distance, the greater the surface exposed root resorption.
In the case of complete dislocation of his early posttraumatic period, ie no later than 2 days after the dislocation, the only way to cure a replantation of the tooth. Carry it should not be at the destruction of the walls and holes which began inflammatory process, with periodontitis, expressed a dislocated fracture of the tooth. The sooner the replantation spend, the more hope for a positive result. The process of root resorption in this case less pronounced. Replantation conducted by conventional methods. Luxated tooth was washed in isotonic sodium chloride solution with antibiotics. J. Jacobcen (1981) recommends that you keep it in milk, osmotic characteristics of which are optimal for the tissues and cells available on the root surface of teeth. While working for the hold the tooth crown and root portion continuously moisturize. The experiment proved that the teeth with dried roots acclimatized worse. If the date of injury was not more than 10 hours, can be replanted luxated teeth without removing the pulp. In this case, trepan tooth to remove the pulp within 2-3 weeks after replantation, when there are signs of engraftment and restoration of the functioning of the pulp according to elektroodon-tometrii no. After extirpation of the pulp canal should not handle potent drugs and antibiotics. Temporarily, you can fill in calcium hydroxide, which to some extent prevents root resorption. He was later replaced evgenolovoy paste.
If the tooth had been outside the mouth for more than 10 h, the pulp is removed from it, and feed after appropriate treatment of sealed phosphate cement with a steel pin [Chuprynina NM, 1993]. After resorption of the root resorption due to the pin with phosphate cement around it keeps the tooth in the hole, preventing mobility and loss of it. When replantation of the tooth with a dead pulp shows resection of the root to remove branches from makrokanala. However, some authors do not consider mandatory resection of the root, giving greater importance to quality of obturation of the canal. In the process of root resorption is not affected. Before the introduction of the prepared tooth in the last hole is washed with isotonic sodium chloride solution, but it does not scrape the wall. According to VV Roginsky, VA Kozlov (1987), more favorable results of replantation marked while maintaining periodontal fragments not only on the root surface, but also on the walls of the hole. The tooth should be removed from the bite, to fix the plastic tire-kappa, if he has the mobility of II degree or not the neighboring teeth. Read the tire in 3-4 weeks.
J. Jacobsen (1981) recommends that the immobilization of a tooth in 1-2 weeks. In his view, a more long-term immobilization increases the risk of exchange resorption. If, after the introduction of replantiruemogo tooth in his lower hole mobility of II degree, splint should not be, because it attaches to the root of a forced situation, resulting in fusion of the root cement with the wall early resorption of the alveoli and his [Kozlov VA, Akhmedov AA , 1965]. This recommendation is competent for both the multi-root, and for one-root tooth. Lack of immobilization slows bone resorption [Odinets EV, 1963; Kozlov VA, 1964].
Elektroodontometriyu nedepulpirovannyh replanted teeth spend a few months after the operation, as the nerve fibers recovered only slowly. X-ray control in terms of 1 to 12 months after replantation can judge the state of the root of the tooth, periodontal and bone.
According to VA Kozlov (1964), depending on the degree of preservation of periodontal fibers are three types of seam alveoli walls with root teeth: periodontal, periodontal-fibrous and osteoid. Periodontal type of seam can be in a good (in sufficient quantity) maintaining periodontal fibers on the root of the tooth and the wall of the alveoli. He is the best. On x-ray can be traced periodontal gap and clearly defines the boundary of cortical alveoli of the plate. When the periodontium is saved only at the root or the wall of the alveoli, there is periodontal disease of the type of seam. On radiographs periodontal slit width is uneven with sections of its complete absence. If periodontal tissue is absent and the root, and on the walls of the alveoli, there is a type of osteoid seam, when the radiographs periodontal gap is not defined.
After replantation root resorption always happens: inflammatory and metabolic resorption. Inflammatory resorption develops in the early stages after replantation (after 6 – 8 weeks) as a result of inflammation in the surrounding tissues. It is accompanied by a development of pathological dentogingival pockets and tooth mobility, which leads to its loss. The cause of progressive motility is the tooth root resorption and the walls of the alveoli. Usually there is exchange resorption – temporary or permanent. Temporary stops spontaneously, permanent – a slowly progressing. The reason for the exchange of resorption is not clear, however, compliance replantation technique reduces its intensity. The sooner an operation, the slower the exchange proceeds resorption. The best results were obtained during replantation within 20-30 min after injury. When the type of osteoid seam resorption occurs early and proceeds rapidly. On x-ray at an exchange rate of resorption of periodontal gap is absent, and in the root determined Uzury filled with bone tissue. Clinically, the tooth retains sufficient stability due to seam remnants of the root with bone alveoli. Removing a tooth due to technical difficulties on the above reason.
Treatment of impacted dislocation presents certain difficulties. Published data on the issue ambiguous. There is an opinion about whether a delaying tactic, designed for spontaneous nomination of impacted teeth. This practice is more justified when vkolachivanii milk incisors: the nomination of the tooth contributes to ongoing formation of the tooth root, if it does not sprout area was lost due to injury. In a shallow vkolachivanii tooth (the crown of the alveoli will hold not less than half) is sometimes possible to observe the spontaneous nomination and permanent teeth, especially at a young age, when there was over the formation of the root zone and there is a sprout. This «re-eruption» coincides with the end of the formation of the root. The first signs of spontaneous nomination of the tooth can be observed already after 1 – 1.5 weeks after injury, at least in 4-6 weeks. In the case of signs of acute inflammation must trepan tooth and remove necrotic pulp. Root resorption also occurs, but it is less intense than in the replantation. Little hope for the possibility of a tooth in his deep vkolachivanii, the inflammatory process, develop after trauma, chronic inflammation in the periapical tissues to injury. Some authors offer immediately after injury to produce reposition impacted tooth and its fixation for 4-6 weeks.
The results of treatment better if reposition held on the day of injury. However, they are encouraging and with the intervention of up to 3 days after it. This manipulation is still accompanied by the loss of marginal land alveoli and root resorption, which resembles a per se in replantation of the tooth. Trephine crown of the tooth and removing the collapse of the pulp should be done after the consolidation of the tooth in the hole. In some situations, it is recommended to nominate impacted teeth using orthodontic appliances. This is possible with shallow introduction of the tooth into the bone, when stood above the gum of the crown technically allows to fix her orthodontic structure. In the case of ankylosis (fusion of the root of the tooth with the jaw bone) orthodontic device is not always able to break it. Therefore reasonable to make preliminary lyuksatsiyu tooth tool to destroy the connection formed between the root and the bone cement.
Deeply impacted teeth sometimes pull surgical techniques to create a more acceptable conditions for the imposition of orthodontic apparatus. It is believed that the nomination of orthodontic tooth should begin immediately after the injury, because it prevents the development of ankylosis, manifestations of which have distinct 5-6-th day. Such tactics, in addition, reduces the frequency of root resorption. NM Chuprynina et al. (1993) argue shown orthodontic treatment for children no earlier than 3-4 weeks after injury.
In the treatment of dislocation of the impacted tooth is sometimes removed with subsequent reimplantation. Earlier held replantation, the later coming root resorption. Such tactics are justified if the tooth is under the mucous membrane of the maxillary sinus or floor of the nose, the soft tissues of the vestibule of the mouth, the body of the mandible, or you can trepan crown of the tooth, and inflammation is increasing. The following removal of impacted tooth without replantation at-developed ankylosis and in case of significant injury alveoli – the turn of a wall.
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