sms vragen en antwoorden - NVvE

Dus wij gaan weer naar extension for prevention?
De Black onder de endo' s.
Voor zover ik de vraag goed begrepen heb: we offeren wat occlusaal
glazuur op om dramatische onbehandelbare gevolgen van barsten te
vermijden

How thick should the overlay/ onlay on a cusp be?
Follow the prostethic /restorative guidelines: gold needs less grainding
down than composite or porcel.

Maak je bij overkappen onderscheid tussen
dragende/niet dragende knobbels?
In geval van knobbelbreuk is het antwoord duidelijk: de aangetaste
knobbel. In alle andere gevallen integraal, en na endo eveneens

Restauratie met composiet langetermijn zonder en met
knobbeloverkapping uitkomst?
Het is me niet direct duidelijk wat hier met uitkomst bedoeld wordt:
overleving restauratie? Overleving pulpa? Overleving kies?

Denkt u dat door het gebruik van rotaries en het feit dat die bewezen veel
microcracks induceren, meer verticale fracturen
na endo ontstaan dan voor.
Goede vraag, waarop ik het antwoord voorlopig schuldig blijf. Het is me
vooralsnog niet duidelijk in welke mate de door onderzoekers o.a. Paul
Wesselink gerapporteerde cracks in wortels als gevolg van het gebruik van
rotaries relevant zijn

Uit de restauratieve kant blijkt een partiele adhesieve onlay een goede
behandeloptie, echter failures met name voorkomen
bij endodontisch behandelde.
Sorry maar de vraag is me niet direct duidelijk

Amalgaam in een kleine occlusale vulling. Van van binnenuit expansie
(corrosie) veroorzaken en dentine uit elkaar drukken.
In hoeverre is dit de oorzaak.
Zoals tijdens de presentatie vermeld is men voor kleime occlusale restauraties op
mechanisch gebied zeker beter af met composiet. Of corrosie de oorzaak van
mechanisch falen zou zijn betwijfel ik. Veel grotere rol wordt gespeeld door de
verhouding tussen de omvang van de restauratie en wat er nog aan gezond weefsel
overeind staat

Is the www.dentaltraumaguide.org
website useful?
Yes – very much so

I was under the assumption that not the overjet but more the motor skills
have an effect on dental trauma.
The overjet seems to be a significant factor in dental trauma, motor skills to
lesser detree

What is the purpose to register a young patients weight at intake after a
dental trauma?
VERY good question, the younger patients tolerate less amount of
medications, most often the safety limit is based on their weight

Is there no risk with immediate cold testing to increase the pulpal
reaction,cq provoking necrosis in the end: might it be
better to test a few days later?
There is no risk, several studies with CO2 snow have shown no effect on the
pulp upto 1 minute exposure

What is the most approppriate solution to rehydrate a fragment in case of
uncomplicated crown fracture?
The study I quoted used water, but saline should be fine as well

Where do you rehydrate a piece of enamel/tooth after trauma which you
want to place back?
Just place it in a cup of saline or water

Biodentine for direct pulp capping?
I do think it is good, we do though need more studies

Why no MTA for direct pulp capping?
Two reasons, cost and danger of discoloration of the crown

For direct pulp capping self etching adhesive was tested. Whats about three
step etch and rinse systems? Also bad influence on pulp vitality?
Unfortunately the same, bad effect

Do recommend local anesthetic before taking radiographs?
Yes in most cases the patient is starting to feel pain and for pt.
management reasons it makes them more receptive of vaiting, etc.

What is saline?
Professionally made salt water, with physiologic osmolarity

Are antibiotics neccesary in the treatment of avulsion?
Difficult questoin, they will not hurt in the sens that they migth reduce the
baceraload and thereby help healing but it is not clear if antibotics
reduces root resorption

Can you please repeat THE mail adres
as7253@NYU.EDU

How do i know from the photo if the internal absorption is inflammatory or
not?
By nature a true internal root resorption is always inflammatory, there is no
way to tell from a radiograph, only by removing the tissue. Different
horizontal angulations should confirm if it is external or internal.

What is your treatment proposal for an avulsed tooth lost for some
minutes in a chlorine swimmingpool?
Unfortunately the chlorine in swimming pools is very bad for the periodontal
ligament cells. If the tooth was only in the pool for few minutes the protocol
is the same. If the tooth was in the pool for long time it should be
treated as tooth with dry time more than 60 min.

Could u replace caoh2 by a permanent root canal filling to stop
inflammatory root resorption.
No, if there is inflammatory root resorption, there is a bacteria or bacterial
byproducts in the dental tubil and that has to be neutralized. Ca(OH) 2 will
do that, a root canal filling material might but without any consistency and
therefore we do recommend Ca(OH) 2 for at least short time of few weeks.

Are there any studies using 3d printing to replace a fractured tooth?
Nothing yet that is clinically applicable, however I am aware of research
that is using CAD/CAM like technology to make implants but those will not
be on the market anytime soon. Interesting concept though.

Is the last treatment also succesful in a case : wide open apex 11 at 9years
trauma now age 17 element slightly discollored but radiolog. massive cys
I assume you are referring to revasculaization. All indications are that this
procedure can be done on any root open tooth without respect to the
age of the patient or time from trauma. Would be worth trying and if it
does not work then do apexification with MTA.