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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078

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Mandibular fracture 3 / fixed orthodontic courses Mandibular fracture 3 / fixed orthodontic courses Presentation Transcript

  • www.indiandentalacademy.com
  • INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • SURGICAL ANATOMY Superior and Posterior view Mandible showing relationship Of Body and ramus Section Of mandible at sysmphysis showing maximum thickness at lower border Section Of mandible www.indiandentalacademy.comdistal to last molar showing maximum thickness at Upper border
  • Internal Architecture of bone : 1; Osteone, 2;Cortical and Medullary bone, 3; A long Bone, 4; Loaded cylinder Trajectories of Mandible Joint Adaption for pressure bearing www.indiandentalacademy.com
  • BLOOD SUPPLY AND NERVE SUPPLY OF MANDIBLE Inferior Alveolar Artery Lateral View Of mandible Inferior Alveolar neurovascular Bundle, Sphenomandibular ligament and mandibular foreman www.indiandentalacademy.com
  • CHANGES ASSOCIATED WITH AGE TO MANDIBULAR BLOOD SUPPLY Cross section of mandibe of 87 yrs old male Left carotid angiogram of 69 yrs old female showing emply inferior dental canal Right Carotid angiogram of a 28 yrs old female showing normal Inferior dental artery Cross section of mandibe of 16 yrs old male www.indiandentalacademy.com
  • AVERAGE MEASUREMENTS IN THE BODY OF THE MANDIBLE P1 P2 M1 M2 M3 Distance between nerve and Lower border of mandible (a) 8.6 8.0 8.0 8.0 8.5 Distance between nerve and inner cortex (b) 3.2 3.2 2.0 2.9 3.0 Distance between nerve and buccal cortex (c) 4.0 4.0 5.4 5.9 4.6 Position of section I1 I2 C Average Thickness of outer cortex (d) 2.2 2.3 2.4 2.5 2.7 3.1 3.2 3.4 Distance between root apices and outer cortex (e) 3.7 4.0 3.2 3.6 3.8 4.7 5.7 6.3 8.8 8.3 6.8 6.0 Distance between root apices and outer cortex (f) www.indiandentalacademy.com
  • THE STRENGTH OF MANDIBLE “The bone fracture at the site of tensile strength since its resistance to compressive strength is more” - Hodgson ( 1967) Distribution of strain lines as a result of force applied over the symphysis menti or mental foramen www.indiandentalacademy.com
  • THE DISPOSITION OF MANDIBULAR FRACTURE LINES 1. Condylar region Extracapsular And Intracapsular fracture of condyle The relationship between the muscle attachments and site of condylar fracture www.indiandentalacademy.com
  • 2. • RAMUS AND CORONOID PROCESS Fractures of the ramus exhibit very little displacement of the fragments as a result of being, to a large extent, splinted by the presence of masseter muscle on the lateral aspect and the medial pterygoid on the medial aspect. • there is usually onlt minimal displacement of the coronoid process, since the fragment is splinted by the tendinous insertion of the temporalis muscle. www.indiandentalacademy.com
  • 3. ANGLE OF THE MANDIBLE Disposition of fracture lines at the angle Thickness of cortex at the angle of mandibel in the presence and absence of teeth Change of angulation at angle www.indiandentalacademy.com
  • Vertically favourable fracture line Vertically unfavourable fracture line Horizontally favourable & unfavourable fracture line www.indiandentalacademy.com
  • FACTORS INFLUENCING DISPLACEMENT OF FRACTURE 1. Direction and intensity of the traumatic force 2. Site of fracture 3. Direction of fracture line 4. muscle pull exerted on fractured fragments. 5. Presence or absence of teeth. 6. Extent of soft tissue wound. www.indiandentalacademy.com
  • HISTORY  Writings on mandible fractures appared as early as 1650 BC, when Egyptian described the examination, diagnosis and treatment of mandible fractures.  Hippocrates described direct reapproximation of the fracture segments with the use of circumdental wiring.  1795, Chopart and Desault were the first to use dental prosthetic devices in an attempt to immobilize fracture segments Chopart and Desault  John Barton described his Barton Bandage in order to immbilize and stabilize fracture fragment www.indiandentalacademy.com
  •  1886, Thomas Brain Gunning was the first person to use a custom fitted intraoral dental splint for immobilization. He used the splint in conjunction with an external head appliance.  Glimer credited with being the first to use method of intermaxillary fixation.  In 1881, Glimer described a method of mandibular fracture fixation that used two heavy rods placed on either side of the fracture and wired together. www.indiandentalacademy.com
  • ETIOLOGY OF MANDIBULAR FRACTURE 1. Vehicular accident – 43% 2. Altercation, assault, interpersonal vilonce – 34% 3. Fall – 7% 4. Sporting accidents – 4% 5. Industrial mishaps or work accidents – 10% 6. Pathological fractures – 2% www.indiandentalacademy.com
  • LOCATION OF MANDIBULAR FRACTURE  Body - 29%  Condyle - 26%  Angle - 25%  Symphyses - 17%  Ramus - 4%  Coronoid - 1% www.indiandentalacademy.com
  • CLASSIFICATION OF MANDIBULAR FRACTURE 1. Kruger's general classification • Simple or Closed Fracture • Compound or Open • Comminuted • Complicated or complex • Impacted Simple fracture Compound Fracture • Greenstick fracture • Pathological Comminuted fracture www.indiandentalacademy.com Greenstick fracture Impacted fracture
  • 2. Rowe & Killey classification • Fractures not involving basal bone • Fractures involving basal bone of the mandible. Subdivided into following:  Single Unilateral  Double unilateral  Bilateral  Multiple 3. Dingman & Natvig classification • Midline • Parasymphyseal • Symphysis • Body • Angle • Ramus • Condylar process • Coronoid process • Alveolar process www.indiandentalacademy.com
  • 4. I. Kruger & Schilli classification Relation to the external environment • Simple Or closed • II. Compound or open Types of fracture • • Greenstick • III. Incomplete Complete • Comminuted Dentition of the jaw with reference to the use of splint • • Edentulous or insufficiently dentulous patient • IV. Sufficiently dentulous patient Primary and Mixed dentition Localization • Fractures of the symphysis region between canines • Fractures of the canine region • Fractures of the body of the mandible • Fractures of the angle • Fractures of the mandibular ramus • Fractures of the coronoid process Fractures of the condyle www.indiandentalacademy.com •
  • 5. Kazanjian classification Class – I : teeth are present on both sides of the fracture line Class – II : Teeth are present on only one side of fracture line Class – III : Patient is edentulolus www.indiandentalacademy.com
  • DIAGNOSIS OF MANDIBULAR FRACTURE  History  Clinical Examination  Change in occlusion  Anesthesia, Paresthesia or Dysesthesia of lower lip  Abnormal mandibular movements  Change in facial contour and mandibular arch form  Laceration, Hematoma and Ecchymosis  Loose teeth and crepitation on palpation  Radiological Examination  Panoramic radiograph  Lateral oblique Radiograph  Posteroanterior Radiograph  Occlusal view  reverse towne’s view  CT scan www.indiandentalacademy.com
  • GENERAL PRINCIPLE IN THE TREATMENT OF MANDIBULAR FRACTURE 1. The patient’s general physical status should be carefully evaluated and monitored prior to any consideration of treating mandibular fracture. 2. Diagnosis and treatment of mandibular fractures should be approached methodically not with an “emergency-type” mentality 3. Dental injuries should be evaluated and treated concurrently with treatment of mandibular fractures 4. Re-establishment of occlusion is the primary goal in the treatment of mandibular fracture. 5. With multiple facial fracture mandibular fracture should be treated first. 6. Intermaxillary fixation time should vary according to the type, location, number severity of the mandibular fracture as well as the patient’s age and health. 7. Prophylactic antibiotics should be used for compound fractures. www.indiandentalacademy.com
  • PROTOCOL FOR TREATMENT OF MANDIBULAR FRACTURES Philip L. Maloney,J Oral Maxillofac Surg,59:879-884, 2001 • Simple fractures of the condylar process and ramus are usually treated by closed reduction. Patients are placed in maxillomandibular fixation (MMF) for 48 to72 hours, followed by training elastics and close observation to ensure that a malocclusion does not occur. • No MMF is required for coronoid fractures; archbars and training elastics are used only if a malocclusion is present. • Simple or compound fractures with a time delay from injury to immobilization of less than 72 hours are treated by a closed reduction (CR) or, if indicated, open reduction with rigid fixation (ORIF). • Compound fractures where there is a delay from injury to immobilization of more than 72 hours are treated with MMF and intravenous antibiotics for a period roughly equal to the time from injury to initialtreatment (eg, a patient with a 5-day-old compound fracture receives intravenous antibiotics for 5 days). If the closed reduction is adequate, the patient is continued on oral antibiotics for an additional 10 to 14days and maintained in MMF and on a blenderized diet for 5 to 6 weeks from the time of closed reduction. If not, ORIF is performed, and MMF is maintained for 10 to 14 additional days. • Edentulous patients are treated with rigid fixation, no MMF, and a blenderized diet for 4 to 5 weeks. • Teeth in the line of fracture are judged individually. If sound, firm, and the supportive tissues are intact, they are retained except if an open reduction is to be performed; then, partially erupted and impacted third molars in the line of fracture are removed. www.indiandentalacademy.com
  • INDICATIONS FOR CLOSED REDUCTION 1. Non-displaced favorable fractures 2. Grossly comminuted fractures 3. Fractures exposed by significant loss of overlying soft tissue. 4. Mandibular fractures in children with developing dentition 5. Coronoid process fracture 6. Condylar fractures www.indiandentalacademy.com
  • INDICATIONS FOR OPEN REDUCTION 1. Displaced unfavorable fracture through angle of the mandible 2. Displaced unfavorable fractures of the body or pasymphyseal region 3. Multiple fractures of the facial bones 4. Midface fractures and displaced Bilateral condyler fractures 5. Fractures of the edentulous mandible with severe displacement of fragments 6. Edentulous maxilla opposing a mandibular fracture 7. Delay of treatment and interposition of soft tissue between noncontacting displaced fracture fragments. 8. Malunion 9. Special systemic conditions contraindicating intermaxillaryfixation www.indiandentalacademy.com
  • METHODS OF IMMOBILIZATION (a) Osteosynthesis without intermaxillary fixation (i) Non-compression small plates (ii) Compression plates (iii) Mini-plates (iv) Lag screws (b) Intermaxillary fixation (i) Bonded brackets (ii) Dental wiring Direct Eyelet (iii) Arch bars (iv) Cap splints (c) Intermaxillary fixation with osteosynthesis (i) Transosseous wiring (ii) Circumferential wiring (iii) External pin fixation (iv) Bone clamps (v) Transfixation with Kirschner wires www.indiandentalacademy.com
  • A GUIDELINE FOR TIME OF IMMOBILIZATION FOR FRACTURES OF TOOTH-BEARING AREA OF THE LOWER JAW - Peter bank (1991) Young Adult With Fracture of the body of the mandible Receiving 3 weeks Early treatment In which Tooth removed from fracture line If : a. Tooth retained in fracture line : add 1 week b. Fracture at the symphysis : add 1 week c. Age 40 years or above : add 1 or 2 weeks d. Children and Adolescents : Subtract 1 week www.indiandentalacademy.com
  • GILMER’S METHOD www.indiandentalacademy.com
  • IVY LOOP METHOD www.indiandentalacademy.com
  • WILLIAMS MODIFICATION(1968) www.indiandentalacademy.com
  • LEONARD BUTTON WIRING www.indiandentalacademy.com
  • STOUT METHOD(1943) • Continous or Multiple loop wiring www.indiandentalacademy.com
  • FULTON RISDON (1968) • Twisted Labial Wire www.indiandentalacademy.com
  • OBWEGESER METHOD • Continous Multiple Loop Wiring www.indiandentalacademy.com
  • ARCH BARS RISDON ARCH BAR JELENKO ARCH BAR ERICH ARCH BAR KRUPPA ARCH BAR ERICH ARCH BAR HAMILTON (1967) www.indiandentalacademy.com
  • ACRYLATED ARCH BARS schuchardt(1956) schuchardt&metz(1966) stanhope(1969) clarke(1977) www.indiandentalacademy.com
  • FRACTURES OF EDENTULOUS MANDIBLE • GUNNING TYPE SPLINTS THOMAS BRYAN GUNNING-(1885) www.indiandentalacademy.com
  • TREATMENT MODALITIES FOR EDENTULOUS MANDIBLE PERALVEOLAR WIRING www.indiandentalacademy.com
  • CIRCUMMANDIBULAR WIRING (Bradley-1975) www.indiandentalacademy.com
  • • INTER OSSEOS WIRING • EXTRA ORAL PIN FIXATION ROGER ANDERSON APPLIANCE • PRIMARY RIB GRAFTING - OBWEGER& SAILER (1973) www.indiandentalacademy.com
  • SURGICAL APPROACHES TO THE MANDIBLE Intraoral symphysis and paarasymphysis Intraoral body, angle and ramus www.indiandentalacademy.com
  • EXTRAORAL APPROACHES Submental Retromandibular Submandibular www.indiandentalacademy.com
  • SUBMANDIBULAR APPROACH www.indiandentalacademy.com
  • RETROMANDIBULAR APPROACH www.indiandentalacademy.com
  • TRANSOSSEOUS WIRING www.indiandentalacademy.com
  • COMPRESSION PLATE OSTEOSYNTHESIS THROUGH THE LUHR SYSTEM www.indiandentalacademy.com
  • COMPRESSION PLATE OSTEOSYNTHESIS THROUGH THE ASIF (Spiessel) SYSTEM Perren Sperical gliding principle www.indiandentalacademy.com
  • COMPRESSION PLATE OSTEOSYNTHESIS THROUGH THE BECKER SYSTEM www.indiandentalacademy.com
  • THE STRASBOURG MINIPLATE OSTEOSYNTHESIS Ideal Osteosynthesis lines developed by Champy www.indiandentalacademy.com
  • LAG SCREWS www.indiandentalacademy.com
  • INTERMEDULLARY WIRING www.indiandentalacademy.com
  • COMPLICATIONS • • • • • • Non-Union Malunion Fibrous Union Paresthesia Anesthesia Infection www.indiandentalacademy.com
  • Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com