Dento Alveolar Fractures


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Dento Alveolar Fractures

  1. 1. Maxillofacial Trauma Dento-alveolar fractures dr shabeel p n
  2. 2. Definition <ul><li>Are those in which avulsion, subluxation or fracture of the teeth occurs in association with a fracture of the alveolus </li></ul><ul><li>It may occur as an isolated clinical entity or in conjunction with any other soft tissue or facial bone fracture </li></ul><ul><li>Isolated dento-alveolar fracture seen among children and adolescents and boys are 3 times at risk than girls (Hunter et al 1990, Andreason & Andreason 1994) </li></ul>
  3. 3. Etiology <ul><li>RTA (minor accidents) </li></ul><ul><li>Collisions and falls </li></ul><ul><li>Cycling accidents </li></ul><ul><li>Epileptic seizures </li></ul><ul><li>Iatrogenic damage during: </li></ul><ul><ul><ul><li>Extraction of teeth </li></ul></ul></ul><ul><ul><ul><li>Endoscopy procedure </li></ul></ul></ul><ul><ul><ul><li>Endotreacheal intubation </li></ul></ul></ul>
  4. 4. Classification of dento-alveolar injuries ( Andreasen & Andreasen 1994) <ul><li>Dental hard tissue injury </li></ul><ul><li>Crown infracture and fracture with or without root fracture </li></ul><ul><li>Periodontal injury </li></ul><ul><li>Concussion, subluxation, intrusion, extrusion, lateral luxation, avulsion </li></ul><ul><li>Alveolar bone injury </li></ul><ul><li>Intrusion of teeth with fracture of socket, alveolus or jaws </li></ul><ul><li>Gingival injury </li></ul><ul><li>contusion, abrasion, laceration, degloving </li></ul><ul><li>Combination of the above </li></ul>
  5. 5. Dental hard tissue injury <ul><li>Occurs as a result of direct trauma or by forcible impaction against the opposing dentition </li></ul><ul><li>Anterior teeth damaged by direct impact while posterior ones damaged by impaction between the two jaws </li></ul><ul><li>Upper teeth intrusion are more frequent and impact against lower teeth may lead to vertical splitting </li></ul><ul><li>Meticulous clinical and radiographical examination are very essential to determine the degree of dental damage and chest x-ray when missing or knocked out tooth is suspected </li></ul><ul><li>Early treatment is imperative to relieve pain and preserve tooth </li></ul>
  6. 6. Treatment objectives <ul><li>Preservation of damaged teeth depends on: </li></ul><ul><ul><ul><li>Complexity of maxillofacial injury </li></ul></ul></ul><ul><ul><ul><li>Age of the patient </li></ul></ul></ul><ul><ul><ul><li>General dental condition </li></ul></ul></ul><ul><ul><ul><li>Site of injury </li></ul></ul></ul><ul><ul><ul><li>Wishes of the patient </li></ul></ul></ul><ul><li>Prognosis is influenced by: </li></ul><ul><ul><ul><li>Open root apices </li></ul></ul></ul><ul><ul><ul><li>Intact gingival tissue </li></ul></ul></ul><ul><ul><ul><li>Absence of root fracture </li></ul></ul></ul><ul><ul><ul><li>periodontal-bone support </li></ul></ul></ul>
  7. 7. Injuries to the primary dentition <ul><ul><li>70% involve maxillary central incisors </li></ul></ul><ul><ul><li>Intrusion, lateral luxation and avulsion are the commonest </li></ul></ul><ul><ul><li>Intruded teeth are likely to normally erupt spontaneously </li></ul></ul><ul><ul><li>Damage to developing permanent teeth by displaced tooth are recognizable problem </li></ul></ul><ul><li>Management: </li></ul><ul><li>Fractured, extruded or grossly displaced teeth are to be extracted </li></ul><ul><li>Less displaced with no occlusal interference should be monitored since extraction carries risk to permanent one </li></ul>
  8. 8. Management of injuries to permanent dentition <ul><li>Crown fracture </li></ul><ul><li>Dressing of exposed dentin, minimal pulpotomy or pulp extirpation and restoration of damaged part of the tooth </li></ul><ul><li>Root fracture </li></ul><ul><li>(Oblique, vertical or transverse) </li></ul><ul><ul><li>Inevitable extraction </li></ul></ul><ul><ul><li>Saving the tooth by: </li></ul></ul><ul><ul><ul><ul><ul><li>Rigid splinting for a minimum of 8 weeks </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Devitlaiztion (RCT) with eventful apico surgery </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Orthodontic extrusion or crown lengthening </li></ul></ul></ul></ul></ul>
  9. 9. Injuries to periodontal tissues <ul><li>Force distributed over several teeth or impact cushioned by overlying soft tissue may result into: </li></ul><ul><ul><ul><li>Concussion </li></ul></ul></ul><ul><ul><ul><li>Subluxation </li></ul></ul></ul><ul><ul><ul><li>Intrusion </li></ul></ul></ul><ul><ul><ul><li>Displacement and avulsion </li></ul></ul></ul><ul><ul><ul><li>Fracture of teeth structure </li></ul></ul></ul><ul><li>Looseness and displacement of teeth carries a high risk of subsequent pulp necrosis </li></ul><ul><li>As with root fracture, late complications can be resorption, canal obliteration, ankylosis and loss of alveolar bone </li></ul>
  10. 10. Management of injuries to the periodontal tissues <ul><li>Loosened, laterally luxated and extruded teeth should be repositioned and splinted for 1-3 weeks respectively by semi rigid splint: </li></ul><ul><ul><ul><li>Acid-etch composite </li></ul></ul></ul><ul><ul><ul><li>Arch bar </li></ul></ul></ul><ul><ul><ul><li>Orthodontic wire </li></ul></ul></ul><ul><ul><ul><li>Soft stainless-steel wire-loop, </li></ul></ul></ul><ul><ul><ul><li>Vacum formed splint </li></ul></ul></ul><ul><li>Avulsed teeth necessities immediate replantation and semi-rigid splinting for 1-2 weeks and prognosis is influenced by: </li></ul><ul><ul><ul><li>stage of root development </li></ul></ul></ul><ul><ul><ul><li>length of exposure </li></ul></ul></ul><ul><ul><ul><li>medium storage </li></ul></ul></ul><ul><ul><ul><li>handling and splinting </li></ul></ul></ul>
  11. 11. Alveolar fracture <ul><li>Alveolar injury in mandible is associated with complete fracture of tooth-bearing area and in maxilla is often isolated injury </li></ul><ul><li>Teeth damage might be no existed but the potential devitilzation should be expected </li></ul><ul><li>Alveolar fractures are often seen as two distinct fragment containing teeth but comminuted fracture is possible </li></ul><ul><li>Alveolar fracture in mandible my go along with mandible fracture and impacted fracture into the maxilla may appear to be immobile </li></ul><ul><li>Midline split of palate with unilateral Le Fort I lead to large dento-alveolar fracture </li></ul><ul><li>Fracture of tuberosity and fracture of antral floor is a recognized complication of upper molars extraction </li></ul>
  12. 12. Management of injuries to the alveolar bone (Block or plate fracture) <ul><li>Finger manipulation </li></ul><ul><li>Reduction (closed ) and fixation </li></ul><ul><li>Rigid wire and composite splint </li></ul><ul><li>Elimination of premature contact and occlusal trauma </li></ul><ul><li>Short inter-maxillary fixation </li></ul>
  13. 13. Management of tuberosity fracture <ul><li>Removal of comminuted fracture of loss alveolar bone and teeth and repair of soft tissue </li></ul><ul><li>Delay of extraction of teeth in case of tuberosity fracture for (6-8 weeks) </li></ul><ul><li>Mandatory extraction of a tooth from a block fracture should be carried out surgically </li></ul><ul><li>Splinting of a tooth of fractured tuberodity in to other standing teeth for one month </li></ul>
  14. 14. Injuries to the gingival and soft tissues <ul><li>Damage to the lip observed more with anterior dento-alveolar fracture </li></ul><ul><li>Embedded of portion of a tooth or foreign bodies in soft tissues is very substantial </li></ul><ul><li>Laceration of the gingiva is associated with dento-alveolar fracture </li></ul><ul><li>Degloving of the mental region is a common injury to the lower anterior teeth </li></ul>
  15. 15. Management of soft tissue injuries <ul><li>Inspection of a full thickness perforating wound </li></ul><ul><li>Debridment and copious lavage </li></ul><ul><li>with cholohexidine solution </li></ul><ul><li>Removal of denuded piece of bone </li></ul><ul><li>Repair of soft tissue injury </li></ul><ul><li>Application of external support strapping to help in tissue adaptation </li></ul><ul><li>Antibiotic prescription </li></ul>