dento – alveolar injuries


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  • Begins immediately when the patient enters the office . Hematoma in the fioor of the moth indicate mand F . If ther is more than 2 teeth alveolar F should be suspected . Non vital tooth often appear dis colored
  • All traumatized teeth should be take a x-ray
  • There are more than 2 classification for classifyng dental trauma but the ellis classifictaion is the most famous and used
  • If the patient came immediately after the trauma (vitality t ,x-ry) very important to provide the basis for comparison of subsequent examination if the patient came very late (no apparent effect or dest calcification or necrosis or resoption )
  • If you tack x_ray immediately following the trauma may be not see the R F , tack anther x-ray after 1-2 weeks . If the F segments close proximity and the pulp remain vital callus may reunite the two segments
  • Reduce the occ surface . Digital pressure , composite splint .
  • Often hemorrhage around the gingival margin . Toled don’t use the affected tooth , reduce the occlusion
  • The root displaced on the opposite direction to the crown . There is mobility and tender to percussion . X-ray widening in PDL . The prognosis for tooth retention is fair and for pulp retention it is poor
  • The crown appear short . Discontanus PMS . . Almost pulp is necrosis especially in mature apex . Tender to percussion no mobility . External R resoripion, loss of marginal bony support complcation of surgical reposition
  • The crown appear long . Mobility
  • Primary tooth: usually the treatment is extraction
  • we can used the Composite with orthodontic wire or heavy nylon suture
  • dento – alveolar injuries

    1. 1. Dr. Mohammad A. Barayan
    2. 2. : DefinitionInjury which is limited to the teethand supporting structures of the.alveolusN.B Boys are three times risk than girls: Causes.Traffic Accident -1.Falls -2.During Epileptic seizures -3 .Sport injuries -4
    3. 3. D iagnos is ClinicalHistory Radiographic examination Vitality test Examination
    4. 4. Personal history (1medical history (2 Previous dental history (3( when ,how ,whereHistory of trauma ( (4
    5. 5. ? When did the accident occur (1 Theshorter the time between accident and treatment thebetter. prognosis? where did the accident occur (2If the accident occurred indirty place prophylactic tetanusis indicated? how did the injury occur (3Direct force under the chin → → condylar fractureDirect force to teeth→ → Crown F, Root F, displacement
    6. 6. Extraoral ExaminationLaceration ;Abrasions ;Contusions on the head andneck can be noted visuallyAnyasymmetries including deviation in mouth.openingIntraoral Examination( .. Soft tissue ( tongue ; gingivaTeeth ( displacement ; mobility ; tooth fracture ;( colour change
    7. 7. Vitality test just following traumaticinjury often given false negativeresponseTypes of vitality testThermal pulp test (1cold testheat test (2Electrical pulp test Cavity test (3
    8. 8. *s o f t t is s u e in ju r ie s1- Determination of child immunizationstatus:-•If the child had received a primaryimmunization activated with booster injectionof toxoid .•Unimmunized child can be protected bytetanus antitoxin.2- Adequate debridment of the wound
    9. 9. stage of root formation -1presence of root fractur -2 periapical radiolucencies -3 injury of the supporting periodontal membrane -4(degree of intrusion or extrusion o the tooth) size of the pulp -5N. B. If a jaw fracture is suspected extaoralradiographs indicated (panoramic and lateral ( oblique views
    10. 10. :Ellis classification :Class I crack or fracture of E only :Class II fracture of E , D with out pulp exposure :Class III fracture of E , D with pulp exposure:Class IVFracture line passes beneath the gingival margin:Class V Root fracture a( vertical b( horizontal ((apical , middle , cervical
    11. 11. : Class I a crack of the -1 enamelwithout loss of tooth. structureDo not require immediate.treatmentfracture of enamel only -2 smoothing the sharp edgeregular vitality test , radiograph
    12. 12. : Class IIImmediate treatment of the crown is:required to (1protect the pulp.restore the esthetics and function (2Cover the expose of the dentine by alayer of calcium hydroxide to.reparative dentine formation.A- Reattachment of tooth fragmentB- Acid-etch composite resinrestoration
    13. 13. : Class IIIThe treatment depends on many:factors such as.vitality of the exposed pulp (1.Size of the exposure (2.Time elapsed since the exposure (3.Degree of root maturation (4Restorability of the fractured (5.crownThe main objective of treatment is to. maintain the vitality of the tooth
    14. 14. Small exposure Large exposure Early Late Early LateOpen Close open closed open closed open Closed pulpoto pulpecto Pulpoto pulpecto Pulpe my my my my ctomy Direct pulp capping pulpec pulpecto pulpecto Apexifi tomy my my cation
    15. 15. : Apexification
    16. 16. : Class IVTreatment usually involve removing. the loose fragmenttooth can be extruded -1orthodonticallycrown lengthening to -2gain access to placement of.restoration
    17. 17. : Class vHorizontal Root fracture (1 When the fracture occur near the apical 1/3, the prognosis is morefavourable than the middle or cervical 1/3: because more alveolar support (1immobilization of the tooth is much easier (2: Treatment of root fracture depends upon Condition of the pulp (1amount of mobility or the level of the (2fracture line
    18. 18. A( apical 1/3 root fracture(reduction , splinting the tooth (1the tooth should be checked(2periodically for vitality and.radiograph
    19. 19. B( middle 1/3 root(: fracturereduction , splinting the tooth (1the patient recall 2-3 months ,(2checked the vitality ,radiographif the tooth non vital and no(3healing the following treatment is:performed a( R C T of both fragments b( apical fragment removed surgicallyc( intraradicular pin to stabilize
    20. 20. : C( cervical 1/3 root fracture( reductin , splinting the tooth(1recall the patient periodically and checked(2the vitality and radiographif there is radiolucent and pulp necrosis the(3 following treatment is performed a( extraction the toothb( removed the apical fragmentand endo-osseous implant placedc( orthodontic extrusiond( if the fracture is 1-2mminfrabony remove the coronal segment and osteoplasty to expose the root
    21. 21. 2) vertical root fracture :• usually the prognosis is not favorable• treatment of V R F :1)extraction of the tooth2)using co2 laser and ND:YAG laser beam
    22. 22. Concussion *• A mild blow to the tooth resulting in mild sensitivity requires little or no treatment• Need only regular vitality test
    23. 23. subluxation*• Mobility of the tooth without displacement• Tooth may be sensitive to percussion• If mobility is extensive splint the tooth using the acid –etch splinting technique.• Regular vitality test and radiograph
    24. 24. • 1) lateral luxation• 2) intrusive luxation• 3) extrusive luxation• 4) avulsion
    25. 25. 1( Lateral luxation :• Displacement of the tooth in any direction other than the axial one• If the patient comes immediately after trauma reposition, splinting• Once the tooth have solidified in their position orthodontic treatment is required
    26. 26. 1( Intrusion:• Displacement the tooth into the socket A) primary tooth: will re-erupted over a period of few months. If the intruded tooth is in contact with underlying permanent tooth should be remove B) permanent tooth:• a) immediate surgical repositioning , splinting• b) orthodontic extrusion• c) incomplete root formation the tooth will erupt spontaneously
    27. 27. 2( Extrusion :• Partially displacement the tooth out of the socket .A) primary tooth: Treatment usually extractedB) permanent tooth :• reposition and splinting• If the vitality of tooth is lost start root treatment immediately placing calcium• hydroxide in the canal for 6-12 month followed permanent filling.
    28. 28. 3( Avulsion:• Complete displacement of the tooth from the socket .• There are tow important factors to be consider in cases of avulsion• 1)time between the injury and treatment• 2)condition under which the tooth have been restored• The tooth must be kept moist to prevent damage to the fibers of PDL
    29. 29. • In many cases the initial patient contact is by phone• The tooth should be handled by the crown• The tooth should be placed in suitable storage medium (milk, unsalted water, lens solution )or in buccal vestibule or under the tongue .• At the dental office :• a) information about tetanus immunization should be obtained• b) replantation , splinting for 1_2weeks but in immature apices 2-3weeks• c) calcium hydroxide should be placed• d) RCT
    30. 30. • Small fracture through the alveolar process.there may be concomitant injuries(crown, root fracture and soft tissue) managed by referral to an oral and maxillofacial surgery .• Treatment: redaction , splinting
    31. 31. : Types of splinting1) acid_etched composite splinting2) Interdental wiring3) ( vacuum_formed plastic) splint4) arch bare splint• More rigid and the longer the stabilization, the more root resorption , ankylosis that can be expected .
    32. 32. Stabilization periods for dentoalveolar injury Dentoalveolar injury Duration of immobilizationMobile tooth (1 days 10 _ 7 Tooth displacement (2 weeks 3 _ 2 Root fracture(3 months 4 _ 2 Avulsion (4 days 10 _ 7 Alveolar fracture (5 weeks 6 _ 4