This is high yield if dentoalvealar injurues

1. Dr.Noura H:Abdirahman( BDS)
Maxillofacial Trauma

2. Maxillofacial Trauma
Dento-alveolar fractures
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3. Dentoalveolar fracture
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 Dentoalveolar fractures are injuries
affecting teeth with its supporting
alveolar bone.
 It commonly presents as a
displaced dentoalveolar segment, tooth
mobility, occlusal disturbance, and
hematoma into the adjacent oral
mucosa.

4. Definition
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 Involves
 avulsion
subluxation or
fracture of the teeth
association with a fracture of the alveolus

5.  Dental avulsion is the complete displacement of
a tooth from its socket in alveolar bone owing to
trauma. The treatment for
permanent teeth consists of replantation,
immediately if possible.
 Deciduous teeth should not be replanted due to
the risk of damaging the permanent tooth germ.
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8.  Subluxation is defined as a physical
injury to the tooth-supporting structures
with some loosening of the tooth but
without fracture or displacement. The
signs and symptoms are marked
tenderness to percussion, mobility, and “a
sore tooth
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11. Etiology of dentoalveolar fracture
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 minor accidents)
 Collisions and falls
 Cycling accidents
 Epileptic seizures
 Iatrogenic damage during:
 Extraction of teeth
 Endoscopy procedure
 Endotreacheal intubation

12. Classification of dento-alveolar injuries
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1) Dental hard tissue injury
Crown in fracture and fracture with or without root
fracture
2) Periodontal injury
Concussion, subluxation, intrusion, extrusion, lateral
luxation, avulsion
3) Alveolar bone injury
Intrusion of teeth with fracture of socket, alveolus or
jaws
4) Gingival injury
contusion, abrasion, laceration

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14. Dental hard tissue injury
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 Occurs as a result of direct trauma or by
forcible impaction against the opposing
dentition
 Anterior teeth damaged by direct impact
while posterior ones damaged by
impaction between the two jaws
 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
 Early treatment is imperative to relieve
pain and preserve tooth

15. Treatment objectives
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Preservation of damaged teeth depends on:
 Severity of maxillofacial injury
 Age of the patient
 General dental condition
 Site of injury
 Wishes of the patient
Prognosis is influenced by:
 Open root apices
 Intact gingival tissue
 Absence of root fracture
 periodontal-bone support

16. Injuries to the primary dentition
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70% involve maxillary central incisors
Intrusion, lateral luxation and avulsion are
the commonest
Damage to developing permanent teeth
by displaced tooth are recognizable
problem
Management:
 Fractured, extruded or grossly displaced
teeth are to be extracted
 Less displaced with no occlusal
interference should be monitored since
extraction carries risk to permanent one

17. Management of injuries to permanent dentition
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Crown fracture
Dressing of exposed dentin, minimal
pulpotomy or pulp extirpation and restoration of
damaged part of the tooth
Root fracture
(Oblique, vertical or transverse)
Inevitable extraction
Saving the tooth by:
oRigid splinting for a minimum of 8 weeks
oDevitlaiztion (RCT) with eventful apico surgery

18. Injuries to periodontal tissues
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Force distributed over several teeth or
impact cushioned by overlying soft
tissue may result into:
 Concussion
 Subluxation
 Intrusion
 Displacement and avulsion
 Fracture of teeth structure
Looseness and displacement of teeth
carries a high risk of subsequent pulp
necrosis
As with root fracture, late
complications can be resorption,

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20. Management of injuries to the periodontal tissues
 Loosened, laterally luxated and extruded teeth should
be repositioned and splinted for 1-3 weeks
respectively by semi rigid splint:
 Acid-etch composite
 Arch bar
 Orthodontic wire
 Soft stainless-steel wire-loop,
 Avulsed teeth replantation and semi-rigid splinting for
1-2 weeks and prognosis is influenced by:
 stage of root development
 length of exposure
 medium storage
 handling and splinting
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22. Alveolar fracture
 Segmental alveolar
fracture is defined as
a fracture of
the alveolar process
which may or may not
involve the socket of the
teeth.
 The typical clinical
appearance is a segment
containing two or more
teeth being displaced
axially or laterally, usually
resulting in occlusal
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23. Alveolar fracture
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Alveolar injury in mandible is
associated with complete fracture of
tooth-bearing area and in maxilla is
often isolated injury
Teeth damage might be no existed but
the potential devitilzation should be
expected
Alveolar fractures are often seen as
two distinct fragment containing teeth
but comminuted fracture is possible

24. Management of injuries to the alveolar bone
(Block or plate fracture)
 Reduction (closed ) and fixation
 Rigid wire and composite splint
 Short inter-maxillary fixation
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25. Injuries to the gingival and soft
tissues
 The most common form of gum injury. It can be
caused by a wide range of things: sporting
injuries, accidental falls, and motor vehicle
accidents.
 The soft tissues in the mouth (tongue, cheeks,
gums and lips) are delicate and sensitive, and
when they get injured, it can be very painful.
 Soft tissues can be injured when
unconsciously bite down on them, fall, are in an
accident, or put food in the mouth that is too
hot or too hard.
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26. Injuries to the gingival and soft tissues
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 Damage to the lip observed more with anterior
dento-alveolar fracture
 Laceration of the gingiva is associated with
dento-alveolar fracture

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28. Management of soft tissue injuries
 Inspection of a full thickness perforating wound
 Debridment and copious lavage
with cholohexidine solution
 Removal of denuded piece of bone
 Repair of soft tissue injury
 Application of external support strapping to help in
tissue adaptation
 Antibiotic prescription
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