Dentoalveolar injuries ppt


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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
  • Dentoalveolar injuries ppt

    2. 2. DEFINITION : Injury which is limited to the teeth and supporting structures of the alveolus. INCIDENCE Boys are three times more at risk than girls. CAUSES : 1- Traffic Accident. 2- Falls. 3- During Epileptic seizures. 4- Sport injuries.
    3. 3. Diagnosis History Clinical examination Vitality test Radiographic Examination
    4. 4. 1) Personal history 2) medical history 3) Previous dental history 4) History of trauma (when ,how ,where )
    5. 5. 11((TIME OF OCCURENCETIME OF OCCURENCE?? TheThe shortershorter the time between accident andthe time between accident and treatment thetreatment the betterbetter prognosisprognosis.. 22((TIME OF OCCURENCETIME OF OCCURENCE?? If the accident occurred inIf the accident occurred in dirty placedirty place prophylactic tetanusprophylactic tetanus is indicatedis indicated 33((TIME OF OCCURENCETIME OF OCCURENCE?? Direct force under the chin →Direct force under the chin → →→ condylar fracturecondylar fracture Direct force to teethDirect force to teeth → →→ → Crown F, Root F, displacementCrown F, Root F, displacement
    6. 6. Extraoral Examination Laceration ; Abrasions; Contusionson thehead and neck can benoted visually Any asymmetriesincluding deviation in mouth opening. Intraoral Examination Soft tissue( tongue; gingiva.. ) Teeth ( displacement ; mobility ; tooth fracture; colour change)
    7. 7. Vitality test just following traumatic injury often given false negative response Types of vitality test 1) Thermal pulp test cold test heat test 2) Electrical pulp test 3) Cavity test
    8. 8. *SOFTTISSUEINJURIES 1- Determination of child immunization status:- •If the child had received a primary immunization activated with boosterinjection of toxoid . •Unimmunized child can be protected by tetanus antitoxin. 2- Adequate debridment of the wound
    9. 9. 1- stage of root formation 2- presence of root fractur 3- periapical radiolucencies 4- injury of the supporting periodontal membrane (degree of intrusion or extrusion o the tooth) 5- size of the pulp N. B. If a jaw fracture is suspected extaoral radiographs indicated (panoramic and lateral oblique views )
    10. 10. Ellis classificationEllis 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 IV: Fracture line passes beneath the gingival margin Class V: Root fracture a) vertical b) horizontal (apical , middle , cervical(
    11. 11. Class IClass I:: 1-a crack of the enamelwithout loss of toothstructure. Do not require immediate treatmentDo not require immediate treatment.. 22--fracture of enamel onlyfracture of enamel only smoothing the sharp edgesmoothing the sharp edge regularvitality test ,regularvitality test , radiographradiograph
    12. 12. Class IIClass II:: Immediate treatment of the crown is required to: 1(protect the pulp 2(restore the esthetics and function. Cover the expose of the dentine by a layer of calcium hydroxide to reparative dentine formation. A- Reattachment of tooth fragment. B- Acid-etch composite resin restoration
    13. 13. Class IIIClass III:: The treatment depends on manyThe treatment depends on many factors such asfactors such as:: 1)vitality of the exposed pulp. 2)Size of the exposure. 3)Time elapsed since the exposure. 4)Degree of root maturation. 5)Restorability of the fractured crown. The main objective of treatment is toThe main objective of treatment is to maintain the vitality of the toothmaintain the vitality of the tooth..
    14. 14. Small exposure Large exposure Early Late Early Late Open Close open closed open closed open Closed Direct pulp capping pulpoto my pulpecto my pulpecto my Pulpoto my pulpecto my pulpecto my Pulpe ctomy Apexifi cation pulpec tomy
    15. 15. APEXIFICATION :
    16. 16. Class IV: Treatment usually involve removing the loose fragment. 11--tooth can beextrudedtooth can beextruded orthodonticallyorthodontically 22--crown lengthening tocrown lengthening to gain accessto placement ofgain accessto placement of restorationrestoration..
    17. 17. Class vClass v:: 11((HORIZONTAL ROOT FRACTUREHORIZONTAL ROOT FRACTURE When the fracture occur near theWhen the fracture occur near the apical 1/3, the prognosis is moreapical 1/3, the prognosis is more favourable than the middle or cervical 1/3favourable than the middle or cervical 1/3 becausebecause:: 1)more alveolar support 2)immobilization of the tooth is much easier Treatment of root fracture depends upon: 1(Condition of the pulp 2(amount of mobility orthe level of the fracture line
    18. 18. (A) APICAL 1/3 ROOT FRACTURE 11((reduction , splinting thetoothreduction , splinting thetooth 22((thetooth should becheckedthetooth should bechecked periodically for vitality andperiodically for vitality and radiographradiograph..
    19. 19. ))B) MIDDLE 1/3 ROOTB) MIDDLE 1/3 ROOT FRACTUREFRACTURE:: 11((reduction , splinting the toothreduction , splinting the tooth 22((the patient recall 2-3 months ,the patient recall 2-3 months , checked the vitality ,radiographchecked the vitality ,radiograph 33((if the tooth non vital and no healingif the tooth non vital and no healing the following treatment is performedthe following treatment is performed:: a) RC Tof both fragmentsa) RC Tof both fragments b) apical fragment removedb) apical fragment removed surgicallysurgically c) intraradicularpin to stabilizec) intraradicularpin to stabilize both segmentsboth segments
    20. 20. ))C) CERVICAL 1/3 ROOT FRACTUREC) CERVICAL 1/3 ROOT FRACTURE :: 11((reductin , splinting the toothreductin , splinting the tooth 22((recall the patient periodically andrecall the patient periodically and checked the vitality and radiographchecked the vitality and radiograph 33((if there is radiolucent and pulp necrosisif there is radiolucent and pulp necrosis the following treatment is performedthe following treatment is performed a) extraction the tootha) extraction the tooth b) removed the apical fragment andb) removed the apical fragment and endo-osseous implantendo-osseous implant placedplaced c) orthodontic extrusionc) orthodontic extrusion d) if the fracture is 1-2mmd) if the fracture is 1-2mm infrabony remove theinfrabony remove the coronal segment andcoronal segment and
    21. 21. 2)VERTICAL ROOT FRACTURE :  usually the prognosis is not favorable  treatment ofV R F : 1)extraction of the tooth 2)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 extracted B) 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 SPLINTING : 1) acid_etched composite splinting 2) Interdental wiring 3) ( vacuum_formed plastic) splint 4) 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 injuryDentoalveolar injury Duration ofDuration of immobilizationimmobilization 11((Mobile toothMobile tooth 77__1010daysdays 22((Tooth displacementTooth displacement 22__33weeksweeks 33((Root fractureRoot fracture 22__44monthsmonths 44((AvulsionAvulsion 77__1010daysdays 55((Alveolar fractureAlveolar fracture 44__66weeksweeks