Maxillofacial Trauma: Dento-alveolar fractures | PPT

| November 1, 2011 | 0 Comments

Maxillofacial Trauma: Dento-alveolar fractures | PPT

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•  Are those in which avulsion, subluxation or fracture of the teeth occurs in association with a fracture of the alveolus

•  It may occur as an isolated clinical entity or in conjunction with any other soft tissue or facial bone fracture

•  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)



• RTA (minor accidents)

• Collisions and falls

• Cycling accidents

• Epileptic seizures

• Iatrogenic damage during:

•Extraction of teeth

•Endoscopy procedure

•Endotreacheal intubation


Classification of dento-alveolar injuries
(Andreasen & Andreasen 1994)

•   Dental hard tissue injury

Crown infracture and fracture with or without root fracture

•   Periodontal injury

Concussion, subluxation, intrusion, extrusion, lateral luxation, avulsion

•   Alveolar bone injury

Intrusion of teeth with fracture of socket, alveolus or jaws

•   Gingival injury

contusion, abrasion, laceration, degloving

•   Combination of the above

Dental hard tissue injury

•   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

•   Upper teeth intrusion are more frequent and impact against lower teeth may lead to vertical splitting

•   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

•   Early treatment is imperative to relieve pain and preserve tooth

Treatment objectives

Preservation of damaged teeth depends on:

•Complexity 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

Injuries to the primary dentition

–    70% involve maxillary central incisors

–    Intrusion, lateral luxation and avulsion are the commonest

–    Intruded teeth are likely to normally erupt spontaneously

–    Damage to developing permanent teeth by displaced tooth are recognizable problem


•    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

Management of injuries to permanent dentition

•  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:

» Rigid splinting for a minimum of 8 weeks

» Devitlaiztion (RCT) with eventful apico surgery

» Orthodontic extrusion or crown lengthening

Injuries to periodontal tissues

•  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, canal obliteration, ankylosis and loss of alveolar bone

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,

• Vacum formed splint

•   Avulsed teeth necessities immediate 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

Alveolar fracture

•    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

•    Alveolar fracture in mandible my go along with mandible fracture and impacted fracture into the maxilla may appear to be immobile

•    Midline split of palate with unilateral Le Fort I lead to large dento-alveolar fracture

•    Fracture of tuberosity and fracture of antral floor is a recognized complication of upper molars extraction

Management of injuries to the alveolar bone
(Block or plate fracture)

•  Finger manipulation

•  Reduction (closed ) and fixation

•  Rigid wire and composite splint

•  Elimination of premature contact and occlusal trauma

•  Short inter-maxillary fixation

Management of tuberosity fracture

•  Removal of comminuted fracture of loss alveolar bone and teeth and repair of soft tissue

•  Delay of extraction of teeth in case of tuberosity fracture for (6-8 weeks)

•  Mandatory extraction of  a tooth from a block fracture should be carried out surgically

•  Splinting of a tooth of fractured tuberodity in to other standing teeth for one month

Injuries to the gingival and soft tissues

•  Damage to the lip observed more with anterior dento-alveolar fracture

•  Embedded of portion of a tooth or foreign bodies  in soft tissues is very substantial

•  Laceration of the gingiva is associated with dento-alveolar fracture

•  Degloving of the mental region is a common injury to the lower anterior teeth

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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