Maxillofacial Trauma: Dento-alveolar fractures | PPT

Maxillofacial Trauma: Dento-alveolar fractures | PPT

PowerPoint lecture slide

Size: 2.71 MB

Download

---

Definition

•  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)

 

Etiology

• 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

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

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

Tags: Classification of dento-alveolar injuries, Dental hard tissue injury, Injuries to periodontal tissues, Injuries to the primary dentition, Management of injuries to permanent dentition, Management of injuries to the periodontal tissues, Management of soft tissue injuries, Management of tuberosity fracture

Category: Lectures, Oral surgery