Maxillofacial Trauma Dentoalveolar fractures

1
Maxillofacial TraumaDento-alveolar fractures
2
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)

3
Etiology

• RTA (minor accidents)
• Collisions and falls
• Cycling accidents
• Epileptic seizures
• Iatrogenic damage during
• Extraction of teeth
• Endoscopy procedure
• Endotreacheal intubation

4
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

5
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

6
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

7
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

8
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

9
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

10
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

11
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

12
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

13
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

14
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

15
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

16
(No Transcript)