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Maxillofacial Trauma

Dento-alveolar fractures
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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)

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Etiology

RTA (minor accidents)


Collisions and falls
Cycling accidents
Epileptic seizures
Iatrogenic damage during:

Extraction of teeth
Endoscopy procedure
Endotreacheal intubation

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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


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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
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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

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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
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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
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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
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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
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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
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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

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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
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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

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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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