Dento alveloar injury hands out

Dento-Alveolar
trauma
Islam Kassem,BDS,MSc,FDS RCS
Oral &Maxillofacial Surgeon
27 Jan 2018
Copy Right 2018

Islam Kassem
• BDS Alexandria Dental school 2002
• MSc Oral & Maxillofacial surgery 2008
• MFDS RCS Ed 2005
• MOMS RCPS Glasg 2009
• FFD RCSI OS OM 2011
• AO-CMF Fellowship 2012
• American Aesthetic fellowship diploma 2013
• Implant Diploma Napoli university 2014
• Laser Diploma ALD 2015
• Oral & Maxillofacial Surgeon

Declaration 
• There is no conflict of interest in this
Lecture .
• I have no monetary benefit from this
Lecture.
• No implied sponsorship by any company to
the speaker
• all photographed patients were treated by
the speaker and consented for
photographing and public publishing
ikassem@dr.com

Learning objectives
• Diagnosis of Dentoalveolar
• Understanding the recent approach for first aid trauma
• In office treatment of Dentoalvelar trauma
• Maxillofacial trauma as Red flag
• Biostimulation in dentoalveolar trauma
• Delayed complication of improper management of
dentoalvolar trauma

If yes , you will
enjoy like them

Traumatic injuries to
the teeth

Definition :
Injury which is limited to the teeth
and supporting structures of the
alveolus. either isolated or with
basal bone.

Diagnosis
History
Clinical
examination Vitality test
Radiographic
Examination

1) Personal history
2) medical history
3) Previous dental history
4) History of trauma (when ,how ,where )
(1)History

1) When did the accident occur ?
The shorter the time between accident and treatment
the better prognosis.
2) where did the accident occur ?
If the accident occurred in dirty place prophylactic tetanus
is indicated
3) how did the injury occur ?
Direct force under the chin → → condylar fracture
Direct force to teeth → → Crown F, Root F, displacement
History of trauma

Pre-School Child:
☼ Fall injuries.
☼ Child abuse.
☼ Injury during play.
☼ Seizures.
School Age:
☼ Athletic injuries.
☼ Fighting.
☼ Auto accidents.
☼ Seizure disorders.

Type of trauma
☼ Direct trauma :
When the tooth itself is
struck
☼ Indirect trauma:
When the lower dental
arch is forcefully closed
against the upper

ikassem@dr.com
Common mechanism of facial fracture in auto accidents

ikassem@dr.com
Mechanism, characterization, incidence

Extraoral Examination
Laceration ; Abrasions ; Contusions on
the head and neck can be noted visually
Any asymmetries including deviation in
mouth opening.
Intraoral Examination
Soft tissue ( tongue ; gingiva .. )
Teeth ( displacement ; mobility ; tooth fracture ; colour
change )
(2)Clinical Examination
ikassem@dr.com

Inspection
ikassem@dr.com
Sublingual ecchymosis Step defects, ridge
discontinuity, malocclusion

Can mandibular Fracture kill the patient?
ikassem@dr.com

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
(3)Vitality test

Treatment
*soft tissue injuries
1- Determination of child immunization status:-
•If the child had received a primary immunization
activated with booster injection of toxoid .
•Unimmunized child can be protected by tetanus
antitoxin.
2- Adequate debridment of the wound

1- stage of root formation
2- presence of root fracture
3- periapical radiolucencies
4- injury of the supporting periodontal membrane
(degree of intrusion or extrusion of the tooth)
5- size of the pulp
N. B. If a jaw fracture is suspected extaoral radiographs
indicated (panoramic and lateral oblique views )
(4)Radiographic Examination

Diagnosis of Maxillofacial Injuries
■ DIAGNOSTIC IMAGING
– Panorex
– Plain films
– CT
– Stereolithography
ikassem@dr.com

Bilateral symmetrical open bite
ikassem@dr.com
If undiagnosed

Ellis classification 
Class I: Enamel fracture
Class II: Enamel and dentin fracture without pulp exposure
Class III: Crown fracture with pulp exposure
Class IV: Traumatized tooth that has become non-vital with or without loss of tooth structure
Class V: Teeth lost as a result of trauma (Avulsion)
Class VI: Fracture of root with or without loss of crown structure
Class VII: Displacement of the tooth without fracture of crown or root
Class VIII: Fracture of the crown en masse and its replacement
Class IX: Fracture of deciduous teeth

Enamel fracture
Class I
A fracture confined to the enamel with loss of tooth structure

Class II 
 
Enamel-dentin fracture
A fracture confined to enamel and dentin with loss of tooth structure
but not involving the pulp

Class III 
Enamel-dentin-pulp fracture  
A fracture involving enamel and dentin with loss of tooth
structure and exposure of the pulp

Tooth becomes non-vital
Class IV
Traumatized tooth that has become non-vital with or without loss of
tooth structure

Class V 
Avulsion
Teeth loss due to trauma

Class VI 
Root Fracture
Fracture of root with or without loss of crown structure

Tooth displacement
Class VII
Displacement of the tooth without fracture of crown or
root

Fracture of crown en masse or its replacement
Class VIII
Complete fracture of the crown

Class IX
Injuries to the primary teeth
Any injury to the primary tooth

Treatment of various dental fractures

Instructions to the patient on Telephone

First aid for avulsed teeth
Keep the patient calm
Find the tooth & pick
it up by the crown
Clean the tooth Place the tooth in a
suitable storage medium
Seek emergency dental treatment immediately

Patient instructions
Avoid participation in contact sports Soft food for up to 2 weeks
Brush teeth with a soft toothbrush after
each meal
Use a chlorhexidine (0.1 %) mouth
rinse twice a day for 1 week.

• 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
Alveolar fracture

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 .

Stabilization periods for dentoalveolar injury
Duration of
immobilization
Dentoalveolar injury
days 10 _ 7Mobile tooth (1
weeks 3 _ 2Tooth displacement (2
months 4 _ 2Root fracture(3
days 10 _ 7Avulsion (4
weeks 6 _ 4Alveolar fracture (5

ikassem@dr.com
Closed reduction

Basal Bone associated
ikassem@dr.com

Mandibular Fractures
■ Mandible is second most
common fractured facial
bone
■ 50% of mandibular
fractures are multiple
– Examine patient and
radiographs closely and
suspect additional
fractures
ikassem@dr.com

Mandibular Fractures
■ Clinical Signs and
Symptoms
– Tenderness & pain
– Malocclusion
– Ecchymosis in floor of
mouth
– Mucosal lacerations
– Step defects inferior border
– CN V3 Disturbances
ikassem@dr.com

ikassem@dr.com
Direction of fracture
PREVENTS
displacement
Direction of fracture
PERMITS
displacement

ikassem@dr.com
Fracture unreduced,
teeth not occluding
Fracture reduced, teeth
occluding correctly

Closed Reduction with IMF
ikassem@dr.com

Energy Production - Components
NADH Dehydrogenase
ATP Synthase
Cytochrome bc1
Complex
Cytochrome c Oxidase

Electron Transport Chain
H+ H+H+
H+
H+
H+
ADP ATP

Effect of Red and Infrared Light
H+ H+ H+ H+ H+ H+
H+
H+
H+
ADP ATP

Put title of slide here
Laser Therapy Effects
Primary
– The light is absorbed by
cytochrome c oxidase
Secondary
– Release of NO into
endothelium of blood
vessels
– Small increases in free
radicals
– Increased proton gradient
in mitochondria
Clinical
– Wound Healing,
Acceleration of the
Inflammatory Process and
Pain Influence

Treatments with low-level laser applications may be
evaluated as noninvasive alternative treatment options
in comparison with endodontic treatment for teeth with
extrusive luxation greater than 2 mm.
Low-level laser therapy effects in traumatized permanent teeth with extrusive luxation in an orthodontic patient
Ilker Gö rü ra
; Kaan Orhanb
; Deniz C. Can-Karabulutc
; Ayse Isıl Orhand
; Adnan Ö ztü rke

References
Gabris K, Tarjan I, Rozsa N. Dental trauma in children presenting for treatment at the Department of Dentistry for Children and Orthodontics, Budapest,
1985-1999. Dent Traumatol 2001;17:103-8.
Rajab LD. Traumatic dental injuries in children presenting for treatment at the Department of Pediatric Dentistry, Faculty of Dentistry, University of Jordan,
1997-2000. Dent Traumatol 2003;19:6-11.
Rezende FM, Gaujac C, Rocha AC, Peres MP. A prospec- tive study of dentoalveolar trauma at the Hospital das Clı ́nicas, Sao Paulo University Medical School.
Clinics (Sao Paulo) 2007;62:133-8. Ekanayake L, Perera L. Pattern of traumatic dental injuries in children attending the University Dental Hospital, Sri
Lanka. Dent Traumatol 2008;24:471-4.
Love RM, Ponnambalam Y. Dental and maxillofacial skeletal injuries seen at the University of Otago School of Dentistry, New Zealand 2000-2004. Dent
Traumatol 2008;24:170-6.
Ivancic Jokic N, Bakarcic D, Fugosic V, Majstorovic M, Skrinjaric I. Dental trauma in children and young adults visiting a University Dental Clinic. Dent
Traumatol 2009;25:84-7.
Eilert-Petersson E, Andersson L, Sorensen S. Trau- Stomatologija, Baltic Dental and Maxillofacial Journal, 2014, Vol. 16, No. 1
Marcenes W, Al Beiruti N, Tayfour D, Issa S. Epide- miology of dental injuries to the permanent incisors of 9-12-year-old schoolchildren in Damascus, Syria.
Endod Dent Traumatol 1999;15:117-23.
Granville-Garcia AF, de Menezes VA, de Lira PIC. Dental trauma and associated factors in Brazilian preschoolers. Dent Traumatol 2006;22:318-22.
Artun J, Behbehani F, Al-Jame B, Kerosuo H. Incisor trauma in an adolescent Arab population. Prevalence, se- verity and occlusal risk factors. Am J Orthod
Dentofacial Orthop 2005;128:347-52.

THANK YOU FOR YOUR ATTENTION! 
PLEASE DON'T ASK DIFFICULT QUESTIONS ☺

Dento alveloar injury hands out

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Semelhante a Dento alveloar injury hands out

Semelhante a Dento alveloar injury hands out (20)

Mais de Islam Kassem

Mais de Islam Kassem (20)

Último

Último (20)

Dento alveloar injury hands out