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This document discusses dentoalveolar trauma, including diagnosis, clinical examination, radiographic examination, classification, and treatment. It covers obtaining a thorough history of the trauma and examining the soft tissues, teeth, and bone clinically and radiographically. Ellis' classification of dental injuries is described. Treatment depends on the class of injury and may include splinting, stabilization, root canal treatment, or referral for surgery. Low-level laser therapy can aid in healing. Management aims to reduce complications and promote healing of injured tissues.
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trauma.pdf
- 1. Dentoalveolar Trauma Islam Kassem,FDS RCS Consultant Maxillofacial Surgeon Copy Right 2018
- 2. • Diagnosis of Dentoalveolar • Understanding the recent approach for fi rst aid trauma • In of fi ce treatment of Dentoalvelar trauma • Maxillofacial trauma as Red fl ag • Biostimulation in dentoalveolar trauma • Delayed complication of improper management of dentoalvolar trauma
- 3. Do you see this before?
- 4. If yes , you will enjoy like them
- 5. Traumatic injuries to the teeth
- 6. Definition : Injury which is limited to the teeth and supporting structures of the alveolus. either isolated or with basal bone.
- 8. 1) Personal history 2) medical history 3) Previous dental history 4) History of trauma (when ,how ,where ) (1)History
- 9. 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
- 10. Pre-School Child: ☼ Fall injuries. ☼ Child abuse. ☼ Injury during play. ☼ Seizures. School Age: ☼ Athletic injuries. ☼ Fighting. ☼ Auto accidents. ☼ Seizure disorders.
- 11. Type of trauma ☼ Direct trauma : When the tooth itself is struck ☼ Indirect trauma: When the lower dental arch is forcefully closed against the upper
- 12. ikassem@dr.com Common mechanism of facial fracture in auto accidents
- 14. ikassem@dr.com
- 15. 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
- 16. Inspection ikassem@dr.com Sublingual ecchymosis Step defects, ridge discontinuity, malocclusion
- 17. Don’t forget
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- 22. 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
- 23. Treatment *soft tissue injurie s 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
- 24. 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
- 25. Diagnosis of Maxillofacial Injuries ■ DIAGNOSTIC IMAGING – Panorex – Plain films – CT – Stereolithography ikassem@dr.com
- 28. ikassem@dr.com
- 29. Do you know him?
- 30. Bilateral symmetrical open bite ikassem@dr.com If undiagnosed
- 31. 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
- 32. Enamel fracture Class I A fracture confined to the enamel with loss of tooth structure
- 33. Class II Enamel-dentin fracture A fracture confined to enamel and dentin with loss of tooth structure but not involving the pulp
- 34. Class III Enamel-dentin-pulp fracture A fracture involving enamel and dentin with loss of tooth structure and exposure of the pulp
- 35. Apexification :
- 36. Tooth becomes non-vital Class IV Traumatized tooth that has become non-vital with or without loss of tooth structure
- 37. Class V Avulsion Teeth loss due to trauma
- 38. Class VI Root Fracture Fracture of root with or without loss of crown structure
- 39. Tooth displacement Class VII Displacement of the tooth without fracture of crown or root
- 40. Fracture of crown en masse or its replacement Class VIII Complete fracture of the crown
- 41. Class IX Injuries to the primary teeth Any injury to the primary tooth
- 42. Treatment of various dental fractures
- 44. 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
- 45. 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.
- 47. • 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
- 48. HOW TO MANAGE • Isolated or with basal bone • Teeth vital or no • Closed or open reduction • Internal fixation or splinting
- 50. 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 .
- 52. Stabilization periods for dentoalveolar injury Duration of immobilization Dentoalveolar injury days 10 _ 7 Mobile tooth (1 weeks 3 _ 2 Tooth displacement (2 months 4 _ 2 Root fracture(3 days 10 _ 7 Avulsion (4 weeks 6 _ 4 Alveolar fracture (5
- 55. 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
- 56. 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
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- 60. 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
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- 66. ikassem@dr.com
- 68. Energy Production - Components NADH Dehydrogenase ATP Synthase Cytochrome bc1 Complex Cytochrome c Oxidase
- 69. Electron Transport Chain H+ H+ H+ H+ H+ H+ ADP ATP
- 70. Effect of Red and Infrared Light H+ H+ H+ H+ H+ H+ H+ H+ H+ ADP ATP
- 71. 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
- 73. 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