Presentation on theme: "Treatment of dento-alveolar injuries"— Presentation transcript:
1Treatment of dento-alveolar injuries Dr. Mohammad A. Barayan
2N.B Boys are three times more at risk than girls. Definition :Injury which is limited to the teeth and supporting structures of the alveolus.N.B Boys are three times more at risk than girls.Causes :1- Traffic Accident.2- Falls.3- During Epileptic seizures.4- Sport injuries.
43) Previous dental history 4) History of trauma (when ,how ,where ) 1) Personal history2) medical history3) Previous dental history4) History of trauma (when ,how ,where )
52) where did the accident occur ? History of trauma1) 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 indicated3) how did the injury occur ?Direct force under the chin → → condylar fractureDirect force to teeth → → Crown F, Root F, displacement
6(2)Clinical Examination Extraoral ExaminationLaceration ; Abrasions ; Contusions on the head and neck can be noted visuallyAny asymmetries including deviation in mouth opening.Intraoral ExaminationSoft tissue ( tongue ; gingiva .. )Teeth ( displacement ; mobility ; tooth fracture ; colour change )Begins immediately when the patient enters the office . Hematoma in the fioor of the moth indicate mand F . If ther is more than 2 teeth alveolar F should be suspected . Non vital tooth often appear dis colored
7(3)Vitality testVitality test just following traumatic injury often given false negative responseTypes of vitality test1) Thermal pulp testcold testheat test2) Electrical pulp test3) Cavity test
8Treatment *soft tissue injuries 2- Adequate debridment of the wound 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
9(4)Radiographic Examination 1- stage of root formation2- presence of root fractur3- periapical radiolucencies4- injury of the supporting periodontal membrane(degree of intrusion or extrusion o the tooth)5- size of the pulpN. B. If a jaw fracture is suspected extaoral radiographs indicated (panoramic and lateral oblique views )All traumatized teeth should be take a x-ray
10Classification of tooth fracture Ellis classification:Class I:crack or fracture of E onlyClass II:fracture of E , D with out pulp exposureClass III:fracture of E , D with pulp exposureClass IV:Fracture line passes beneath the gingival marginClass V:Root fracturea) vertical b) horizontal (apical , middle , cervical)There are more than 2 classification for classifyng dental trauma but the ellis classifictaion is the most famous and used
11Class I : 1- a crack of the enamel without loss of tooth structure. Do not require immediate treatment.2- fracture of enamel only smoothing the sharp edgeregular vitality test , radiographIf the patient came immediately after the trauma (vitality t ,x-ry) very important to provide the basis for comparison of subsequent examination if the patient came very late (no apparent effect or dest calcification or necrosis or resoption )
12Class II : Immediate treatment of the crown is required to: 1) protect the pulp2) restore the esthetics and function.Cover the expose of the dentine by a layer of calcium hydroxide to reparative dentine formation.A- Reattachment of tooth fragment.B- Acid-etch composite resin restoration
13Class III : The treatment depends on many factors such as: 1) vitality of the exposed pulp.2) Size of the exposure.3) Time elapsed since the exposure.4) Degree of root maturation.5) Restorability of the fractured crown.The main objective of treatment is to maintain the vitality of the tooth.
14Direct pulp capping Large exposure Small exposure Late Early Closed openclosedCloseOpenpulpectomyPulpectomyApexificationPulpotomypulpotomyDirect pulp capping
161- tooth can be extruded orthodontically Class IV :Treatment usually involve removing the loose fragment .1- tooth can be extruded orthodontically2- crown lengthening to gain access to placement of restoration.
17Class v : 1) Horizontal Root fracture When the fracture occur near the apical 1/3, the prognosis is more favourable than the middle or cervical 1/3 because :1) more alveolar support2) immobilization of the tooth is much easierTreatment of root fracture depends upon :1) Condition of the pulp2) amount of mobility or the level of the fracture lineIf you tack x_ray immediately following the trauma may be not see the R F , tack anther x-ray after 1-2 weeks . If the F segments close proximity and the pulp remain vital callus may reunite the two segments
181) reduction , splinting the tooth (A) apical 1/3 root fracture1) reduction , splinting the tooth2)the tooth should be checked periodically for vitality and radiograph.Reduce the occ surface Digital pressure , composite splint .
19(B) middle 1/3 root fracture : 1) reduction , splinting the tooth2)the patient recall 2-3 months , checked the vitality ,radiograph3)if the tooth non vital and no healing the following treatment is performed:a) R C T of both fragmentsb) apical fragment removed surgicallyc) intraradicular pin to stabilize both segments
20(C) cervical 1/3 root fracture : 1)reductin , splinting the tooth2)recall the patient periodically and checked the vitality and radiograph3)if there is radiolucent and pulp necrosis the following treatment is performeda) extraction the toothb) removed the apical fragment and endo-osseous implant placedc) orthodontic extrusiond) if the fracture is 1-2mm infrabony remove the coronal segment and osteoplasty to expose the root
212) vertical root fracture : usually the prognosis is not favorabletreatment of V R F :1)extraction of the tooth2)using co2 laser and ND:YAG laser beam
22* ConcussionA mild blow to the tooth resulting in mild sensitivity requires little or no treatmentNeed only regular vitality test
23*subluxation Mobility of the tooth without displacement Tooth may be sensitive to percussionIf mobility is extensive splint the tooth using the acid –etch splinting technique.Regular vitality test and radiographOften hemorrhage around the gingival margin Toled don’t use the affected tooth , reduce the occlusion
25Displacement of the tooth in any direction other than the axial one 1) Lateral luxation :Displacement of the tooth in any direction other than the axial oneIf the patient comes immediately after trauma reposition, splintingOnce the tooth have solidified in their position orthodontic treatment is requiredThe root displaced on the opposite direction to the crown . There is mobility and tender to percussion . X-ray widening in PDL . The prognosis for tooth retention is fair and for pulp retention it is poor
261) Intrusion: Displacement the tooth into the socket A) primary tooth: will re-erupted over a period of few months. If the intruded tooth is in contact with underlying permanent tooth should be removeB) permanent tooth:a) immediate surgical repositioning , splintingb) orthodontic extrusionc) incomplete root formation the tooth will erupt spontaneouslyThe crown appear short . Discontanus PMS . . Almost pulp is necrosis especially in mature apex . Tender to percussion no mobility . External R resoripion, loss of marginal bony support complcation of surgical reposition
272) Extrusion : Partially displacement the tooth out of the socket . A) primary tooth: Treatment usually extractedB) permanent tooth :reposition and splintingIf the vitality of tooth is lost start root treatment immediately placing calciumhydroxide in the canal for 6-12 month followed permanent filling.The crown appear long . Mobility
28Complete displacement of the tooth from the socket . 3) Avulsion:Complete displacement of the tooth from the socket .There are tow important factors to be consider in cases of avulsion1)time between the injury and treatment2)condition under which the tooth have been restoredThe tooth must be kept moist to prevent damage to the fibers of PDL
29In many cases the initial patient contact is by phone The tooth should be handled by the crownThe tooth should be placed in suitable storage medium (milk, unsalted water, lens solution )or in buccal vestibule or under the tongue .At the dental office :a) information about tetanus immunization should be obtainedb) replantation , splinting for 1_2weeks but in immature apices 2-3weeksc) calcium hydroxide should be placedd) RCTPrimary tooth: usually the treatment is extraction
30Alveolar fracture there may be concomitant injuries Small fracture through the alveolarprocess.there may be concomitant injuries(crown, root fracture and soft tissue) managed by referral to an oral and maxillofacial surgery .Treatment: redaction , splinting
31Types of splinting : 1) acid_etched composite splinting 2) Interdental wiring3) ( vacuum_formed plastic) splint4) arch bare splintMore rigid and the longer the stabilization, the more root resorption , ankylosis that can be expected .we can used the Composite with orthodontic wire or heavy nylon suture
32Stabilization periods for dentoalveolar injury Duration of immobilizationDentoalveolar injury7 _ 10 days1) Mobile tooth2 _ 3 weeks2) Tooth displacement2 _ 4 months3)Root fracture4) Avulsion4 _ 6 weeks5) Alveolar fracture
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