Fractures of the Teeth & Jaws
Joseph L. McQuirter, DDSOral and Maxillofacial
Surgery
Fractures of the Teeth & Jaws(Orofacial Fractures)
Dentoalveolar (teeth and surrounding bone)
Mandibular (lower jaw)
Maxillary (upper jaw)
Learning Objectives
List the types of orofacial injuries
List anatomic structures commonly affected by orofacial injuries
Describe functional impairments resulting from orfacial fractures
Explain the mechanism of injury for orofacial fractures
Become familiar with the diagnostic work up for patients presenting orofacial injury
List the treatment options and surgical intervention for orofacial fractures
Understand the approach to treatment for specific orofacial fractures
List common early and late complications of orofacial injuries
Fractures of the Teeth and Jaws
Dentoalveolar
Mandibular
Maxillary
When facial bones break
How effective are our attempts to repair?
» Vehicular Injury
» Sports
» Falls
» Assault
»Domestic
»Workplace
»Associated with Crime
» Interpersonal Conflicts
» Self Inflicted
» High Impact
» Low Impact
» Penetrating
High Impact Facial Fractures
Vehicular high speed
deceleration type-injury
Sports Related Injuries (low impact)
Rihanna
Lucy Newman
» Assault»Domestic
»Workplace
»Associated with Crime
» Interpersonal Conflicts
Fist blow to face
Sports Safety Equipment
In spite of our best efforts and millions being spent to protect and ensure safety
there are still unexplained injuries
Fractures of the Teeth and Jaws
Dentoalveolar
Mandibular
Maxillary
Dento alveolar Fractures(Dental / Tooth) (Alveolar Bone)
Dental
Alveolar Bone
Dentoalveolar Fractures Fracture of teeth and adjacent alveolar bone
Classification of Tooth Injuries 1. Fracture of tooth crown without pulp involvement
2. Fracture of tooth crown with pulp involvement
3. Crown root fractures
4. Root fractures
5. Concussion injuries
6. Luxation injuries
7. Tooth avulsion (Exarticulation)
123
4
Alveolar Bone Fractures
Diagnosis – Dentoalveolar injuries
1. Clasic signs of inflammation from injury (Pain, swelling, redness) 2. Mobility
3. Malocclusion (malaligned/displaced teeth)
Etiology of Dentoalveolar Injuries
1. Altercations2. Falls3. Seizure disorders4. Sporting activity5. Vehicular injuries6. Endoscopic procedures (anesthesia intubation)7. Abusive behavior8. Mental health disorders
Treatment Objective
1. RESTORE FORM
2. RESTORE FUNCTION
RESTORE FORM
~ Place displaced teeth of tooth/bone segment back to their natural position
~ Stabilize repositioned teeth/bone segment
RESTORE FUNCTION
~ Normal bite - Non injured teeth should come together without interference from the displaced/fractured segments.
~ Preserve vitality of dislodged teeth or dentoalveolar segment
Prognosis is Dependent on Viability of Pulp and Periodontal Tissues
Injuries to the tooth 1. Fracture of tooth crown without pulp involvement
2. Fracture of tooth crown with pulp involvement
3. Crown root fractures
4. Root fractures
5. Concussion injuries
6. Luxation injuries
7. Tooth avulsion (Exarticulation)
123
4
Root CanalTreatmentLikely
Injuries to the tooth 1. Fracture of tooth crown without pulp involvement
2. Fracture of tooth crown with pulp involvement
3. Crown root fractures
4. Root fractures
5. Concussion injuries
6. Luxation injuries
7. Tooth avulsion (Exarticulation)
Requires reduction and stabilization
Requires reimplantation
and stabilization
IntrudedTooth
ExtrudedTooth
Avulsed Tooth
TOOTH AVULSION
Out of mouth for less than 2 hours
1. Reimplant immediately if possible2. Transport in Hank’s solution, milk, saline or saliva (mouth)3. Provide local anesthesia 4. Saline irrigation and gentle evacuation of blood from socket5. Reimplant tooth and stabilize
Transport media for the avulsed tooth1. In the tooth socket2. Saliva (in the mouth)3. Milk4. Hank’s balanced salt solution 5. ViaSpan cold storage solution
PRESERVING THE AVULSED TOOTH
ViaSpan, cold storage solution is currently available as an organ transport solution
Hank’s balanced salt solution, commercially available as : Save-A-Tooth (Phoenix Lazarus, Inc.)(Save-A-Tooth is a mainstay in many athletic first aid kits)
Reduce Dentoalveolar Fractures
Simple, non-traumatic stabilization for
mobile teeth and dentoalveolar fractures
COMPLICATIONS OF DENTAL INJURIESMissing teeth, tooth fragments, broken fillings, appliances must be accounted for ~ Aspirated ~ Ingested
~ Witnessed expelled tooth at the injury locationTraumatic occlusionInfectionLoss of Teeth and BoneAssociated injuries
~ Blunt head trauma~ Soft tissue injuries
~ Bleeding ~ Infection risk (Tetanus prophylaxis /risk)
Ingested Tooth
Aspirated Tooth
Tongue Bite - Look for Tooth Fragment
Tooth Fragment in Lip
McQuirter JL, et al. Elevated Blood Lead Resulting from Maxillofacial Gunshot Injuries: Three Case Reports of Ingested Lead Particles after Gunshot Injury to the Face. J Oral Maxillofac Surg 61(5):593-603, 2003.
Molar tooth dislodged to mid-tongue area from gunshot injury
LATE COMPLICATIONS
•Infection
•Ankylosis of Teeth •Devitalization/Discoloration of Teeth
•Loss of Teeth/Dentoalveloar Segment
Dentoalveolar segment loss due to periodontal disease compromising interdental blood supply
Fractures of the Teeth and Jaws
Dentoalveolar
Mandibular
Maxillary
Mandibular Fractures
Diagnosis
Clinical/Physical Findings Diagnostic Studies
Clinical Findings
Altered FormAltered Function
Altered Form
> Swelling
>Displacement of Anatomical parts
>Decreased Muscle Tone
Swelling and bleeding
Step / Gap defect in dental arch
Displaced anatomy in both jaws
Superimposition of other anatomical parts sometimes makes radiographic diagnosis difficult
Clinical confirmation of suspected fracture
Altered Function> Occlusal Abnormalities > Decrease Range of Motion> Deviation of Jaw with Opening> Altered mental nerve function> Structural Integrity of the
Bone> Compromised of Host
Defense > Soft Tissue Compromise> Speech> Swallowing> Respiration> Bleeding
Bimanual palpation of themandible in a cephalad position allows excellent evaluation and comparison ofthe anatomic structures
The application of gentle bimanual pressure over the angle regions can unmask a minimally displaced fracture in the anterior region of the mandible.
Treatment Objective
1. RESTORE FORM
2. RESTORE FUNCTION