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Fractures of the Teeth & Jaws
Joseph L. McQuirter, DDSOral and Maxillofacial
Surgery
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Fractures of the Teeth & Jaws(Orofacial Fractures)
Dentoalveolar (teeth and surrounding bone)
Mandibular (lower jaw)
Maxillary (upper jaw)
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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
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Fractures of the Teeth and Jaws
Dentoalveolar
Mandibular
Maxillary
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When facial bones break
How effective are our attempts to repair?
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» Vehicular Injury
» Sports
» Falls
» Assault
»Domestic
»Workplace
»Associated with Crime
» Interpersonal Conflicts
» Self Inflicted
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» High Impact
» Low Impact
» Penetrating
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High Impact Facial Fractures
Vehicular high speed
deceleration type-injury
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Sports Related Injuries (low impact)
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Rihanna
Lucy Newman
» Assault»Domestic
»Workplace
»Associated with Crime
» Interpersonal Conflicts
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Fist blow to face
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Sports Safety Equipment
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In spite of our best efforts and millions being spent to protect and ensure safety
there are still unexplained injuries
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Fractures of the Teeth and Jaws
Dentoalveolar
Mandibular
Maxillary
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Dento alveolar Fractures(Dental / Tooth) (Alveolar Bone)
Dental
Alveolar Bone
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Dentoalveolar Fractures Fracture of teeth and adjacent alveolar bone
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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)
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Alveolar Bone Fractures
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Diagnosis – Dentoalveolar injuries
1. Clasic signs of inflammation from injury (Pain, swelling, redness) 2. Mobility
3. Malocclusion (malaligned/displaced teeth)
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Etiology of Dentoalveolar Injuries
1. Altercations2. Falls3. Seizure disorders4. Sporting activity5. Vehicular injuries6. Endoscopic procedures (anesthesia intubation)7. Abusive behavior8. Mental health disorders
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Treatment Objective
1. RESTORE FORM
2. RESTORE FUNCTION
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RESTORE FORM
~ Place displaced teeth of tooth/bone segment back to their natural position
~ Stabilize repositioned teeth/bone segment
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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
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Prognosis is Dependent on Viability of Pulp and Periodontal Tissues
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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
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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
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IntrudedTooth
ExtrudedTooth
Avulsed Tooth
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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
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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
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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)
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Reduce Dentoalveolar Fractures
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Simple, non-traumatic stabilization for
mobile teeth and dentoalveolar fractures
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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)
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Ingested Tooth
Aspirated Tooth
Tongue Bite - Look for Tooth Fragment
Tooth Fragment in Lip
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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.
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Molar tooth dislodged to mid-tongue area from gunshot injury
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LATE COMPLICATIONS
•Infection
•Ankylosis of Teeth •Devitalization/Discoloration of Teeth
•Loss of Teeth/Dentoalveloar Segment
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Dentoalveolar segment loss due to periodontal disease compromising interdental blood supply
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Fractures of the Teeth and Jaws
Dentoalveolar
Mandibular
Maxillary
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Mandibular Fractures
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Diagnosis
Clinical/Physical Findings Diagnostic Studies
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Clinical Findings
Altered FormAltered Function
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Altered Form
> Swelling
>Displacement of Anatomical parts
>Decreased Muscle Tone
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Swelling and bleeding
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Step / Gap defect in dental arch
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Displaced anatomy in both jaws
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Superimposition of other anatomical parts sometimes makes radiographic diagnosis difficult
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Clinical confirmation of suspected fracture
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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
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Bimanual palpation of themandible in a cephalad position allows excellent evaluation and comparison ofthe anatomic structures
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The application of gentle bimanual pressure over the angle regions can unmask a minimally displaced fracture in the anterior region of the mandible.
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Treatment Objective
1. RESTORE FORM
2. RESTORE FUNCTION