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)

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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)

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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