Dentoalveolar Fractures

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DENTOALVEOLAR FRACTURES

DENTOALVEOLAR FRACTURES

Dentoalveolar fractures involves the bone surrounding the teeth without involving the deeper bone of the upper or lower jaw. They occur in the age group of 8–12 years as children are more engaged in physical activities and contact sports. They  involve teeth, soft tissues, and surrounding bone.

Time elapsed after such injuries plays a major role in determining the outcome of the intervention. Apart from  the previous position of the fractured tooth in its socket, the treatment goal is to achieve good occlusion (bite) and contour.

DENTOALVEOLAR FRACTURES

Diagnosis and Treatment Planning

Based on three vital information from the patient or their attenders:

  • Time interval between injury and treatment may significantly affect the condition for cases of pulp exposure and displacement
  • The place of injury : The injury of the teeth getting infected on a playground is high compared to an injury occurred at home in cleaner surroundings. The place of injury has medico-legal repercussions in case of any assault or accident has occurred at the place of work. Depending on the cleanliness, the physician can also consider protection against tetanus.
  • Any other associated like soft tissue injuries secondary to the trauma
DENTOALVEOLAR FRACTURES

Reason for Dentoalveolar Injuries in children

  • Bicycle injuries
  • Falls Sports injuries
  • Car crashes
  • Child abuse
  • Iatrogenic injuries(dental extractions, endoscopy, oral intubation)
  • Industrial accidents
DENTOALVEOLAR FRACTURES

Reason for Dentoalveolar Injuries in Adult patients

  • Motor vehicular accidents
  • Interpersonal violence
  • Sports injuries(contact injuries)
  • Falls
  • Work-related trauma

What should a patient or parent do when the tooth is out ?

  • To hold the tooth by its head and not to touch the root surface.
  • To rinse the tooth immediately with tap water or salt water solution or saliva and replace the tooth in the socket.
  • If the patient cannot replace the tooth, the tooth shoulbe be held between the cheeks and teeth (only if patient is fully conscious).
  • Gentle wash with saline or gauze soaked with saline can be done to remove blood clots or foreign objects from the root surface.

What the patient should not do:

    • No effort should be made to rub or clean the root of the tooth because this would damage the remaining periodontal ligament on the root surface.
DENTOALVEOLAR FRACTURES

Storage and Transportation Media

If the tooth cannot be replaced within 5 min or more, it should be stored in a medium or container that will maintain its vitality and root surface structures.

Transportation media for avulsed teeth include

    1. Viaspan: a specialized tissue storage media
    2. Hanks balanced salt solution: it has physiologic with compatible pH and osmolality. it is easily available and cost-effective .
    3. Commercial products are designed especially for storing avulsed teeth.
    4. Milk: is a readily available medium. It can be used in the abscenes of Hanks or saline. Milk will only prevent further cellular demise and is used specifically when the teeth has been outside in the environment for less than 20 min.
    5. Saliva: is an excellent transport medium and effective as saline. patients orany attenders saliva can be used
    6. Tap water: it has been commonly recommended storage solution but it leads to rapid cell lysis and increased inflammation on replantation. NOT SUGGESTED.
    7. Contact lens solution: acceptable short-term substitute storage liquid.
    8. Green Tea: it has antioxidative, anti-carcinogenic, anti-mutagenic, anti-inflammatory, antimicrobial, and antiviral effect.
    9. Egg white, coconut water, rehydrating solution, lens solution, probiotic solutions, honey, milk, and ascorbic acid can been used as a transportation medium.
DENTOALVEOLAR FRACTURES

Radiographic Examination

    1. Radiographic examination is required to assess the damage to underlying structures and should include intraoral periapical (IOPA), occlusal, panoramic radiographs (OPG), and cone-beam computed tomography (CBCT) imaging

DENTOALVEOLAR FRACTURES

Types of dentoalveolar fracture

  1. Fracture involving enamel
  2. Fracture involving enamel and dentin
  3. Fracture involving enamel, dentin and pulp
  4. Fracture involving enamel, dentin, cementum
  5. Crown/ root fracture
  6. Luxation of tooth
  7. Intrusion and extrusion
  8. Avulsion
DENTOALVEOLAR FRACTURES

Treatment Options

Our treatment options are based on the type of fracture the teeth and the surrounding bone has encountered.

    1. Arch bars
    2. Loop wiring
    3. Orthodontic bands
    4. Acrylic/metallic splints
    5. Acid etch composite

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