7-trauma to teeth and factial structures

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and and Facial Facial Structures Structures

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  • Trauma to Teeth and Facial Structures

  • Radiographs are essential to:To identify the location and orientation of fractures.The number of fractures.To indicate the degree of separation or displacement of fracture margins.To locate a foreign object associated with the trauma.Relationship of a tooth or root to the fracture lineUnion or nonunion.

  • Traumatic Injuries of the TeethConcussionLuxation- Intrusive luxation - Extrusive luxation- Lateral displacementAvulsionFractures

  • ConcussionThe term is used in those circumstances where the traumatic injury caused some injury to the supporting structures but without abnormal loosening or displacement of the toothClinical FeaturesTraumatized tooth is sore Markedly sensitive to both vertical and horizontal percussion It may also sensitive to biting forcesDefinition

  • Radiographic FeaturesWidening of the periodontal membrane space Reduction in the size of the pulp chamber and pulp canals may also seen after months or years The reduction in size in some cases may result in pulpal necrosis and periapical lesion and root resorption.

  • LuxationIt is dislocation of the articulation (periodontal attachment) of the toothTypes:Intrusive LuxationExtrusive LuxationLateral DisplacementDisplacement of teeth into the alveolar bonePartial displacement of teeth out of the socketMovement of teeth other than axial displacementDefinition

  • Clinical Features: Appear in normal location but will be abnormally mobile Some bleeding from the gingival crevice Extremely sensitive to percussion The clinical crown that have been intruded may appear to be shortened The root may be pushed through the buccal or lingual alveolar plate The sensitivity of the luxated tooth may be temporarily decreased or nondetectable

  • Radiographic Features:Intrusive LuxationDepressed position of the crown Partial or total obliteration of the periodontal ligament space

  • Extrusive Luxation Increased width of the PDL space which may be accentuated in the apical region

  • Lateral DisplacementWidened PDL space, the increase in width will be greater on the side of impact Some of these teeth might be extruded

  • AvulsionAvulsion is a term used to describe the complete displacement of a tooth from its alveolusDefinitionCauses:Direct TraumaIndirect TraumaWhen the force is applied directly to the toothWhen the force causes the jaws to strike together

  • Clinical Features:It will be missing from the arch

    The appearance of the alveolus depends on the period of time between its loss and the clinical examination

    Encountered in a relatively young age group, when the permanent central incisors are just erupting and the periodontal ligament is immature

    Fractures of the alveolus wall and lip injuries are frequently seen

  • Radiographic features:The radiograph will show an empty socket The displaced tooth may be located in adjacent soft tissue The lamina dura will probably be apparent

  • Fractures of the TeethDental crown fracturesDental root fracturesCrown-root fracturesOblique root fractures

  • Traumatic Injuries to Facial Bones Injury to facial bones may be isolated to one bone or involve multiple bones.They include:Mandibular Fractures

    Maxillary FracturesZygomatic FracturesNasal FracturesBlow-Out (Orbital) Fracture

  • Mandibular FracturesSymphysis Fracture Body FractureAngle FractureRamus FractureCondylar FractureCoronoid Fracture

    Include:Sites of mandibular fractures

  • Symphysis Fractures It is a fracture located between the right and left canine teeth. Trauma to the anterior mandible that does not fracture this region may still result in a unilateral or bilateral fracture of the condylar processes.Radiographic Examination:- Occlusal radiograph (bucco-lingual extension of the fracture.- PA and Panoramic views.

  • Mandibular Body Fractures It is any fracture that lies between the antigonial notch and the area of cuspid tooth. Fracture of the body on one side is frequently accompanied by fracture of the condylar process on the opposite side.Mandibular Fractures may be:Favorable fracturesUnfavorable fracturesFractures reduced by the action of muscleFractures displaced by the action of muscles attached to the mandible

  • Radiographic Examination:- Panoramic radiographs- Lateral oblique radiographs- Postero-anterior radiographs- Occlusal radiographs

  • Mandibular Angle Fracture A vertical or oblique fracture passing from the superior surface of the mandibular body to a point near the angle.Radiographic Examination:- Panoramic radiographs- Lateral oblique radiographs- PA radiographs

  • Ramus Fracture A fracture that lies between the mandibular angle and the base of the condylar process.Radiographic Examination:- Lateral oblique radiographs - PA radiographs- Panoramic radiographs

  • Condylar FractureA fracture through the mandibular condylar head above the attachment of the joint capsule.Radiographic Examination:- Panoramic radiographs- TMJ Views:- Trans-cranial.- Trans-pharyngeal.- Trans-orbital

  • Sub-condylar Fracture A fracture through the mandibular condylar neck. Fracture of the subcondylar area will lead to medial, inferior and anterior displacement of the condylar head.Radiographic Examination:- Panoramic radiographs.

  • - Townes or Reverse Townes views- Postero-anterior Views

  • Coronoid Fracture A fracture through the coronoid process of the mandible. Usually a portion of the coronoid process is separated from the remainder of the mandible.

    Radiographic Examination:- Lateral oblique radiographs- Panoramic radiographs- Sinus radiographs

  • Maxillary FracturesMaxillary Alveolar Ridge Fracture

    Midface Fractures (Le Fort Fractures)- Le Fort I Fracture- Le Fort II Fracture- Le Fort III Fracture

    Include:

  • Maxillary Alveolar Ridge Fracture It is a fracture of the maxillary alveolar bone. The closer the fracture to the alveolar crest, the greater the possibility that root fractures will be found.Radiographic Examination:- Intra-oral radiographs- Postero-anterior radiographs- Panoramic radiographs

  • Midface Fractures (Le Fort Fractures) Fractures of the midfacial region may be limited to the maxilla alone or may involve other bones, including the frontal, nasal, lacrimal, zygoma, vomer, ethmoid and sphenoid.Radiographic Examination:** Plain Views:- Panoramic radiographs- Posteroanterior radiographs- Waters radiographs- Submentovertex radiographs** Specialized Views- Tomograms- Computerized Tomography

  • Le Fort Fractures

  • Le Fort I (Horizontal Fracture) It is horizontal separation of the maxilla from the middle face. The fracture line passes above the teeth and below the the zygomatic process and crossing the following structures bilaterally: nasal septum, maxillary sinuses, tuberosities and pterygoid plates.

  • Le Fort II (Pyramidal Fracture) It is a pyramidal infra-zygomatic separation of the maxilla from the base of the skull. The fracture crosses the following structures bilaterally: nasal bone, nasal septum, floor and medial walls of the orbits, anterior and lateral walls of the orbits, anterior and lateral walls of the maxillary sinuses and the pterygoid plates.

  • Le Fort III (Craniofacial Disjunction) A bilateral supra-zygomatic fracture resulting in a floating fragment composed of the midfacial bone that is totally separated from the cranial bones. The fracture line crosses the following structures bilaterally: nasal bone, nasal septum, medial wall of orbit, lateral wall of the orbit, and zygomatic arch.

  • Le Fort ILe Fort IILe Fort III

  • Zygomatic Fractures Zygomatic Fractures rarely affect the zygoma itself. More commonly the zygomatic arch is fractured. Radiographic Examination:- Submentovertex view- Sinus view- Computerized Tomography

  • Blow-Out (Orbital ) Fracture It is a fracture of the orbit involving only the orbital floor and not the remaining orbital bones. Radiographic Examination- Sinus Views- Panoramic Views

  • Nasal Fractures Fractures that involve the bony nasal complex and the nasal septumRadiographic Examination:- Occlusal views- Panoramic view- Lateral Skull views- PA and Sinus views

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