Maxillofacial Trauma

Dento-alveolar fractures

Definition
Are those in which avulsion, subluxation or
fracture of the teeth occurs in association with a
fracture of the alveolus
It may occur as an isolated clinical entity or in
conjunction with any other soft tissue or facial
bone fracture
Isolated dento-alveolar fracture seen among
children and adolescents and boys are 3 times
at risk than girls (Hunter et al 1990, Andreason &
Andreason 1994)

Etiology

RTA (minor accidents)

Collisions and falls
Cycling accidents
Epileptic seizures
Iatrogenic damage during:
Extraction of teeth
Endoscopy procedure
Endotreacheal intubation
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Classification of dento-alveolar injuries

(Andreasen & Andreasen 1994)

Dental hard tissue injury

Crown infracture and fracture with or without root fracture
Periodontal injury
Concussion, subluxation, intrusion, extrusion, lateral luxation,
avulsion
Alveolar bone injury
Intrusion of teeth with fracture of socket, alveolus or jaws
Gingival injury
contusion, abrasion, laceration, degloving
Combination of the above
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Dental hard tissue injury

Occurs as a result of direct trauma or by forcible
impaction against the opposing dentition
Anterior teeth damaged by direct impact while
posterior ones damaged by impaction between the
two jaws
Upper teeth intrusion are more frequent and impact
against lower teeth may lead to vertical splitting
Meticulous clinical and radiographical examination
are very essential to determine the degree of dental
damage and chest x-ray when missing or knocked
out tooth is suspected
Early treatment is imperative to relieve pain and
preserve tooth

Treatment objectives

Preservation of damaged teeth depends on:

Complexity of maxillofacial injury
Age of the patient
General dental condition
Site of injury
Wishes of the patient

Prognosis is influenced by:

Open root apices
Intact gingival tissue
Absence of root fracture
periodontal-bone support
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Injuries to the primary dentition

70% involve maxillary central incisors
Intrusion, lateral luxation and avulsion are the commonest
Intruded teeth are likely to normally erupt spontaneously
Damage to developing permanent teeth by displaced tooth
are recognizable problem

Management:
Fractured, extruded or grossly displaced teeth are to be
extracted
Less displaced with no occlusal interference should be
monitored since extraction carries risk to permanent one
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Management of injuries to permanent dentition

Crown fracture
Dressing of exposed dentin, minimal pulpotomy or
pulp extirpation and restoration of damaged part of
the tooth

Root fracture
(Oblique, vertical or transverse)

Inevitable extraction
Saving the tooth by:
Rigid splinting for a minimum of 8 weeks
Devitlaiztion (RCT) with eventful apico surgery
Orthodontic extrusion or crown lengthening
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Injuries to periodontal tissues

Force distributed over several teeth or impact
cushioned by overlying soft tissue may result
into:
Concussion
Subluxation
Intrusion
Displacement and avulsion
Fracture of teeth structure

Looseness and displacement of teeth carries a

high risk of subsequent pulp necrosis
As with root fracture, late complications can be
resorption, canal obliteration, ankylosis and loss
of alveolar bone
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Management of injuries to the periodontal tissues

Loosened, laterally luxated and extruded teeth should
be repositioned and splinted for 1-3 weeks
respectively by semi rigid splint:
Acid-etch composite
Arch bar
Orthodontic wire
Soft stainless-steel wire-loop,
Vacum formed splint

Avulsed teeth necessities immediate replantation and

semi-rigid splinting for 1-2 weeks and prognosis is
influenced by:
stage of root development
length of exposure
medium storage
handling and splinting

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Alveolar fracture
Alveolar injury in mandible is associated with complete fracture
of tooth-bearing area and in maxilla is often isolated injury
Teeth damage might be no existed but the potential
devitilzation should be expected
Alveolar fractures are often seen as two distinct fragment
containing teeth but comminuted fracture is possible
Alveolar fracture in mandible my go along with mandible
fracture and impacted fracture into the maxilla may appear to
be immobile
Midline split of palate with unilateral Le Fort I lead to large
dento-alveolar fracture
Fracture of tuberosity and fracture of antral floor is a
recognized complication of upper molars extraction
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Management of injuries to the alveolar bone

(Block or plate fracture)
Finger manipulation
Reduction (closed ) and fixation
Rigid wire and composite splint
Elimination of premature contact and
occlusal trauma
Short inter-maxillary fixation
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Management of tuberosity fracture

Removal of comminuted fracture of loss
alveolar bone and teeth and repair of soft
tissue
Delay of extraction of teeth in case of
tuberosity fracture for (6-8 weeks)
Mandatory extraction of a tooth from a block
fracture should be carried out surgically
Splinting of a tooth of fractured tuberodity in
to other standing teeth for one month
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Injuries to the gingival and soft tissues

Damage to the lip observed more with
anterior dento-alveolar fracture
Embedded of portion of a tooth or foreign
bodies in soft tissues is very substantial
Laceration of the gingiva is associated with
dento-alveolar fracture
Degloving of the mental region is a common
injury to the lower anterior teeth
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Management of soft tissue injuries

Inspection of a full thickness perforating wound
Debridment and copious lavage
with cholohexidine solution
Removal of denuded piece of bone
Repair of soft tissue injury
Application of external support strapping to help in
tissue adaptation
Antibiotic prescription
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