MANAGEMENT OF DENTOALVEOLAR INJURIES

IntroductionDENTOALVEOLAR INJURIESCHILDREN1-4 y.o.WalkRun

8-11 y.o.SportsPlay

IMMEDIATE EVALUATIONDIAGNOSIS & TREATMENT

EtiologyFallsSport injuriesPlayground accidentsMotor vehicle accidents

Examination & DiagnosisDentoalveolar injuries emergency

General condition: A, B, CMechanism of injuryExtra oralIntra oral

Radiographic examinationPresence of root fracturesDegree of extrusion or intrusionPresence of preexisting periodontal diseaseExtent of root developmentSize of the pulp chamber and root canalPresence of jaw fracturesTooth fragments & foreign bodies lodged in soft tissues

ClassificationA. Injuries to hard dental tissue & pulp:Crown infractionUncomplicated crown fractureComplicated crown fractureUncomplicated crown-root fractureComplicated crown-root fractureRoot fractureB. Injuries to the periodontal tissue:ConcussionSubluxationIntrusive luxationExtrusive luxationLateral luxationRetained root fractureExarticulation

ClassificationC. Injuries to the supporting bone:Comminution of the alveolar socketFracture of the alveolar socket wallFracture of the alveolar processFractures of the mandible or maxilla

D. Injuries to the gingiva or oral mucosa:Laceration of gingiva or oral mucosaContusion of gingiva or oral mucosaAbrasion of gingiva or oral mucosa

Injuries to hard dental tissue & pulpA. Crown InfractionB. Uncomplicated crown #C. Complicated crown #D.Uncomplicated crown-root #E. Complicated crown-root # F. Root #

Injuries to the periodontal tissuesA. ConcussionB. SubluxationC. Intrusive luxation /Central dislocation)D.Extrusif luxation (Pheriperal dislocation, partial avulsion)E. Lateral luxationF. Retained root #G. Exarticulation (complete avulsion)

Injuries to the supporting boneComminution alveolar socket# of the alveolar socket wall # of alveolar proc.# mandible or maxilla

TreatmentAgeCooperationPrimary or permanent dentitionRoot developmentLocation & extent of injuryResidual bone supportPeriodontal health of the remaining teethFracture of supporting boneVitality of the teethApical foraminaInjury to soft tissueHead, chest, or abdominal injuryTime between trauma and treatment

Injuries to hard dental tissue & pulp

Injuries to hard dental tissue & pulpPrimary teeth observationPermanent teeth splint (8 weeks)

Injuries to the periodontal tissue

Primary color changesPermanent > 2 mm splint (7-10 days)Primary labial extractionPermanent < 5 mm 50% vital reposition & splint (2-3 weeks)

Injuries to the periodontal tissue

Primary no replantationPermanent < 1hrs: immediate replant splint (4-6 weeks) > 1 hrs: clean the root + salin endodontic after 1 week

Injuries to the periodontal tissue

Prognosis for avulsion tooth:Time spent out of the mouthStorage methodDamage to the toothCondition of periodontal ligament

Storage medium:SalivaSalineMilkCell culture mediaOrgan transplant media

Injuries to the supporting bonePrimary minimal dislocation no splint diet 2 weeks vitality testPermanent reposition & splint (1-2 months) root involved endodontic (2 wks)

Injuries to the gingiva or oral mucosaContusionAbrasionLaceration

ABRATIONIrrigation with saline sol orSurgical scrub brush (toothbrush) under local anesthesiaApplication of an antibiotic ointmentBandage if the abrasion is deep

CONTUSIONWith an icePressure dressingLegation of vessel with surgical exploration

LACERATIONCleansing of the woundDebridement of the woundHomeostasis in the woundClosure of the wound

FIXATION & STABILISATIONThe requirements acceptable splint are :Easy to fabricate directly in the mouth without lengthy laboratory proceduresCan be placed passively without causing forces on the teethDont contact the gingival tissue & cause irritationDont interfere with normal occlusionEasley cleaned Should not traumatize the teeth/ gingivalAllows an approach for endodontic therapyEasley removedProvide good aesthetic results

Foil splintEnamel bonded composite resin splintComposite retained nylon/ flossComposite retained wireArch barFigure of 8Loop wiringOrthodontic bandingThermoplastic material splintAcrylic splintSilver alloy splint

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Conclusion Dentoalveolar injuriesEmergencyDiagnosis & TreatmentPrognosisDentists knowledge trauma care