Traumatic Injuries of the Teeth

8/3/2019 Traumatic Injuries of the Teeth

http://slidepdf.com/reader/full/traumatic-injuries-of-the-teeth 1/99

By:

BABY JANE M. ENDAYA

DOCTOR OF DENTAL MEDICINE II

1



TERMINOLOGIES

TRAUMA – External violence producing injury

TRAUMATICTRAUMATIC – Occuring due to trauma

INJURY – Damage sustained by tissue

FRACTURE – Sudden violent breach in the continuity

AVULSION – Complete loss of tissue

INFARCTION – Incomplete fracture

2



These are the types of injuries that teeth may sustain from trauma:

Concussion

Luxation

DilacerationFracture

Intrusion

Extrusion

3



CONCUSSION

Severe jarring of a tooth with contusionof periodontal ligament but does notresult in dislocation nor fracture.

Area most affected is the apicalperidental membrane in which thecapillaries are ruptured andinflammatory reaction may set in.

Healing may follow or such traumamay lead to necrosis of the pulp.

4



ETIOLOGY

Trauma or force such direct blow on atooth or indirect blow from jarring ofthe jaw.

5



6



CLINICAL PATHOLOGY

⋆Tooth is sore or painful to percussion.

⋆May develop into periodontitis if conditiondoes not subside.

⋆Tooth elongates and become loose.

⋆Necrosis of the pulp

⋆If pulpitis develops, there is pain of

neuralgic character.

7



LUXATION

A condition where there is partial or complete dislocation of tooth from thesocket either to labial, buccal, or

lingual directions.

8



ETIOLOGY

Direct or indirect blow

9



CLINICAL PATHOLOGY

ළ Tooth is tender to percussion.

ළ Soft tissues may be lacerated.

ළ Periodontal membrane may be torn and

bone may be fractured.ළHemorrhage due to blood vessels that

ruptured.

ළ Ecchymosis of gingiva.ළNecrosis of the pulp may set in and tooth

becomes discolored.

10



11



DILACERTAION

A deformity of the tooth characterizedby a sharp bend or angulations at theneck or root part of the tooth.

12



ETIOLOGY

☻Pre-eruptive injury to the permanentteeth like a blow or fall which mayseverely traumatized the deciduous or

the jaw bones and transmit such blowto the underlying permanent toothgerm.

☻Bending and hypoplasia may result ifenamel is still forming.

13



14



15



INTRUSION

♀ Injury to teeth more often result indisplacement of teeth rather thanfractures.

♂ Displacement of the tooth into thealveolar bone along the axis of thetooth and is accompanied by

comminution of fracture of thealveolar socket

16



ETIOLOGY

♥ A typical cause is a directed forcesufficient to overcome the bondbetween the affected tooth and the

periodontal ligament within thecradling alveolar socket

♥ These forces may lead to pulp necrosis

and apical abscess formation.

17



18



EXTRUSION

• Elongation of a tooth; movement of atooth in an occlusal or incisal direction

19



20



AVULSION

☺Most severe of luxation injury

☺Tooth is completely displaced fromalveolar socket

21



22



23



24



FRACTURE

A break in the continuity of the dentalhard tissues.

25



ETIOLOGY

o Direct or indirect blow, a violence fromkick fall or external force fromaccidents, undue occlusal stresses

which may occur during masticationespecially the root canal treatedtooth.

26



TYPES

♦ Pathological spontaneous fracture

♦ Traumatic fracture

27



PATHOLOGICAL OR SPONTANEOUS FRACTURE

◙ Fracture which occur in teeth whichhas been weakened so that ordinarymasticatory forces could break it.

◙ Ex:

◙ Teeth with large occlusal fillings or deep

cervical filling

◙ Teeth with internal resorption

◙ Root canal treated tooth

28



TRAUMATIC FRACTURE

♫ Fracture caused by external forceinjuries to the teeth from play, sports or car accidents.

29



30



FIGHTS

31



Falls

32



Accidents

33



Sports

34



Battered child

35



PREDISPOSING FACTORS

⋆Children from broken homes

⋆Low-socio economic status

⋆Deleterious oral habit

⋆Extensive caries

⋆Accident prone profile

⋆Inc overjet⋆Angle’s class II div. I

⋆Angle’s class I type 2

36



⋆Children with cerebral palsy

⋆Epileptic patient

⋆Dentinogenesis imperfecta

37



Classification of fractures

⌖ Ellis’ and Davey classification (1970)

⌖ Class I: Simple fracture of the crown involving little or no dentin

⌖ Class II: Extensive fracture of the crown involving considerable dentin

but not the pulp

⌖ Class III: Extensive fracture of the crown with a pulpal exposure⌖ Class IV: traumatized tooth become non-vital

⌖ Class V: tooth loss as a result of trauma

⌖ Class VI: fracture root with or without loss of crown structure

⌖ Class VII: displacement of tooth without fracture of crown or root

⌖ Class VIII: fracture of crown en masse and its replacement

⌖ Class IX: traumatic injuries to primary teeth.

38



39



CLASS 1

Simple fracture of the crown involving little or no dentin

40



41



CLASS II Extensive fracture of the crown involving considerable dentin but not the

pulp

42



CLASS III

Extensive fracture of the crown with a pulpalexposure

43



44



CLASS IV

• A fracture in which the entire crownhas been lost

45



CLASS V

• tooth loss as a result of trauma

46



CLASS VI

• fracture root with or without loss ofcrown structure

47



48



V

E F

R R

T A

I CC T

A U

L RE

S49



CRAZE LINES

• Craze lines are tiny cracks that affect only theouter enamel of the tooth. They are commonin all adult teeth and cause no pain.

• Craze lines need no treatment. They do NOT

extend into dentin.• Hence, these cracks are observed in most

teeth and are considered normal. They arethe result of "wear and tear" on teeth.

• Hence, the answer is no, not all cracks seenon the outside of teeth are bad.

50



51



52



CUSPAL FRACTURE

When a cusp or the pointed part of thechewing surface of your tooth becomesweakened, the cusp will fracture.

Part of the cusp may break off or may need

to be removed by your dentist.Depending upon the extent of the fracture,the pulp may also become damaged.

Endodontic therapy is needed when the pulpis damaged beyond repair and a crown willbe placed to help protect the tooth andreplace the fractured tooth structure.

53



54



⋆CRACKED TOOTH

⋆ This type of crack extends from the chewing surface ofthe tooth vertically towards the root and sometimesbelow the gum line.

⋆ A cracked tooth is not completely split into two distinctmovable segments. If caught early enough, the tooth isusually crowned but endodontic therapy may beneeded at a later date (typically in the first 6 months).

⋆ Nonsurgical endodontic therapy (root canal) will beneeded when the pulp becomes substantially injured or exposed.

⋆ During endodontic therapy the inside crown portion of

the tooth is stained with a temporary dye and viewedmicroscopically for the extent of the fracture.

⋆ Prognosis depends on the severity of the crack.

⋆ A full crown is needed to hold the tooth together.

55



56



SPLIT TOOTH

ළ A split tooth is a cracked tooth in which thecrack has progressed so there are 2 distinctsegments that can be separated from oneanother.

ළ Unfortunately, with today’s technology, a splittooth can never be saved intact.ළ The extent and position of the crack will

determine if any portion can be maintainedbut most of these teeth will be extracted.

ළ In rare instances, endodontic treatment,possibly some gum surgery, and a crown maybe used to retain a portion of the tooth.

57



58

VERTICAL FURCATION



VERTICAL FURCATION FRACTURE

♂ The furcation is the place where thetooth splits into two or more separateroots.

♂ A crack like this always involves thenerve of the tooth.

♂ In addition, since both pieces of thetooth are held in position by the bone,this type of crack seldom separates allthe way.

59



60



61



ROOT FRACTURES

62

VERTICAL ROOT FRACTURES



VERTICAL ROOT FRACTURES OR “SPLIT ROOT”

Typically symptoms are associatedwith a tooth that has had endodontictherapy

Also these teeth commonly presentwith bone loss around an entire root inmore advanced fractures and often

go unnoticed until surrounding boneand gums become infected.

63



ETIOLOGY

♀ Commonly a complication fromendodontic therapy.

♀ Sometimes believed to exacerbated

by large post placement.

64



DIRECTION OF FRACTURE

• Vertical root fractures begin in the roottypically near the end and extendtoward the chewing surface.

65



66



67



OBLIQUE ROOT FRACTURES

• Root fractures do not involve thecrown of the tooth at all.

• The broken fragment is generally

entirely below the gum line, most oftenentirely under the bone.

68



69

VERTICAL APICAL ROOT



VERTICAL APICAL ROOT FRACTURES

♥ Vertical fractures at the apex (tip ofthe root), while not generally fatal tothe tooth, are still some of the most

difficult to deal with.♥ This type of crack causes mild to

moderate pain to pressure even when

the nerve has been removed via aroot canal.

70



71



MANDIBULAR FRACTURES

72



• Fractures of the mandibular body may beclassified by anatomic location, condition, and

position of teeth relative to the fracture,favorableness, or type.

• Angle fractures occur in a triangular regionbetween the anterior border of the masseter andthe posterosuperior insertion of the masseter.These fractures are distal to the third molar.

• Mandible fractures are also described by the

relationship between the direction of the fractureline and the effect of muscle distraction onfracture fragments.

73

• Mandible fractures are favorable when



• Mandible fractures are favorable whenmuscles tend to draw bony fragmentstogether and unfavorable when bony

fragments are displaced by muscleforces.

• Vertically unfavorable fractures allowdistraction of fracture segments in a

horizontal direction.• These fractures tend to occur in the body

or symphysis-parasymphysis area.• Horizontally unfavorable fractures allow

displacement of segments in the verticalplane.

74



75

UNFAVORABLE



UNFAVORABLE

76

FAVORABLE



FAVORABLE

77

PROBLEM



PROBLEM

• The angle of the mandible is thetriangular region bounded by the anterior border of the masseter muscle to theposterior and superior attachment of themasseter muscle (usually distal to the thirdmolar).

• This area may become fractured

secondary to vehicular accidents,assaults, falls, sporting accidents, andother miscellaneous causes.

78

ETIOLOGY



ETIOLOGY

• Vehicular accidents and assaults are the primary causesof mandibular fractures throughout the world.

• Data from industrialized nations suggest that mandiblefractures have various causes as follows:

•

Vehicular accidents - 43%• Assaults - 34%

• Work-related causes - 7%

• Falls - 7%

• Sporting accidents - 4%

• Miscellaneous causes - 5%

• Assault most often causes mandible angle fractures.

79

CLASSIFICATIONS OF



CLASSIFICATIONS OF MANDIBULAR FRACTURE

• Simple or closed - Fracture that does notproduce a wound open to the externalenvironment, whether it be through the skin,mucosa, or periodontal membrane

• Compound or open - Fracture in which anexternal wound, involving skin, mucosa, orperiodontal membrane, communicates with the

break in the bone• Comminuted - Fracture in which the bone is

splintered or crushed

80

COMMINUTED



COMMINUTED

81



• Greenstick - Fracture in which one cortex of the bone isbroken and the other cortex is bent

•

Pathologic - Fracture occurring from mild injury because of preexisting bone disease

• Multiple - Variety in which two or more lines of fracture onthe same bone are not communicating with one another

•

Impacted - Fracture in which one fragment is driven firmlyinto the other

• Atrophic - Fracture resulting from severe atrophy of the bone,as in edentulous mandibles

•

Indirect - Fracture at a point distant from the site of injury• Complicated or complex - Fracture in which considerable

injury to the adjacent soft tissues or adjacent parts occurs;may be simple or compound

82



CLASSIFICATION BY ANATOMIC REGION

83

SYMPHYSIS



SYMPHYSIS

Fracture in the region of the centralincisors that runs from the alveolar

process through the inferior border of

the mandible

84



85





87

Right mandibular parasymphysis fracture.

BODY



BODY

From the distal symphysis to a linecoinciding with the alveolar border ofthe masseter muscle (usually including

the third molar).

88



89

Right sagittal mandibular body fracture and left parasymphysis fracture.

ANGLE



ANGLE

Triangular region bounded by theanterior border of the masseter muscleto the posterosuperior attachment of

the masseter muscle (usually distal tothe third molar)

90



91

Right mandibular body fracture. Left mandibular angle fracture going through tooth #17.

RAMUS



RAMUS

Bounded by the superior aspect of theangle to two lines forming an apex at

the sigmoid notch

92



93

Right mandibular ramus and left mandibular parasymphysis fractures.

CONDYLAR PROCESS



CONDYLAR PROCESS

Area of the condylar process superior tothe ramus region.

94



95

Right mandibular condylar fracture.

CORONOID PROCESS



CORONOID PROCESS

Includes the coronoid process of themandible superior to the ramus region.

96

ALVEOLAR PROCESS



ALVEOLAR PROCESS

Region that normally contains teeth

97



98

Mandibular sagittal symphysis fracture and dentoalveolar fracture.



Traumatic Injuries of the Teeth

Documents