MANAGEMENT OF DENTOALVEOLAR INJURIES

Introduction
DENTOALVEOLAR INJURIES

CHILDREN
1-4 y.o.

8-11 y.o.

Walk

Sports

Run

Play

IMMEDIATE EVALUATION
DIAGNOSIS & TREATMENT

Etiology

Falls
Sport injuries
Playground accidents
Motor vehicle accidents

Examination & Diagnosis

Dentoalveolar injuries

emergency

General condition: A, B, C
Mechanism of injury
Extra oral
Intra oral

Radiographic examination

Presence of root fractures

Degree of extrusion or intrusion
Presence of preexisting periodontal disease
Extent of root development
Size of the pulp chamber and root canal
Presence of jaw fractures
Tooth fragments & foreign bodies lodged in soft
tissues

Classification
A. Injuries to hard dental tissue & pulp:
Crown infraction
Uncomplicated crown fracture
Complicated crown fracture
Uncomplicated crown-root fracture
Complicated crown-root fracture
Root fracture
B. Injuries to the periodontal tissue:
Concussion
Subluxation
Intrusive luxation
Extrusive luxation
Lateral luxation
Retained root fracture
Exarticulation

Classification
C. Injuries to the supporting bone:
Comminution of the alveolar socket
Fracture of the alveolar socket wall
Fracture of the alveolar process
Fractures of the mandible or maxilla
D. Injuries to the gingiva or oral mucosa:
Laceration of gingiva or oral mucosa
Contusion of gingiva or oral mucosa
Abrasion of gingiva or oral mucosa

Injuries to
hard dental tissue & pulp

A. Crown
Infraction
B. Uncomplicated
crown #
C. Complicated
crown #
D.Uncomplicated
crown-root #
E. Complicated
crown-root #
F. Root #

Injuries to
the periodontal tissues
A. Concussion
B. Subluxation
C. Intrusive luxation
/Central dislocation)
D.Extrusif luxation
(Pheriperal
dislocation, partial
avulsion)
E. Lateral luxation
F. Retained root #
G. Exarticulation
(complete avulsion)

Injuries to
the supporting bone

Comminution
alveolar socket
# of the
alveolar socket
wall
# of alveolar
proc.
# mandible or
maxilla

Treatment

Age
Cooperation
Primary or permanent dentition
Root development
Location & extent of injury
Residual bone support
Periodontal health of the remaining teeth
Fracture of supporting bone
Vitality of the teeth
Apical foramina
Injury to soft tissue
Head, chest, or abdominal injury
Time between trauma and treatment

Injuries to hard dental tissue & pulp

Injuries to hard dental tissue & pulp

Primary teeth
observation
Permanent teeth
splint (8 weeks)

Injuries to the periodontal tissue

Primary

color changes

Permanent > 2 mm

Primary
Permanent

labial

splint (7-10 days)

extraction

< 5 mm

50% vital

reposition & splint (2-3 weeks)

Injuries to the periodontal tissue

Primary
Permanent

no replantation
< 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 mouth
Storage method
Damage to the tooth
Condition of periodontal ligament
Storage medium:
Saliva
Saline
Milk
Cell culture media
Organ transplant media

Injuries to the supporting bone

Primary

Permanent

minimal dislocation

no splint
diet 2 weeks
vitality test
reposition & splint (1-2 months)
root involved
endodontic (2 wks)

Injuries to the gingiva or oral mucosa

Contusion
Abrasion
Laceration

ABRATION

Irrigation with saline sol or

Surgical scrub brush
(toothbrush) under local
anesthesia
Application of an antibiotic
ointment
Bandage if the abrasion is deep

CONTUSION

With an ice
Pressure dressing
Legation of vessel with
surgical exploration

LACERATION

Cleansing of the wound

Debridement of the wound
Homeostasis in the wound
Closure of the wound

FIXATION & STABILISATION

The requirements acceptable splint are :
Easy to fabricate directly in the mouth without lengthy laboratory
procedures
Can be placed passively without causing forces on the teeth
Dont contact the gingival tissue & cause irritation
Dont interfere with normal occlusion
Easley cleaned
Should not traumatize the teeth/ gingival
Allows an approach for endodontic therapy
Easley removed
Provide good aesthetic results

1. Foil splint
2. Enamel bonded composite resin splint
3. Composite retained nylon/ floss
4. Composite retained wire
5. Arch bar
6. Figure of 8
7. Loop wiring
8. Orthodontic banding
9. Thermoplastic material splint
10.Acrylic splint
11.Silver alloy splint

11

Conclusion
Dentoalveolar injuries
Emergency
Diagnosis & Treatment
Prognosis
Dentists knowledge

trauma care