1. Fractures of the Teeth & Jaws Joseph L
Fractures of the Teeth & Jaws Joseph L. McQuirter, DDS Oral and Maxillofacial Surgery

2. Fractures of the Teeth & Jaws (Orofacial Fractures)
Dentoalveolar (teeth and surrounding bone)
Mandibular (lower jaw)
Maxillary (upper jaw)

3. Learning Objectives
List the treatment options and surgical intervention for orofacial fractures
Understand the approach to treatment for specific orofacial fractures
List common early and late complications of orofacial injuries
List the types of orofacial injuries
List anatomic structures commonly affected by orofacial injuries
Describe functional impairments resulting from orfacial fractures
Explain the mechanism of injury for orofacial fractures
Become familiar with the diagnostic work up for patients presenting orofacial injury

4. Fractures of the Teeth and Jaws
Dentoalveolar
Mandibular
Maxillary

5. When facial bones break
How effective are our attempts to repair?

6. Mechanism of Injury Accidental Intentional Assault Domestic
Workplace
Associated with Crime
Interpersonal Conflicts
Self Inflicted
Vehicular Injury
Sports
Falls

7. Mechanism of Injury
High Impact
Low Impact
Penetrating

8. deceleration type-injury
High Impact Facial Fractures
Vehicular
high speed
deceleration type-injury

9. Sports Related Injuries (low impact)

10. Fall Injury
(unrestrained)

11. Assault Domestic Workplace Associated with Crime
Rihanna
Lucy Newman
Assault
Domestic
Workplace
Associated with Crime
Interpersonal Conflicts

12. Fist blow to face

13. Sports Safety Equipment

14. there are still unexplained injuries
In spite of our best efforts and millions being spent to protect and ensure safety
there are still unexplained injuries

15. Fractures of the Teeth and Jaws
Dentoalveolar
Mandibular
Maxillary

16. Dento alveolar Fractures
(Dental / Tooth)
(Alveolar Bone)
Dental
Alveolar Bone

17. Dentoalveolar Fractures Fracture of teeth and adjacent alveolar bone

18. Classification of Tooth Injuries
Fracture of tooth crown without pulp involvement
Fracture of tooth crown with pulp involvement
Crown root fractures
Root fractures
Concussion injuries
Luxation injuries
Tooth avulsion (Exarticulation) 4 3 2 1

19. Alveolar Bone Fractures

20. Diagnosis – Dentoalveolar injuries 1
Diagnosis – Dentoalveolar injuries 1. Clasic signs of inflammation from injury (Pain, swelling, redness) 2. Mobility 3. Malocclusion (malaligned/displaced teeth)

21. Etiology of Dentoalveolar Injuries
Altercations
Falls
Seizure disorders
Sporting activity
Vehicular injuries
Endoscopic procedures (anesthesia intubation)
Abusive behavior
Mental health disorders

22. Treatment Objective 1. RESTORE FORM 2. RESTORE FUNCTION

23. RESTORE FORM ~ Place displaced teeth of tooth/bone segment back to their natural position ~ Stabilize repositioned teeth/bone segment

24. RESTORE FUNCTION ~ Normal bite - Non injured teeth should come together without interference from the displaced/fractured segments. ~ Preserve vitality of dislodged teeth or dentoalveolar segment

25. Prognosis is Dependent on Viability of Pulp and Periodontal Tissues

26. Injuries to the tooth Root Canal Treatment Likely
Fracture of tooth crown without pulp involvement
Fracture of tooth crown with pulp involvement
Crown root fractures
Root fractures
Concussion injuries
Luxation injuries
Tooth avulsion (Exarticulation)
Root
Canal
Treatment
Likely 4 3 2 1

27. Injuries to the tooth Luxation injuries
Fracture of tooth crown without pulp involvement
Fracture of tooth crown with pulp involvement
Crown root fractures
Root fractures
Concussion injuries
Luxation injuries
Tooth avulsion (Exarticulation)
Requires reduction and stabilization
Requires reimplantation and stabilization

28. Intruded
Tooth
Avulsed Tooth
Extruded
Tooth

29. Tooth avulsion Out of mouth for less than 2 hours
Reimplant immediately if possible
Transport in Hank’s solution, milk, saline or saliva (mouth)
Provide local anesthesia
Saline irrigation and gentle evacuation of blood from socket
Reimplant tooth and stabilize

30. Transport media for the avulsed tooth
In the tooth socket
Saliva (in the mouth)
Milk
Hank’s balanced salt solution
ViaSpan cold storage solution

31. Preserving The avulsed tooth
Hank’s balanced salt solution, commercially available as :
Save-A-Tooth (Phoenix Lazarus, Inc.)
(Save-A-Tooth is a mainstay in many athletic first aid kits)
ViaSpan, cold storage solution is currently available as an organ transport solution

32. Reduce Dentoalveolar
Fractures

33. Simple, non-traumatic stabilization for
mobile teeth and dentoalveolar fractures

34. Complications of Dental Injuries
Missing teeth, tooth fragments, broken fillings, appliances must be accounted for
~ Aspirated
~ Ingested
~ Witnessed expelled tooth at the injury location
Traumatic occlusion
Infection
Loss of Teeth and Bone
Associated injuries
~ Blunt head trauma
~ Soft tissue injuries
~ Bleeding
~ Infection risk (Tetanus prophylaxis /risk)

35. Ingested Tooth Aspirated Tooth Tooth Fragment in Lip
Tongue Bite - Look for Tooth Fragment
Ingested Tooth
Tooth Fragment in Lip
Aspirated Tooth

36. Lead Poisoning from Retained and Swallowed
Shotgun Pellets
in Maxillofacial Gunshot Injury
McQuirter JL, et al. Elevated Blood Lead Resulting from Maxillofacial Gunshot Injuries: Three Case Reports of Ingested Lead Particles after Gunshot Injury to the Face. J Oral Maxillofac Surg 61(5): , 2003.

37. Molar tooth dislodged to mid-tongue area from gunshot injury

38. Late Complications Infection Ankylosis of Teeth
Devitalization/Discoloration of Teeth
Loss of Teeth/Dentoalveloar Segment

39. Dentoalveolar segment loss due to periodontal disease compromising interdental blood supply

40. Fractures of the Teeth and Jaws
Dentoalveolar
Mandibular
Maxillary

41. Mandibular Fractures

42. Diagnosis
Clinical/Physical Findings
Diagnostic Studies

43. Clinical Findings
Altered Form
Altered Function

44. Altered Form Swelling Displacement of Anatomical parts
Decreased Muscle Tone

45. Swelling and bleeding

46. Step / Gap defect in dental arch

47. The Opposing Jaw
Displaced anatomy in both jaws

48. Superimposition of other anatomical parts sometimes makes radiographic diagnosis difficult

49. Clinical confirmation of suspected fracture
Ecchymosis
In The
Floor of the Mouth
Clinical confirmation of suspected fracture

50. Altered Function Occlusal Abnormalities Decrease Range of Motion
Deviation of Jaw with Opening
Altered mental nerve function
Structural Integrity of the Bone
Compromised of Host Defense
Soft Tissue Compromise
Speech
Swallowing
Respiration
Bleeding

51. Bimanual palpation of the
mandible in a cephalad position allows excellent evaluation and comparison of
the anatomic structures

52. The application of gentle bimanual pressure over the angle regions can unmask a minimally displaced fracture in the anterior region of the mandible.

56. Treatment Objective 1. RESTORE FORM 2. RESTORE FUNCTION