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2. INDIAN DENTAL ACADEMY
Leader in continuing dental education
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3. FRACTURE
FRACTURE IS DEFINED AS A SUDDEN, VIOLENT
SOLUTION OF CONTINUITY OF BONE AND MAY
BE COMPLETE OR INCOMPLETE IN CHARACTER.
FRACTURE MAY BE FROM:
1. Direct violence
2. Indirect violence
3. Excessive muscular contraction.
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4. Mandibular fractures
Etiology of mandibular fractures.
R.T.A.------------------------------- 43%
Assaults-------------------------------34%
Work related------------------------ 7%
As a result of fall------------------- 7%
Sporting accidents------------------ 4%
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6. Classification
According to Dorland’s medical dictionary
Simple
Compound
Comminuted
Greenstick
Pathologic
Multiple
Impacted
Atrophic
Indirect
Complex
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7. Based on the anatomic region by Dingman and Natvig
Midline
Parasymphysis
Body
Angle
Ramus
Coronoid Process
Condylar Process
Dentoalveolar segment
Based on the presence or absence of teeth- Kazanjian
and Converse.
Class I - Teeth present on either side of fracture fragment
Class II- Teeth present on only one side of fracture fragment
Class III- The patient is edentulous.
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11. Clinical features
Change in occlusion
Anesthesia, paresthesia or dysesthesia.
Abnormal mandibular movements
Change in facial contour and mandibular arch form
Laceration, Hematoma and Echymosis
Loose teeth and crepitation on palpation
Dolor, Tumor, Ruber and Color
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14. Indications of closed reduction
Nondisplaced favorable fractures
Grossly comminuted fractures
Fractures exposed with significant loss of overlying
soft tissues
Edentulous mandibular fractures
Mandibular fractures in children
Coronoid process fracture
Condylar fracture
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15. Choice of Method
1. Fracture pattern
2. Skill of the operator
3. Resources Available
4. General medical condition of the patient
5. Presence of other injuries
6. Degree of local contamination and infection
7. Associated soft tissue injury
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16. Closed reduction and indirect
skeletal fixation- different methods
Direct interdental wiring (Gilmer)
Indirect interdental wiring (eylet or Ivy loop)
Continuous or multiple loop wiring
Arch bars
Cap splints
Gunning type splints
Pin fixation
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26. Indications for Open reduction
Displaced unfavorable fracture through the angle
Displaced unfavorable fracture of the body
Multiple fractures of the facial bones
Multiple # and Displaced Bilateral condylar #
Fracture of an edentulous mandible with severe
displacement
Edentulous maxilla opposing fractured mandible
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27. Open reduction and Direct skeletal
fixation- Different methods
Transosseous wiring
Bone plating
Intermedullary pinning
Lag screws
Titanium mesh
Circumferential straps
Bone clamps and Staples
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