1. Dr.V.RAMKUMAR
CONSULTANT
DENTAL&FACIOMAXILLARYSURGEON
REG.NO.4118-TAMILNADU –INDIA(ASIA(
DENTOALVEOLARINJURIES

2. DEFINITION :
Injury which is limited to the
teeth and supporting
structures of the alveolus.
INCIDENCE Boys are
three times more at risk than
girls.
CAUSES :
1- Traffic Accident.
2- Falls.
3- During Epileptic seizures.
4- Sport injuries.

3. Diagnosis
History
Clinical
examination Vitality test
Radiographic
Examination

4. 1) Personal history
2) medical history
3) Previous dental history
4) History of trauma (when ,how ,where )

5. 11((TIME OF OCCURENCETIME OF OCCURENCE??
TheThe shortershorter the time between accident andthe time between accident and
treatment thetreatment the betterbetter prognosisprognosis..
22((TIME OF OCCURENCETIME OF OCCURENCE??
If the accident occurred inIf the accident occurred in dirty placedirty place prophylactic tetanusprophylactic tetanus
is indicatedis indicated
33((TIME OF OCCURENCETIME OF OCCURENCE??
Direct force under the chin →Direct force under the chin → →→ condylar fracturecondylar fracture
Direct force to teethDirect force to teeth → →→ → Crown F, Root F, displacementCrown F, Root F, displacement

6. Extraoral Examination
Laceration ; Abrasions; Contusionson thehead
and neck can benoted visually
Any asymmetriesincluding deviation in mouth
opening.
Intraoral Examination
Soft tissue( tongue; gingiva.. )
Teeth ( displacement ; mobility ; tooth fracture;
colour change)

7. Vitality test just following traumatic injury
often given false negative response
Types of vitality test
1) Thermal pulp test
cold test
heat test
2) Electrical pulp test
3) Cavity test

8. *SOFTTISSUEINJURIES
1- Determination of child immunization
status:-
•If the child had received a primary immunization
activated with boosterinjection of toxoid .
•Unimmunized child can be protected by tetanus
antitoxin.
2- Adequate debridment of the wound

9. 1- stage of root formation
2- presence of root fractur
3- periapical radiolucencies
4- injury of the supporting periodontal membrane
(degree of intrusion or extrusion o the tooth)
5- size of the pulp
N. B. If a jaw fracture is suspected extaoral
radiographs indicated (panoramic and lateral
oblique views )

10. Ellis classificationEllis classification::
Class I:
crack or fracture of E only
Class II:
fracture of E , D with out pulp exposure
Class III:
fracture of E , D with pulp exposure
Class IV:
Fracture line passes beneath the gingival margin
Class V:
Root fracture
a) vertical b) horizontal
(apical , middle ,
cervical(

11. Class IClass I::
1-a crack of the enamelwithout
loss of toothstructure.
Do not require immediate treatmentDo not require immediate treatment..
22--fracture of enamel onlyfracture of enamel only
smoothing the sharp edgesmoothing the sharp edge
regularvitality test ,regularvitality test ,
radiographradiograph

12. Class IIClass II::
Immediate treatment of the crown is
required to:
1(protect the pulp
2(restore the esthetics and function.
Cover the expose of the dentine by a
layer of calcium hydroxide to
reparative dentine formation.
A- Reattachment of tooth fragment.
B- Acid-etch composite resin
restoration

13. Class IIIClass III::
The treatment depends on manyThe treatment depends on many
factors such asfactors such as::
1)vitality of the exposed pulp.
2)Size of the exposure.
3)Time elapsed since the exposure.
4)Degree of root maturation.
5)Restorability of the fractured
crown.
The main objective of treatment is toThe main objective of treatment is to
maintain the vitality of the toothmaintain the vitality of the tooth..

14. Small exposure Large exposure
Early Late Early Late
Open Close open closed open closed open Closed
Direct pulp
capping
pulpoto
my
pulpecto
my
pulpecto
my
Pulpoto
my
pulpecto
my
pulpecto
my
Pulpe
ctomy
Apexifi
cation
pulpec
tomy

15. APEXIFICATION :

16. Class IV:
Treatment usually involve removing
the loose fragment.
11--tooth can beextrudedtooth can beextruded
orthodonticallyorthodontically
22--crown lengthening tocrown lengthening to
gain accessto placement ofgain accessto placement of
restorationrestoration..

17. Class vClass v::
11((HORIZONTAL ROOT FRACTUREHORIZONTAL ROOT FRACTURE
When the fracture occur near theWhen the fracture occur near the
apical 1/3, the prognosis is moreapical 1/3, the prognosis is more
favourable than the middle or cervical 1/3favourable than the middle or cervical 1/3
becausebecause::
1)more alveolar support
2)immobilization of the tooth is much easier
Treatment of root fracture depends upon:
1(Condition of the pulp
2(amount of mobility orthe level of the fracture
line

18. (A) APICAL 1/3 ROOT
FRACTURE
11((reduction , splinting thetoothreduction , splinting thetooth
22((thetooth should becheckedthetooth should bechecked
periodically for vitality andperiodically for vitality and
radiographradiograph..

19. ))B) MIDDLE 1/3 ROOTB) MIDDLE 1/3 ROOT
FRACTUREFRACTURE::
11((reduction , splinting the toothreduction , splinting the tooth
22((the patient recall 2-3 months ,the patient recall 2-3 months ,
checked the vitality ,radiographchecked the vitality ,radiograph
33((if the tooth non vital and no healingif the tooth non vital and no healing
the following treatment is performedthe following treatment is performed::
a) RC Tof both fragmentsa) RC Tof both fragments
b) apical fragment removedb) apical fragment removed
surgicallysurgically
c) intraradicularpin to stabilizec) intraradicularpin to stabilize
both segmentsboth segments

20. ))C) CERVICAL 1/3 ROOT FRACTUREC) CERVICAL 1/3 ROOT FRACTURE
::
11((reductin , splinting the toothreductin , splinting the tooth
22((recall the patient periodically andrecall the patient periodically and
checked the vitality and radiographchecked the vitality and radiograph
33((if there is radiolucent and pulp necrosisif there is radiolucent and pulp necrosis
the following treatment is performedthe following treatment is performed
a) extraction the tootha) extraction the tooth
b) removed the apical fragment andb) removed the apical fragment and
endo-osseous implantendo-osseous implant
placedplaced
c) orthodontic extrusionc) orthodontic extrusion
d) if the fracture is 1-2mmd) if the fracture is 1-2mm
infrabony remove theinfrabony remove the
coronal segment andcoronal segment and

21. 2)VERTICAL ROOT FRACTURE :
 usually the prognosis is not favorable
 treatment ofV R F :
1)extraction of the tooth
2)using co2 laser and ND:YAG laser beam

22. * CONCUSSION
 A mild blow to the tooth resulting in mild
sensitivity requires little or no treatment
 Need only regular vitality test

23. *SUBLUXATION
 Mobility of the tooth without displacement
 Tooth may be sensitive to percussion
 If mobility is extensive splint the tooth
using the acid –etch splinting technique.
 Regular vitality test and radiograph

24.  1) lateral luxation
 2) intrusive luxation
 3) extrusive luxation
 4) avulsion

25. 1) LATERAL LUXATION :
 Displacement of the tooth in any
direction other than the axial one
 If the patient comes immediately
after trauma reposition, splinting
 Once the tooth have solidified in
their position orthodontic
treatment is required

26. 1) INTRUSION:
 Displacement the tooth into the socket
A) primary tooth:
will re-erupted over a period of few months. If
the intruded tooth is in contact with
underlying permanent tooth should be
remove
B) permanent tooth:
 a) immediate surgical repositioning ,
splinting
 b) orthodontic extrusion
 c) incomplete root formation the tooth
will erupt spontaneously

27. 2) Extrusion :
 Partially displacement the tooth out of the socket .
A) primary tooth: Treatment usually extracted
B) permanent tooth :
 reposition and splinting
 If the vitality of tooth is lost start root treatment
immediately placing calcium
 hydroxide in the canal for 6-12 month followed
permanent filling.

28. 3) Avulsion:
 Complete displacement of the tooth
from the socket .
 There are tow important factors to be
consider in cases of avulsion
 1)time between the injury and treatment
 2)condition under which the tooth have been
restored
 The tooth must be kept moist to
prevent damage to the fibers of PDL

29.  In many cases the initial patient contact is by
phone
 The tooth should be handled by the crown
 The tooth should be placed in suitable storage
medium (milk, unsalted water, lens solution )or
in buccal vestibule or under the tongue .
 At the dental office :
 a) information about tetanus immunization
should be obtained
 b) replantation , splinting for 1_2weeks but in
immature apices 2-3weeks
 c) calcium hydroxide should be placed
 d) RCT

30.  Small fracture through the alveolar
process.
there may be concomitant injuries
(crown, root fracture and soft tissue) managed by referral to an
oral and maxillofacial surgery .
 Treatment: redaction , splinting

31. TYPES OF SPLINTING :
1) acid_etched composite splinting
2) Interdental wiring
3) ( vacuum_formed plastic) splint
4) arch bare splint
 More rigid and the longer the stabilization,
the more root resorption , ankylosis that can
be expected .

32. Stabilization periods for
dentoalveolar injury
Dentoalveolar injuryDentoalveolar injury Duration ofDuration of
immobilizationimmobilization
11((Mobile toothMobile tooth 77__1010daysdays
22((Tooth displacementTooth displacement 22__33weeksweeks
33((Root fractureRoot fracture 22__44monthsmonths
44((AvulsionAvulsion 77__1010daysdays
55((Alveolar fractureAlveolar fracture 44__66weeksweeks