39
Dento-alveolar Injuries David B. Ettinger MD,DMD Newark, DE Oral and Maxillofacial Surgery

Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

  • Upload
    others

  • View
    8

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Dento-alveolar Injuries

David B. Ettinger MD,DMD

Newark, DE

Oral and Maxillofacial Surgery

Page 2: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Overview

• H&P/Maxillofacial Examination

• Radiographic Exam

• Injury

• Treatment

Page 3: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Examination

• Thorough History – CC, HPI, PMH, PSH, FH, SH, Meds, All, ROS

• Full Examination – R/O Spinal injuries, Head Injuries

– Cleanse area for visualization

– Account for missing teeth, restoration fragments (Aspiration? Swallowed? In soft tissues?)

Page 4: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Examination

• Signs of underlying injury

– Sublingual ecchymosis

– Step defects

– crepitation

– malocclusion

– gingival lacerations

Page 5: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Severe malocclusion with posterior contact only

Page 6: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Examination

• Mobility

• Bleeding

• Tooth fractures

• Percussion

• Vitality testing -controversial

Page 7: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Radiographic Exam-hard tissues

• Ideally 2 views at right angles

• Panorex

• PA (most detail)

• Occlusal

• Hospital setting? Mandibular series, Caldwell views may supplement.

• Chest and KUB/abdominal films (aspiration vs swallowed)

• Soft Tissue x-rays for foreign bodies

Page 8: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Radiographic Exam-soft tissues

Page 9: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Root fragments with other foreign bodies in lip

Page 10: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Classification of Dental Injuries

• Dental Tissues and Pulp – Ellis Classification: 1-4

– Uncomplicated Crown Fx

– Complicated Crown Fx

– Uncomplicated Crown root Fx

– Complicated Crown root Fx

– Root Fx

Page 11: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Exposed nerve with bleeding from pulp

Page 12: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Treatment

• Ellis Class III – Time

• Best if within 2 hours

– Stage of tooth development • Mature – favor pulp extirpation

• Immature – favor preservation of pulp

– Size of pulp exposure • Pinpoint (<1.5 mm)

– Direct pulp cap with CaOH if within 24 hours

• Large exposure

– CaOH Pulpotomy on open apex,

– Root canal therapy for closed apex

Page 13: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Treatment

• Root Fracture – Often not immediately apparent on x-ray

• 1-2 weeks s/p injury: inflammation, hemorrhage, resorption separates segments

– Location • Cervical 1/3: Extraction vs. Orthodontic extrusion

• Middle 1/3: If mobile rigid splint 2-3 months

• Apical 1/3: Best prognosis, only splint if mobile

Page 14: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Splinting to adjacent teeth using bonding resin

Page 15: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Intruded teeth, orthodontically extruded over 4-6 months

Page 16: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Treatment

• Avulsion (Exarticulation) – Fate of tooth depends upon viability of PDL

– Immediate re-implantation if possible

– Storage solution if not: HBSS, Viaspan, Milk Saliva, Saline

– Do not rinse in H20

– PDL becomes irreversibly necrotic after 2 hours

– Open Apex (>1 mm) better prognosis than closed

,

Page 17: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Avulsed Central Incisor

Page 18: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Contact with crown only, irrigated with normal saline

Page 19: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Tooth repositioned

Page 20: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Splinted Central Incisor

Page 21: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin
Page 22: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

• Dent Clin North Am. 1995 Jan;39(1):93-112. Links – Clinical management of the avulsed tooth.

– Trope M.

– Department of Endodontics, School of Dentistry, University of North Carolina at Chapel Hill, USA.

– Replant immediately after gentle washing if practical.

– Place tooth in HBSS while exam is conducted and history is taken.

– Extraoral dry time < 20 minutes: • Closed apex--replant immediately after gentle washing.

• Open apex--soak in 1 mg doxycycline in 20 mg saline for 5 minutes.

– Extraoral dry time 20 to 60 minutes: Soak in HBSS for 30 minutes and replant.

– Extraoral dry time > 60 minutes: soak in citric acid, 2% stannous fluoride, and doxycycline and replant. Endodontics can be done extraorally.

Page 23: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Classification of Dental Injuries

• Injuries to supporting bone – Communution of

alveolar housing (intrusive, lateral)

– Fx of single wall

– Fx of alveolar process, en bloc

– Fx involving main body of max., mand.

Page 24: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Communuted alveolar fracture

Page 25: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Treatment

• Alveolar Fracture

– Open or closed technique (incision placement)

– Digital manipulation

– Rigid stabilization 4-6 weeks

– Pulpal healing dependent on fracture location

– Consider early removal of teeth that have lost bony support

Page 26: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Displaced alveolar segment

Page 27: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Treatment

• Stabilization Times

– Subluxation 2-3 weeks

– Lateral Luxation 2-3 weeks

– Avulsion 7-10 days

– Root Fx 2-3 months

– Alveolar Fx 4-6 weeks • If the diagnosis is Fx, then rigid fixation

Page 28: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Common oral lesions

Page 29: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

PERICORONITIS associated with impacted third molar

Page 30: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Treatment of Pericoronitis

1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin derivative (clindamycin if allergic)

3)Allow soft tissue infection to resolve

4)Remove offending tooth

Page 31: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Common Mucocele traumatically induced

Page 32: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Tobacco induced leuloplakia

Page 33: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Sialolith in submandibular duct

Page 34: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Palatal eruptions-tobacco induced

Page 35: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Tobacco induced salivary gland inflammation

Page 36: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Mandibular tori -variation of normal anatomy

Page 37: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Palatal maxillary TORI

Page 38: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Burn from topical aspirin

Page 39: Dento-alveolar Injuries - NNOHA › ... › Dento-alveolar-Injuries.pdfTreatment of Pericoronitis 1)local debridement using combination H2O2/H2O under flap 2)administration of penicillin

Herpetic gingivostomatitis