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DENTOALVEOLAR TRAUMA. AO ASIF PRINCIPLES OF OPERATIVE TREATMENT OF CRANIOMAXILLOFACIAL TRAUMA AND RECONSTRUCTION AUGUST 11& 12, 2007. BRETT L. FERGUSON DDS FACD. CHAIRMAN ORAL AND MAXILLOFACIAL SURGERY UNIVERSITY OF MISSOURI-KC SCHOOLS OF MEDICINE AND DENTISTRY. TO BE OR NOT TO BE.
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DENTOALVEOLAR TRAUMA AO ASIF PRINCIPLES OF OPERATIVE TREATMENT OF CRANIOMAXILLOFACIAL TRAUMA AND RECONSTRUCTION AUGUST 11& 12, 2007
BRETT L. FERGUSON DDS FACD CHAIRMAN ORAL AND MAXILLOFACIAL SURGERY UNIVERSITY OF MISSOURI-KC SCHOOLS OF MEDICINE AND DENTISTRY
TO BE OR NOT TO BE INVOLVED OR FRACTURED IS THE QUESTION
CLINICAL EVALUATION • Soft tissues • Nerves • Skeleton • Dentition
DENTOALVEOLAR TRAUMA • Injuries involving the teeth, the alveolar portion of the maxilla/mandible and the adjacent soft tissues
NATIONAL HEALTH AND NUTRITION EXAMINATON SURVEY • Subjects from 6-50 years of age • Enamel fracture identified as most common sequela of trauma- 45.8% • 25% of US pop. with dental trauma • Upper centrals most commonly traumatized tooth • M:F 1.5:1
EPIDEMIOLOGY CON’T • Prevalence in hospital emergency departments: 4.6% to 10.5% of trauma admissions have dental trauma 42% age less than 6 y.o., 21% age 6-10 and 11% age 11-15, however 79% involved permanent teeth. 45% of patients have concomittant soft tissue injuries
ASSOCIATION OF OTHER OROFACIAL INJURIES • 1/3 of all mand. condyle fractures involve injury to 3.7 teeth • If the MOA was a MVA to produce the condyle fx, then related injury to teeth was 47% • Bilateral condyle fx resulted in 64% of pts with dental injury • Unilateral condyles: 25% with dental injury • Endoscopy/intubation= .06% dental injury
FACIAL AND MANDIBULAR INJURIES SINGLE MOST COMMON ANTECEDENT OF TMJ INTERNAL DERANGEMENT
EXAMINATION • Usually associated with trauma or violence therefore trauma survey mandated for elucidation of other injury patterns
ASSESSMENT • Debridement and removal of intraoral and extraoral blood • Record location and size of all lacerations, abrasions, contusions, hematomas • Radiography to include periapicals, panoramic and if head and neck trauma then a standard radiographic survey • TMJ assessment
Missing Teeth • In the mouth • In the body • In the Street
WHAT IF NO APPARENT ACCIDENTAL CAUSE HIGH INDEX OF SUSPENSION FOR CHILD AND ELDER ABUSE
Diagnosis • Crown fracture • Root fracture • Concussion/subluxation • Extrusion/lateral luxation • Intrusion • Avulsion • Alveolar fracture
NONDISPLACEMENT VS DISPLACEMENT INJURIES • Nondisplacement: Concussive i.e. tooth has sustained an injury but not displaced, not mobile but very sensitive to percussion • Displacement: Luxation i.e. displacement or dislocation from socket. Types: 1)Extrusive; 2) Intrusive 3) Lateral luxation 4) Avulsion/Exarticulation
CROWN FRACTURES • Crown fxs comprise 26-76% of injuries to permanent dentition • enamel vs dentin vs pulp vs cementum • ROOT FRACTURES VS CROWN FXS AND NEED TO RESTORE AND/OR EXTIRPATE PULP