Alveolo-dental trauma

Alveolo-dental trauma

Alveolo-dental trauma

1. Introduction
2.  Etiology 
3.  Classification  
4.  Mechanism of action 
5.  Diagnosis 

     V.1. Clinical examination 

      V.1.1. Interrogation

      V.1.2. Exoral examination

      V.1.3. Intraoral examination

V.2. Radiological examination 

VI. Clinical study of alveolo-dental lesions 

     VI.1. Damage to supporting tissues

VI.1.1. Contusions 

VI.1.2. Subluxations 

1. Intrusions (dental intrusions)
2. Extrusions (dental egressions) 
3. Lateral movements  

VI.1.3. Avulsions (total dislocation) 

     VI.2. Damage to the dental organ 

VI.2.1. Cracks 

VI.2.2. Enamel chips 

VI.2.3. Fractures without pulp exposure 

VI.2.4. Fractures with pulp exposure 

1. Isolated coronary fractures 
2. Coronal-radicular fractures 
3. Isolated root fractures

VI.3. Bone lesions (Alveolar fracture) 

     VI.4. Soft tissue injuries 

VIII. Evolution, complications and sequelae 

      VIII.1. Evolution 

     VIII.2. Complications 

          VIII.3. Sequelae 

CONCLUSION 

Alveolo-dental trauma

1. Introduction

Alveolar fractures are very common in the jaws. They are partial fractures most often located at the point of impact of the trauma.

They appear benign, but remain important in maxillary trauma.

Located in the anterior region, these lesions would pose very different problems depending on whether we are dealing with an adult or a child.

2. Etiology:

II.1. trauma:

• Falls on the face (while walking)
• Accidents due to games and sports
• Assaults and traffic accidents 

II.2. Favoring factors: 

• Upper alveoli (makes central incisors vulnerable)
• Labial incontinence
• Periodontal disease: makes dislocations more frequent

3. Classification  

   The most common is that of the WHO modified by ANDERSSEN and that of MUGNIER.

III.1. Fractures: 

• Coronary fractures

• Crack
• Simple fracture without pulp exposure
• Simple fracture with pulp exposure

• Coronal-radicular fractures
• Root fractures
  • 1/3 cervical
  • 1/3 medium 
  • 1/3 apical

III.2. Dislocations

• Bruises
• Subluxations 

   -Intrusions 

   -Extrusions 

   – Lateral dislocation 

• Total dislocation (avulsion)

III.3. Alveolar fractures:

• Fractures of the external and internal tables 
• Fracture of the alveolar processes
• Communicative fractures of the alveolus 

4. Mechanism of action: 

• Injuries most often following direct impact
• Antero-posterior shock
• The speed of the shock, its intensity, its direction and its point of impact: determine the type of injury.

5. Diagnosis:

V.1. Clinical examination:

V.1.1. Interrogation

It will bring together: 

• Patient identification. 
• The circumstances of the accident. 
• General condition. It is always advisable to look for a general condition that puts dental trauma in the background,
• Personal medical and surgical history.

V.1.2. Exoral examination

He will be particularly interested in:

• The condition of the integuments looking for edema, wounds or hematoma. 
• The condition of the facial bone contours in search of associated bone fracture.
• Mandibular kinetics in search of fracture of the articular region.

V.1.3. Intraoral examination

• Examine the oral mucosa for wounds, hematomas, swelling or bleeding. 
• Examine the dentition for fracture, mobility, missing or displaced teeth.
• Examine the bony contours for mobility of the alveolar processes or loss of the alveolar wall. 
• Perform a pulp vitality test on the teeth affected by the trauma and on neighboring teeth.

V.2. Radiological examination:

  It includes a mandatory radiological assessment because it alone allows a precise diagnosis. The most used radiographs are: 

• Retro-alveolar images.
• Orthopantomography (dental panoramic). 

   Retro-alveolar images have the advantage of being taken on site and provide sufficient information on the root condition and the presence of permanent tooth germs. 

   Panoramic radiography provides an overview of the maxillary bones and teeth. It is useful in the case of associated alveolar or maxillary fracture.

6. Clinical study of alveolar-dental lesions:

VI.1. Damage to supporting tissues:

VI.1.1. Contusions: 

   It is caused by a low-intensity trauma. It affects one or more teeth while respecting the integrity of the gum, tooth and bone. The ligament fibers are compressed, causing an inflammatory phenomenon in the reduced desmodontal space. 

• Clinic: 

   This inflammation causes pulp pain which can be complicated by necrosis.

• Tooth enamel sometimes has cracks. 
• The X-ray shows a desmodontal enlargement. 
• The bone is intact.

VI.1.2. Subluxations:

1. Intrusions (dental intrusions):

   There is a partial vertical displacement of the tooth in its alveolus by ingression. Seems to be more frequent on deciduous teeth “upper incisors” (fragile alveolar bone, presence of definitive germ favoring the penetration of the tooth into the maxilla).

  Impaction of permanent teeth is rarer and often incomplete, and may be accompanied by alveolar fractures.

  The tooth may be sensitive to percussion.

2. Extrusions (dental egressions):

There is a partial vertical displacement by egression (outward displacement of the alveolus).

• Tooth out of its socket, mobile
• Bleeding at the gingival neck
• Radio: widening, sometimes asymmetrical, of the alveolo-dental space
• Vitality tests frequently disrupted.

3. Lateral movements: 

The most common of incomplete dislocations. More common in the anteroposterior direction

• Vestibular or palatal version
• The tooth is mobile in its socket.
• Bleeding at the gingival neck
• Pain when moving

 The more severe the lesions, the greater the risk of pulp mortification.

VI.1.3. Avulsions (total dislocation):

    This is the complete loss of the tooth from its socket. The patient often presents with a tooth in his hand or in a handkerchief when he has not lost it. 

   The clinic shows an empty alveolus sometimes associated with mucosal lesions or alveolar fracture.

   The retro-alveolar image confirms the alveolar emptiness.

Alveolo-dental trauma

VI.2. Damage to the dental organ:

VI.2.1. Cracks:

  Considered the first stage of coronary fractures. 

  The macroscopic examination of the crown does not reveal anything in particular, nor does the X-ray.

  It is only on examination by transillumination that this isolated damage to the enamel is highlighted.

VI.2.2. Enamel chips:

• Partial amputation of the crown, respecting the dentin
• More frequent at the level of the incisors and are most often limited to an angle of the free edge of the tooth.

VI.2.3. Fractures without pulp exposure:

  Most often the involvement is isolated coronal, where it exposes the coronal dentin. More frequent in the upper incisors (proalveoli, overlap).

  The patient presents with pain when hot and cold, awakened by palpation with the probe which looks for a communication towards a pulp horn.

  Radio: assesses the thickness of remaining hard tissue (dentine) and looks for any associated root fracture.

VI.2.4. Fractures with pulp exposure:

They can sit: 

• Either at the crown level, 
• Either at the root level, 
• Either at the crown or root level. 

A fracture of the alveolar bone can complicate dental fractures.

1. Isolated coronary fractures:

• The fracture line affects the dentin and the pulp.
• The line is oblique or horizontal and then located, most often, at the neck of the tooth.
• The proximal fragment may or may not remain in place.
• The central pulp appears pink in color, sometimes hemorrhagic. 
• The tooth is hypersensitive.
• The retro-alveolar image looks for an associated root fracture.

2. Coronal-radicular fractures:

• The fracture line involves the dentin and the pulp, both coronal and radicular.
• This line can be vertical or oblique.
• The obliquity of the fracture line and the opening towards the desmodont make the preservation of the tooth difficult.

3. Isolated root fractures

Horizontally, depending on the height of the lesion, we distinguish the fractures of interest:

• 1/3 cervical 
• 1/3 medium
• 1/3 apical

  They are often associated with alveolar fractures, especially if the root lesion is close to the apex.

  When the tooth persists on the arch, the pain is variable because it is linked to the mobility of the proximal fragment, all the more significant as the lesion is close to the neck.

  Vitality tests almost always negative

  The retro-alveolar image which makes the topographic diagnosis of the fracture and looks for an associated bone lesion.

VI.3. Bone lesions (Alveolar fracture):

  They are more frequent in the anterior region and most often result from a violent shock affecting several teeth.

V.3.1. Partial fractures:

  It is rare for the alveolar edge to be damaged without the tooth suffering the backlash.

• The fracture may be limited to a single tooth
• Or extended to several teeth where the risk of infection is increased

Clinic:

• Swollen vestibule
• Torn mucosa 
• Mobility (tooth + bone)
• Vitality tests +/- negative 
• Fracture line may be visible radiologically

V.3.2. total fractures:

  They concern both external and internal tables

• In the upper jaw they are accompanied by epistaxis
• In the lower jaw they are associated with a fracture of the basilar rim.

Clinic: 

• Block movement
• Presence of hematoma with tearing of the mucosa
• Palpation restores overall mobility (tooth + bone)
• Negative vitality tests
• Radio: fracture lines most often associated with root fractures.
• Alveolo-dental trauma

The risks of these fractures are:

• Bone fragment sequestration
• Rupture of the vascular-nervous bundle

VI.4. Soft tissue injuries:

• Gingival lacerations:

  They are common with damage to the underlying alveolar bone or a displaced fracture of the bone bases.

  They are due to the adhesion of the fibro-mucosa to the bone cortex.

  The presence of these lacerations should lead to a search for deep bone damage.

7. Evolution, complications and after-effects:

VIII.1. Evolution:

   It is from a combination of periodontal tissues and pulp tissue that the construction of the hard tissues of inter-fragmentary filling is made.

VIII.2. Complications:

• Pulp mortification 
• Pulpopathies 
• Infectious accidents (cellulitis, osteitis, etc.)

VIII.3. Sequelae:

In adults:

The future of any traumatized tooth is compromised by the shock which leads to mortification and pulp necrosis.

• Infection —> dental abscess
• Either tumoral —> granuloma or cyst
• Alveolysis
• Egression and dental articulation disorder    

In children: 

  The after-effects will be specific due to the presence of dental germs and the risks of disruption of their development.

  The lesions vary depending on the stage of tooth formation:

• Direct lesions of the permanent tooth germ:

• Adamantine dyschromia
• Enamel hypoplasia
• Fragmentation of the germ
• Ectopic eruption 
• Indirect lesions of the permanent tooth germ:

• Absence of rhizalysis of the temporary tooth
• Migration of the incisors (following extraction of the temporary tooth )
• Eruption of permanent incisors
• Traumatized permanent tooth injury: 

• Fracture —> pulp necrosis 
• Root fracture —> ankylosis, rhizosis
• Dislocations —> necrosis, ankylosis, rhizosis.

Alveolo-dental trauma

CONCLUSION :

We can conclude that individualized clinical forms are rare, if one part of the trauma concerns the hard tissues of the tooth, the other would concern its periodontium. So there is a double pathology on the tooth itself.

It should be kept in mind that any traumatized tooth presents a pulp lesion and a periodontal lesion which must be taken into account at the time of treatment to avoid pulp mortification and infection.

Alveolo-dental trauma

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Bibliography:

1. DECHAUME M. Summary of stomatology. Masson Editions. 1980
2. DUHAMEL P. Examination of a facial trauma patient. EMC Stomato 22-068-A-05. 2002, 24p.
3. LE BRETON G. Treatise on semiology and odonto-stomatological clinic. Editions Cdp 1997.

4. TARDIF .A. Dental and alveolar trauma. EMC Stomato 22-097-A-05. 2004, 14p.
5. Guyot, L., Seguin, P., & Benateau, H. (2010). Alveolo-dental trauma. In Techniques in maxillofacial and plastic surgery of the face (pp. 109-111). Springer, Paris.
6. Bah, AT, Diallo, OR, Bah, A., Diop, A., Kourouma, A., & Bah, FY (2021). ALVEOLO-DENTAL TRAUMA: EPIDEMIOLOGY, CLINICAL AND THERAPEUTIC AT DONKA NATIONAL HOSPITAL.  African Journal of Dentistry & Implantology , (20).
7. Bah, AT, Diallo, OR, Bah, A., Diop, A., Kourouma, A., & Bah, FY (2021). ALVEOLO-DENTAL TRAUMA: EPIDEMIOLOGY, CLINICAL AND THERAPEUTIC AT DONKA NATIONAL HOSPITAL.  African Journal of Dentistry & Implantology , (20).

Good oral hygiene  Regular scaling at the dentist  Dental implant placement Dental x-rays  Teeth whitening  A visit to the dentist  The dentist uses local anesthesia to minimize pain  

Alveolo-dental trauma