15a - Traumatic Injuries

prognosis

prospect of recoovery as anticipated from usual course of disease or peculiarities of the case

• excellent, good, fair, questionable, poor, hopeless

concussion

dental injury from hard impact

• there may be no radiographic changes

• tooth may have widened PDL space

• pulp space may greatly reduce in size or disappear after months or years

• if a young tooth devitalizes due to concussion, pulp space may remain wider than other teeth as the patient ages

• if the pulp space of one tooth is a different size than surrounding teeth, suspect a non-vital tooth

lateral luxation

tooth is displaced mesially, distally, buccally, or lingually

• often accompanied by fracture of alveolar bone

• may have apical displacement

  • should try to reposition tooth into socket if possible

extrusion

tooth travels incisally out of socket, or partially

• avulsion → tooth completely leaves socket

• can mimic appearance of a periapical lesion, but crown appears supererupted

• questionable prognosis → depends on how soon tooth is repositioned into socket

intrusion

tooth travels apically into the socket

• poorest prognosis

• high degree of damage to neurovascular bundles at apex of tooth, which gets squashed

coronal fracture and intrusion

coronal fracture involves enamel only; enamel and dentin; or enamel, dentin, and pulp

• prognosis depends on how much tooth structure is lost

• prognosis is good as long as there is no pulp involvement

root fracture

radiolucent line travels through root of tooth — horizontal, vertical, or oblique

• most tooth fractures are too small to detect radiographically

• horizontal fractures have a better prognosis than vertical fractures

  • vertical fractures prone to bacterial intrusion

  • widening of PDL space indicates presence of fracture

• the more apical the fracture is, the better the prognosis

• vertical root fracture has vertical separation of apical third of root

  • shows radiolucent area

alveolar process fracture

radiolucent line travels through the bone

mandibular body fracture

fracture in mandibular body

• if you see one fracture, be on a close lookout for a second mandibular fracture

• jaw fracture often comes in pair

mandibular condyle fracture

orbital blowout fracture

look for “trap door”

• inferior orbit breaks because it is the weakest

zygomatic fracture

injury on patient’s left

LeFort I

horizontal fracture of maxilla

• least amount of force to cause fracture

LeFort II

pyramidal horizontal

• fracture of maxilla and nose

LeFort III

craniofacial disjunction

• bone is not stabilized and is mobile

• face not attached to cranium

• fracture near orbits

• least common injury, with extreme force needed to occur