trauma

lecture given 6/8/2026

what imaging modalities are used for trauma?

panoramic- useful for localizing injuries to teeth and bone, lacks resolution and anatomic detail, esp mand anterior

periapical- always required for dentoalveolar fracture for adequate anatomical detail

occlusal- may be useful for mand body or alveolar process

towne view- suspected trauma to the condylar head and neck areas

CBCT- method of choice for maxillofacial fractures, particularly multiple bone

*concussion

crushing injury to the tooth apex and PDL

minimal loosening or displacement

slight hyperocclusion

percussion sensitive

radiographically subtle, slightly widened PDL particularly in the apical 1/3

monitor with slight occlusal adjustment if necessary

concussion

what is this, and what does it result from?

osteodentin cap, concussion

osteodentin cap

trauma results in pulpal necrosis

vital odontoblasts at the apex deposit tertiary dentin, coronal portion of the root remains open

*luxation

PDL is severed

teeth are displaced/mobile

subluxation implied the PDL is injured without frank dislocation

radiographically subtle, slightly widened PDL, similar to concussion but may show altered position of tooth, may require occlusal projections

management: reposition and splint, remove if in proximity to a developing adult tooth

luxation

*avulsion

complete displacement from the alveolar process

fights are the most common cause, max central incisors are most common teeth

lamina dura often persists for up to several months

if the tooth is not found- chest radiograph to rule out aspiration

can attempt to reimplant if out of mouth for a short period of time, RCT ~2 weeks later

avulsion

re-implantation

the time outside of the socked for an avulsed tooth is the most critical factor for its survival

if the tooth in replanted within 30 min or kept in a physiological solution of specialized media or milk for a few hours, it has a fairly good prognosis

if the tooth has been dry for more than one hour, the PDL cannot be expected for survive and the tooth will likely become ankylosed

*class I crown fracture

involve enamel only (infraction or crack)

no treatment required, smooth edges, monitor with vitality tests, 2% pulp necrosis

*class II crown fracture

involve enamel and dentin (uncomplicated fracture)

horizontal better prognosis than oblique (due to less surface area of dentin exposed)

3% pulpal necrosis

*class III crown fracture

involve enamel, dentin, and pulp (complicated fracture)

pulp cap vs pulpotomy vs pulpectomy

deciduous teeth often extracted

crown fracture

horizontal root fracture

uncommon- account for 7% or fewer traumatic injuries to permanent teeth

most occur in middle 1/3 of root

not always visible

can sometimes see increased PDL space size adjacent to fracture location

fracture in coronal 1/3 of root has poor prognosis, usually extract

fracture in middle or apical 1/3 of roots only 20-24% get pulpal necrosis

vertical root fractures

usually oriented in the facial-lingual plane

most frequently in posterior teeth, esp mand molars

usually iatrogenic following insertion of screws or pins

patient complains of persistent dull pain (cracked tooth syndrome)

extract single rooted teeth, hemisect multi-rooted teeth

crown-root fracture

just what the name implies

management: remove coronal fragment to evaluate the extent of the fracture if pulp involvement usually extract, if no pulp involvement and does not extend more than 3-4mm below the epithelial attachment, usually able to restore

crown-root fracture

*

alveolar process fracture

*radiographic signs of fracture

radiolucent line contained within the boundaries of a bone

a change in the normal outline or shape of a structure (bone or teeth)

loss of continuity of outer border; gap or **step defect

increased radiopacity in a structure (overlap)

normal anatomy!! space between tongue and soft palate from pt swallowing mid pano

where are the most common mandibular fractures?

condylar (29.1%), angle (24.5%, associated with extraction of impacted teeth), symphysis (22%)

**

mandibular fracture

mandibular fracture

mandibular fracture

**

mandibular fracture

mandibular fracture

maxillary fracture

commonly orbital wall- lamina papyracea (medial wall) and floor

associated with domestic violence

maxillary fracture

zygomatic tripod fracture- look for the elephant

lefort I fracture

horizontal

lefort I fracture

lefort II fracture

pyramidal

lefort II fracture

lefort III fracture

craniofacial disjunction

lefort III fracture

what is the monitoring/healing for lefort fractures?

examine alignment of cortical plates and remodeling/remineralization

fracture increased in width 2 weeks after reduction, remineralization occurs 5-6 weeks after treatment

obliteration of fracture line may take several months and occasionally it lasts for several years

look out for non-union and misalignment of fractured segments, inflammatory lesions associated with teeth in the area, osteomyelitis