A tooth present at a fracture line.

By Dr. Vishaal Bhat on Tuesday 20 November 2007 with 0 comments



With regards to healing of fractures of the jawbones, a question of teeth presence at a fracture line is often discussed. At those parts of jawbones which contain teeth, a fracture line runs always across the alveolus of one of the teeth. The teeth itself may get damaged during an injury at the same time (subluxations, fractures of roots). As a rule, teeth that had been proven as devitalized or with a peri-apical finding before an injury has happened, should be removed from fracture lines. Retained or semi-retained teeth should be removed as well, providing that fragments moved or a gingival cover integrity was damaged thus increasing risk of infection. Damaged teeth are extracted from a fracture line, unless they can be treated according to rules for therapy of damaged teeth. Teeth germs in cases of fractures at children should be approached as retained teeth during a surgical treatment. They are usually removed from a fracture line.


Pseudoarthrosis

Occurrence of a mock joint is one of the most serious complications of healing. It is a state during which fragments are not joined firmly by a bony callus. A fracture heals only by a primary ligamentous callus and pathological movability remains at the broken site. This kind of complication may happen at fractures of the lower jawbones. There are three types of pseudoarthrosis:

  • syndesmosis (the bones are joined by a ligamentous tissue)

  • synchondrosis (fragments fused by a cartilage)

  • neoarthrosis (a mock joint is formed together with a joint slit)

These healing complications require surgical ways of treatment, often even transfer of a bone transplant (commonly from ala ilii or a rib) and a long-term fixation.


Ankylosis

Ankylosis appears most frequently at an injured mandibular joint, fractures of a joint head, fractures of comminuted character, overlooked fractures at children or newborn babies. Ankylosis may also result from inflammatory complications (osteomyelitis) at the mandibular joint area. The basis for ankylosis is elimination of a joint slit and bony consolidation from the movable lower jaw onto the skull’s base or zygomatic arches that results in immobility of the lower jaw and inability to open the mouth. Therapy is always surgical - wide interruption of pathologically fused bones and insertion of a material (fascia, muscle) between edges of formed breakage in order to prevent coalescence. An intense rehabilitation of the mouth opening is necessary.


Traumatic osteomyelitis

An inflammatory complication at the site of fracture can spread onto a surrounding bony tissue, causing osteitis or osteomyelitis. The causative agent is most often Staphylococcus aureus or a mixed non-specific infection. Specific actinomycotic osteomyelitis of the lower jawbone have been described, resulting from a bone injury. Therapy is analogous to that of inflammatory non-traumatic states, it is a long-term one, and an affected bone deformation may persist.

Category: Orthodontics Notes

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