Injuries of the Teeth

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

Either an individual tooth or the whole groups of teeth may be subject to an injury. The frontal teeth of the upper jaw are affected in most cases due to their prominence at the upper jaw. Teeth damage is often associated with injuries of bones and soft tissues.

Tooth subluxation

Subluxation appears as a result of damage to supporting apparatus of a tooth causing a tooth to move at its alveolus, but without leaving it. A fracture of the alveolus may occur at the same time. Clinically, a tooth protrudes out, it is sensitive to percussion and loose to a various degree. The vicinity of marginal gingiva is usually bruised and sometimes even torn. Therapy requires a good anesthesia that enables for pushing a tooth back to its bed and for fixing it at this position by a resin splint made by molding at a prosthetic laboratory according to an impression, or more often, from a free hand made of a fast polymerizing resin. Wire fixtures or splints do not provide for good results since they rather pull a tooth out from its socket by wire loops. Required period of fixation is usually 3-4 weeks, eating soft foods and increased oral hygiene are a must. An antibiotic therapy is not necessary at isolated injuries of the teeth.

Tooth luxation

Luxation results from breakage of the supporting apparatus of a tooth, that leaves its socket completely. The alveolus edge does not have to be necessarily damaged. Especially teeth with incomplete root development are prone to luxation. It is necessary to replant a tooth as soon as possible (only at young individuals providing the bony tooth socket is not damaged). A tooth should be kept at moist environment before replanting. Excochleation and rinsing of the tooth socket should be performed under a local anesthesia followed by replanting of a tooth washed at sterile physiological solution (remnants of the periodontium at the root must not be removed). Fixation is the same as in case of subluxation, duration of fixation should be longer - 4 to 5 weeks. It is desirable to use an antibiotic screen. After a fixture is removed, a tooth vitality should be followed, and an eventual resorption assessed on X-ray images.

Fractures of the Teeth

Teeth breakages can affect their crowns (treatment described at the chapter on restorative stomatology), or its root. In case of a longitudinal root fracture, extraction of such a damaged tooth is unequivocally indicated. In case of a fracture across a root at its half, such breakage can be treated by intra-dental fixation (by a titanium pin inserted through the fracture line and the apex into the peri-apical bone, so called trans-dental implant). A degree of the root’s development is crucial for this kind of treatment since it is necessary to dress and close hermetically the root canal. A dental splint (resin or metal molded) is left at place for at least 5 to 8 weeks. If the root development is incomplete, it is possible to use a conservative approach, i.e. to fix a tooth by a splint for a long period of time, thus allowing for formation of a ligamentous fusing band on the root, or rarely joining by the secondary cement and dentine. If a root is broken at its apical part, removal of the split apex has to be made followed by filling the root canal, excochleation and egalization of the root fragment. Fixation is not needed.

Category: Orthodontics Notes



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