Trauma to Teeth

and
Facial Structures

Radiographs are essential to:

To identify

the location and orientation of

fractures.
The number of fractures.
To indicate the degree of separation or
displacement of fracture margins.
To locate a foreign object associated with the
trauma.
Relationship of a tooth or root to the fracture line
Union or nonunion.

Traumatic Injuries of the Teeth

Concussion
Luxation

- Intrusive luxation
- Extrusive luxation
- Lateral displacement
Avulsion
Fractures

Concussion
Definition
The term is used in those circumstances where the traumatic
injury caused some injury to the supporting structures but
without abnormal loosening or displacement of the tooth

Clinical Features
-Traumatized tooth is sore
- Markedly sensitive to both vertical and horizontal percussion
- It may also sensitive to biting forces

Radiographic Features
-Widening of the periodontal membrane space
- Reduction in the size of the pulp chamber and pulp canals
may also seen after months or years
- The reduction in size in some cases may result in pulpal
necrosis and periapical lesion and root resorption.

Luxation
Definition
It is dislocation of the articulation (periodontal
attachment) of the tooth

Types:
Intrusive Luxation

Displacement of
teeth into the
alveolar bone

Extrusive Luxation

Partial displacement
of teeth out of the
socket

Lateral Displacement

Movement of teeth
other than axial
displacement

Clinical Features:
- Appear in normal location but will be abnormally mobile
- Some bleeding from the gingival crevice
- Extremely sensitive to percussion
- The clinical crown that have been intruded may appear to be
shortened
- The root may be pushed through the buccal or lingual alveolar
plate
- The sensitivity of the luxated tooth may be temporarily
decreased or nondetectable

Radiographic Features:
Intrusive Luxation

-Depressed position
of the crown
- Partial or total
obliteration of the
periodontal ligament
space

Extrusive Luxation

Increased width of the

PDL space which may
be accentuated in the
apical region

Lateral Displacement

-Widened PDL space,

the increase in width
will be greater on the
side of impact
- Some of these teeth
might be extruded

Avulsion
Definition
Avulsion is a term used to describe the complete
displacement of a tooth from its alveolus
Causes:

Direct Trauma
When the force is applied
directly to the tooth
Indirect Trauma
When the force causes the
jaws to strike together

Clinical Features:
-It will be missing from the arch
-The appearance of the alveolus depends on the period
of time between its loss and the clinical examination
- Encountered in a relatively young age group, when
the permanent central incisors are just erupting and the
periodontal ligament is immature
- Fractures of the alveolus wall and lip injuries are
frequently seen

Radiographic features:
-The radiograph will show an empty socket
- The displaced tooth may be located in adjacent soft tissue
- The lamina dura will probably be apparent

Fractures of the Teeth

Dental crown
fractures

Dental root
fractures

Crown-root
fractures

Oblique root
fractures

Traumatic Injuries to Facial

Bones
Injury to facial bones may be isolated to one bone or
involve multiple bones.

They include:
Mandibular Fractures
Maxillary Fractures
Zygomatic Fractures
Blow-Out (Orbital) Fracture
Nasal Fractures

Mandibular Fractures

Include:

Symphysis

Fracture
Body Fracture
Angle Fracture
Ramus Fracture
Condylar Fracture
Coronoid Fracture

Sites of mandibular fractures

Symphysis Fractures
It is a fracture located between the right and left canine teeth.
Trauma to the anterior mandible that does not fracture this
region may still result in a unilateral or bilateral fracture of the
condylar processes.
Radiographic Examination:
- Occlusal radiograph (bucco-lingual extension of the fracture.
- PA and Panoramic views.

Mandibular Body Fractures

It is any fracture that lies between the antigonial notch and the area
of cuspid tooth. Fracture of the body on one side is frequently
accompanied by fracture of the condylar process on the opposite side.
Mandibular Fractures may be:
Favorable fractures
Fractures reduced by the action of muscle
Unfavorable fractures
Fractures displaced by the action of muscles
attached to the mandible

Radiographic Examination:
- Occlusal radiographs
- Panoramic radiographs
- Lateral oblique radiographs
- Postero-anterior radiographs

Mandibular Angle Fracture

A vertical or oblique fracture passing from the superior surface
of the mandibular body to a point near the angle.

Radiographic Examination:
- Lateral oblique radiographs
- Panoramic radiographs
- PA radiographs

Ramus Fracture
A fracture that lies between the mandibular angle and the
base of the condylar process.

Radiographic Examination:
- Panoramic radiographs
- Lateral oblique radiographs
- PA radiographs

Condylar Fracture
A fracture through the mandibular condylar head above the
attachment of the joint capsule.

Radiographic Examination:
- Panoramic radiographs
- TMJ Views:
- Trans-cranial.
- Trans-pharyngeal.
- Trans-orbital

Sub-condylar Fracture
A fracture through the mandibular condylar neck. Fracture
of the subcondylar area will lead to medial, inferior and
anterior displacement of the condylar head.

Radiographic Examination:
- Panoramic radiographs.

- Townes or Reverse Townes views

- Postero-anterior Views

Coronoid Fracture
A fracture through the coronoid process of the mandible.
Usually a portion of the coronoid process is separated from the
remainder of the mandible.

Radiographic Examination:
- Lateral oblique radiographs
- Panoramic radiographs
- Sinus radiographs

Maxillary Fractures
Include:
Maxillary Alveolar
Midface

Ridge Fracture

Fractures (Le Fort Fractures)

- Le Fort I Fracture
- Le Fort II Fracture
- Le Fort III Fracture

Maxillary Alveolar Ridge

Fracture
It is a fracture of the maxillary alveolar bone. The
closer the fracture to the alveolar crest, the greater the
possibility that root fractures will be found.
Radiographic Examination:
- Intra-oral radiographs
- Panoramic radiographs
- Postero-anterior radiographs

Midface Fractures (Le Fort

Fractures)
Fractures of the midfacial region may be limited to the
maxilla alone or may involve other bones, including the
frontal, nasal, lacrimal, zygoma, vomer, ethmoid and
sphenoid.
Radiographic Examination:
** Plain Views:
- Panoramic radiographs
- Posteroanterior radiographs
- Waters radiographs
- Submentovertex radiographs
** Specialized Views
- Tomograms
- Computerized Tomography

Le Fort Fractures

Le Fort I (Horizontal Fracture)

It is horizontal separation of the maxilla from
the middle face. The fracture line passes above the
teeth and below the the zygomatic process and crossing
the following structures bilaterally: nasal septum,
maxillary sinuses, tuberosities and pterygoid plates.

Le Fort II (Pyramidal Fracture)

It is a pyramidal infra-zygomatic separation of the maxilla
from the base of the skull. The fracture crosses the
following structures bilaterally: nasal bone, nasal septum,
floor and medial walls of the orbits, anterior and lateral
walls of the orbits, anterior and lateral walls of the
maxillary sinuses and the pterygoid plates.

Le Fort III (Craniofacial

Disjunction)
A bilateral supra-zygomatic fracture resulting in a floating
fragment composed of the midfacial bone that is totally separated
from the cranial bones. The fracture line crosses the following
structures bilaterally: nasal bone, nasal septum, medial wall of
orbit, lateral wall of the orbit, and zygomatic arch.

Le Fort II

Le Fort I

Le Fort III

Zygomatic Fractures
Zygomatic Fractures rarely affect the zygoma itself. More
commonly the zygomatic arch is fractured.
Radiographic Examination:
- Submentovertex view
- Sinus view
- Computerized Tomography

Blow-Out (Orbital ) Fracture

It is a fracture of the orbit involving only the orbital
floor and not the remaining orbital bones.

Radiographic Examination
- Sinus Views
- Panoramic Views

Nasal Fractures
Fractures that involve the bony nasal complex and
the nasal septum

Radiographic Examination:
- Lateral Skull views
- Occlusal views
- Panoramic view
- PA and Sinus views