MANAGEMENT OF DENTOALVEOLAR

FRACTURES A CASE SERIES

Presented By Guided By
Ankita Khandelwal Dr. Santhosh Kumar S. N.
INTRODUCTION
Maxillofacial injuries involve traumatic
injuries of the soft and / or hard tissues of
the face.
These traumatic injuries can be complex
and may require multidisciplinary
approach.
They range from abrasion to deep
puncture wounds and from simple
dentoalveolar fracture to fracture of base
of skull.
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 INTRODUCTION
Dentoalveolar fractures occupy a
minor, yet an important variety of
maxillofacial injuries.
Dentoalveolar fractures accounts for
5% of all injuries in school, preschool
and young adults.
Dentoalveolar fractures can lead to
swelling, unaesthetic appearance,
subluxation, avulsion, mobility,
extrusion and malocclusion. 3
 INTRODUCTION
The management of dentoalveolar
fractures follows the basic principles
of fracture management.
Generally the dentoalveolar fractures
is managed by splinting. However,
some cases may require an open
reduction with internal fixation.

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 INTRODUCTION
This paper aims to present a series of
cases of dentoalveolar fractures of
maxilla/mandible managed mainly by
splinting. A detailed case report of
palatally displaced maxillary anterior
dentoalveolar fracture fragment will
be discussed.

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 MATERIALS AND METHOD
Patients who reported to the OPD of
department of oral and maxillofacial surgery
with dentoalveolar fractures (2014-2015) of
maxilla/mandible were included.
Dental fractures were excluded.
All these patients were examined clinically.
They were advised appropriate radiographs.
These patients were managed surgically and
then referred to the department of
conservative dentistry and endodontics.

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 RESULTS
Total of 5 patients came to the
department of oral and maxillofacial
surgery.
Majority of the patients were
between 18 34 years. One patient
was of 83 years.
4 patients were males.
The major cause for this type of
fracture in this series was fall
followed by road traffic accidents.7
 RESULTS
All of our patients had maxillary dentoalveolar
fracture.
Majority of our patients were treated with
splinting using arch bars and wires.
One of the patients came to us 1 months
after fall. This patient was operated under local
anesthesia with sedation, where the fracture
was exposed, followed by refracturing and
fixation with microplates and screws.
All the patients were referred for root canal
treatment after 1 month.
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 CASE REPORT
PREOPERATIVE VIEW

FRONTAL VIEW PROFILE VIEW

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CASE REPORT
PREOPERATIVE VIEW

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INTRAORAL VIEW
 CASE REPORT
PREOPERATIVE X-RAY

PREOPERATIVE OPG SHOWING MALALIGNED MAXILLARY RIGHT

CENTRAL INCISOR AND FRACTURE LINE IN THE SUBAPICAL
REGION OF THE SAME TOOTH. 11
 CASE REPORT
INTRAOPERATIVE VIEW

INCISION FLAP REFLECTION AND CURETTAGE

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 CASE REPORT
INTRAOPERATIVE VIEW

REFRACTURING OF THE FRACTURE DIRECT REDUCTION AND FIXATION WITH

FRAGMENTS MICROPLATES AND SCREWS

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CASE REPORT
INTRAOPERATIVE VIEW

WOUND CLOSURE
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 CASE REPORT
POSTOPERATIVE VIEW

FRONTAL VIEW PROFILE VIEW 15

CASE REPORT
POSTOPERATIVE VIEW

INTRAORAL VIEW 16
 CASE REPORT
POSTOPERATIVE X-RAY

STOPERATIVE OPG SHOWING THE PROPER ALIGNMENT OF THE MAXILLARY CENTR

SOR AND PRESENCE OF MICROPLATES AND SCREWS IN THE SUBAPICAL REGION A
ARCH BAR.
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 DISCUSSION
Dentoalveolar injuries are those injuries
involving the teeth, the supporting
structures, gingiva, oral mucosa, alveolar
process of the maxilla or mandible, with
or without injuries of the adjacent soft
and hard tissues. These injuries include
the fracture, displacement or avulsion of
teeth and fractures of the alveolar
process.

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 DISCUSSION
The age group of the patients in this
case series was between 18-83 years.
However, various studies have shown
that dentoalveolar fractures are
common in children and young adults.
This disparity may be attributed to the
fact that all children and young adults
are managed well in the pediatric
dentistry department.
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 DISCUSSION
Boys have more traumatic dental fractures
(22.4%) than girls (12.6%). According to
Gassner, male to female ratio is 3.3:1. Male to
female ratio in this case series was 4:1.
The explanation for these findings could be the
historically active role played by men in our
society, while females are mostly confined to
home. Moreover, girls are more mature in their
behavior than boys, who tend to be more
energetic and inclined towards vigorous
outdoor activities.
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 DISCUSSION
The major cause for dentoalveolar fracture in
this series was fall.
According to Nilatty, fall is the most common
cause of dentoalveolar trauma in all age groups
(42.7%) as compared to other etiological factors
like, hit (18%), sports (16%), collision with an
object (14.7%) and road traffic accident only
(3.3%).
A study in Brazil also showed fall to be the most
common cause of dentoalveolar injuries(72.4%)
followed by road traffic accident (6.8%).

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 DISCUSSION
In this series we found that maxillary
anterior dentoalveolar fracture was
present in all our patients.
This may be attributed to the
prominent position of the maxillary
anteriors that will come in contact
with either static or dynamic surface
or object first.

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 DISCUSSION
Fractured alveolar process requires
reduction, immobilization followed by
stabilization for 24 weeks for its treatment.
Arch bars are not suitable in children due to
the size of teeth in mixed dentition and
newly erupted permanent teeth have
immature roots.
However, all the patients in this case series
were adults, splinting using arch bars and
wires were preferred.

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 DISCUSSION
The time interval elapsed since injury is very
important because it influences the choice of
treatment.
In this case series, one of our patients reported
to us after 1 months after injury.
This necessitated refracturing of the malunited
fracture fragments.
The advent of microplates and self drilling
screws have allowed surgeons to fix the fracture
fragments without much injury to the teeth.

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 CONCLUSION
Cases of dentoalveolar fractures, like any other
trauma, should be evaluated on an individual
basis.
It is impossible to completely prevent
accidents that might result in dental injuries,
but their associated complications can be
avoided by ready and adequate treatment and
follow-up.
No such treatment is complete, without
endodontic, restorative and periodontal inputs.

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THANK
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