29: Trauma to the teeth and facial skeleton

Trauma to the teeth and facial skeleton

Introduction

Injuries to the teeth and facial skeleton are, unfortunately, common. The type and severity of injuries can vary considerably, from minor damage to the teeth to grossly comminuted fractures of the skull.

Whatever the suspected injury, radiography is an essential requirement both in the initial assessment and in the follow-up appraisal. However, the radiographic examination may be restricted and limited by the general state of the patient and the type and severity of other injuries. For example, severe facial injuries are often associated with intracranial damage and/or cervical spine injuries, the importance of which far outweighs any damage to the teeth and their supporting structures. The radiographic investigation must therefore be tailored to each patient’s needs.

This chapter outlines the approach to radiographic investigation of trauma by separating injuries into four distinct categories:

Injuries to the teeth and their supporting structures

Types of injury

Based broadly on the classification suggested by Andreasen and Andreasen (2001), the different types of dental injuries can be divided into:

Radiographic investigation

Although the type of injury may be evident clinically, radiographic investigation of all traumatized teeth is needed initially, to assess fully the degree of underlying damage. Radiographs are also required later to assess healing and/or the development of post-trauma complications. The ideal radiographic requirements include:

Radiographic interpretation

The expected radiographic features indicating a fractured root are shown in Fig. 29.1 and include:

Examples of injured teeth and some of the more common post-injury complications evident radiographically are shown in Figs 29.2 and 29.3.

Limitations of radiographic interpretation of fractured roots

Unfortunately, as a result of the inherent limitations of a two-dimensional image, radiographic interpretation of traumatized teeth is not always straightforward.

As shown in Fig. 29.4 the radiographic appearances can be influenced by:

It is for these reasons that a minimum of two views, from two different angles, is essential if small volume CBCT is not available.

Fractures of the mandible

Clinicians need to know:

Jan 12, 2015 | Posted by in Oral and Maxillofacial Radiology | Comments Off on 29: Trauma to the teeth and facial skeleton
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