By: BABY JANE M.

ENDAYA DOCTOR OF DENTAL MEDICINE II

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TERMINOLOGIES
TRAUMA
External violence producing injury Occuring due to trauma

TRAUMATICTRAUMATIC INJURY

FRACTURE

Damage sustained by tissue

Sudden violent breach in the continuity Complete loss of tissue Incomplete fracture

AVULSION

INFARCTION

These are the types of injuries that teeth may sustain from trauma:
Concussion Luxation Dilaceration Fracture Intrusion Extrusion

CONCUSSION
Severe jarring of a tooth with contusion of periodontal ligament but does not result in dislocation nor fracture. Area most affected is the apical peridental membrane in which the capillaries are ruptured and inflammatory reaction may set in. Healing may follow or such trauma may lead to necrosis of the pulp.
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ETIOLOGY
Trauma or force such direct blow on a tooth or indirect blow from jarring of the jaw.

CLINICAL PATHOLOGY
Tooth is sore or painful to percussion. May develop into periodontitis if condition does not subside. Tooth elongates and become loose. Necrosis of the pulp If pulpitis develops, there is pain of neuralgic character.

LUXATION
A condition where there is partial or complete dislocation of tooth from the socket either to labial, buccal, or lingual directions.

ETIOLOGY
Direct or indirect blow

CLINICAL PATHOLOGY
Tooth is tender to percussion. Soft tissues may be lacerated. Periodontal membrane may be torn and bone may be fractured. Hemorrhage due to blood vessels that ruptured. Ecchymosis of gingiva. Necrosis of the pulp may set in and tooth becomes discolored.
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DILACERTAION
A deformity of the tooth characterized by a sharp bend or angulations at the neck or root part of the tooth.

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ETIOLOGY
Pre-eruptive injury to the permanent teeth like a blow or fall which may severely traumatized the deciduous or the jaw bones and transmit such blow to the underlying permanent tooth germ. Bending and hypoplasia may result if enamel is still forming.
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INTRUSION
Injury to teeth more often result in displacement of teeth rather than fractures. Displacement of the tooth into the alveolar bone along the axis of the tooth and is accompanied by comminution of fracture of the alveolar socket
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ETIOLOGY
A typical cause is a directed force sufficient to overcome the bond between the affected tooth and the periodontal ligament within the cradling alveolar socket These forces may lead to pulp necrosis and apical abscess formation.

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EXTRUSION
Elongation of a tooth; movement of a tooth in an occlusal or incisal direction

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AVULSION
Most severe of luxation injury Tooth is completely displaced from alveolar socket

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FRACTURE
A break in the continuity of the dental hard tissues.

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ETIOLOGY
o Direct or indirect blow, a violence from kick fall or external force from accidents, undue occlusal stresses which may occur during mastication especially the root canal treated tooth.

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TYPES
Pathological spontaneous fracture Traumatic fracture

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PATHOLOGICAL OR SPONTANEOUS FRACTURE

Fracture which occur in teeth which has been weakened so that ordinary masticatory forces could break it. Ex:
Teeth with large occlusal fillings or deep cervical filling Teeth with internal resorption Root canal treated tooth
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TRAUMATIC FRACTURE
Fracture caused by external force injuries to the teeth from play, sports or car accidents.

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FIGHTS

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Falls

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Accidents

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Sports

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Battered child

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PREDISPOSING FACTORS
Children from broken homes Low-socio economic status Deleterious oral habit Extensive caries Accident prone profile
Inc overjet Angles class II div. I Angles class I type 2
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 Children with cerebral palsy Epileptic patient Dentinogenesis imperfecta

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Classification of fractures
Ellis and Davey classification (1970) Class I: Simple fracture of the crown involving little or no dentin Class II: Extensive fracture of the crown involving considerable dentin but not the pulp Class III: Extensive fracture of the crown with a pulpal exposure Class IV: traumatized tooth become non-vital Class V: tooth loss as a result of trauma Class VI: fracture root with or without loss of crown structure Class VII: displacement of tooth without fracture of crown or root Class VIII: fracture of crown en masse and its replacement Class IX: traumatic injuries to primary teeth.

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CLASS 1
Simple fracture of the crown involving little or no dentin

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CLASS II
Extensive fracture of the crown involving considerable dentin but not the pulp

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CLASS III
Extensive fracture of the crown with a pulpal exposure

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CLASS IV
A fracture in which the entire crown has been lost

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CLASS V
tooth loss as a result of trauma

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CLASS VI
fracture root with or without loss of crown structure

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V E R T I C A L

F R A C T U R E S

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CRAZE LINES
Craze lines are tiny cracks that affect only the outer enamel of the tooth. They are common in all adult teeth and cause no pain. Craze lines need no treatment. They do NOT extend into dentin. Hence, these cracks are observed in most teeth and are considered normal. They are the result of "wear and tear" on teeth. Hence, the answer is no, not all cracks seen on the outside of teeth are bad.

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CUSPAL FRACTURE
When a cusp or the pointed part of the chewing surface of your tooth becomes weakened, the cusp will fracture. Part of the cusp may break off or may need to be removed by your dentist. Depending upon the extent of the fracture, the pulp may also become damaged. Endodontic therapy is needed when the pulp is damaged beyond repair and a crown will be placed to help protect the tooth and replace the fractured tooth structure.
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CRACKED TOOTH
This type of crack extends from the chewing surface of the tooth vertically towards the root and sometimes below the gum line. A cracked tooth is not completely split into two distinct movable segments. If caught early enough, the tooth is usually crowned but endodontic therapy may be needed at a later date (typically in the first 6 months). Nonsurgical endodontic therapy (root canal) will be needed when the pulp becomes substantially injured or exposed. During endodontic therapy the inside crown portion of the tooth is stained with a temporary dye and viewed microscopically for the extent of the fracture. Prognosis depends on the severity of the crack. A full crown is needed to hold the tooth together.
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SPLIT TOOTH
A split tooth is a cracked tooth in which the crack has progressed so there are 2 distinct segments that can be separated from one another. Unfortunately, with todays technology, a split tooth can never be saved intact. The extent and position of the crack will determine if any portion can be maintained but most of these teeth will be extracted. In rare instances, endodontic treatment, possibly some gum surgery, and a crown may be used to retain a portion of the tooth.
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VERTICAL FURCATION FRACTURE

The furcation is the place where the tooth splits into two or more separate roots. A crack like this always involves the nerve of the tooth. In addition, since both pieces of the tooth are held in position by the bone, this type of crack seldom separates all the way.
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ROOT FRACTURES
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VERTICAL ROOT FRACTURES OR SPLIT ROOT

Typically symptoms are associated with a tooth that has had endodontic therapy Also these teeth commonly present with bone loss around an entire root in more advanced fractures and often go unnoticed until surrounding bone and gums become infected.
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ETIOLOGY
Commonly a complication from endodontic therapy. Sometimes believed to exacerbated by large post placement.

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DIRECTION OF FRACTURE
Vertical root fractures begin in the root typically near the end and extend toward the chewing surface.

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OBLIQUE ROOT FRACTURES

Root fractures do not involve the crown of the tooth at all. The broken fragment is generally entirely below the gum line, most often entirely under the bone.

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VERTICAL APICAL ROOT FRACTURES

Vertical fractures at the apex (tip of the root), while not generally fatal to the tooth, are still some of the most difficult to deal with. This type of crack causes mild to moderate pain to pressure even when the nerve has been removed via a root canal.
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MANDIBULAR FRACTURES
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 Fractures of the mandibular body may be classified by anatomic location, condition, and position of teeth relative to the fracture, favorableness, or type. Angle fractures occur in a triangular region between the anterior border of the masseter and the posterosuperior insertion of the masseter. These fractures are distal to the third molar. Mandible fractures are also described by the relationship between the direction of the fracture line and the effect of muscle distraction on fracture fragments.

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 Mandible fractures are favorable when muscles tend to draw bony fragments together and unfavorable when bony fragments are displaced by muscle forces. Vertically unfavorable fractures allow distraction of fracture segments in a horizontal direction. These fractures tend to occur in the body or symphysis-parasymphysis area. Horizontally unfavorable fractures allow displacement of segments in the vertical plane.
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UNFAVORABLE

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FAVORABLE

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PROBLEM
The angle of the mandible is the triangular region bounded by the anterior border of the masseter muscle to the posterior and superior attachment of the masseter muscle (usually distal to the third molar). This area may become fractured secondary to vehicular accidents, assaults, falls, sporting accidents, and other miscellaneous causes.
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ETIOLOGY
Vehicular accidents and assaults are the primary causes of mandibular fractures throughout the world. Data from industrialized nations suggest that mandible fractures have various causes as follows: Vehicular accidents - 43% Assaults - 34% Work-related causes - 7% Falls - 7% Sporting accidents - 4% Miscellaneous causes - 5% Assault most often causes mandible angle fractures.
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CLASSIFICATIONS OF MANDIBULAR FRACTURE

Simple or closed - Fracture that does not produce a wound open to the external environment, whether it be through the skin, mucosa, or periodontal membrane Compound or open - Fracture in which an external wound, involving skin, mucosa, or periodontal membrane, communicates with the break in the bone Comminuted - Fracture in which the bone is splintered or crushed
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COMMINUTED

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 Greenstick - Fracture in which one cortex of the bone is broken and the other cortex is bent Pathologic - Fracture occurring from mild injury because of preexisting bone disease Multiple - Variety in which two or more lines of fracture on the same bone are not communicating with one another Impacted - Fracture in which one fragment is driven firmly into the other Atrophic - Fracture resulting from severe atrophy of the bone, as in edentulous mandibles Indirect - Fracture at a point distant from the site of injury Complicated or complex - Fracture in which considerable injury to the adjacent soft tissues or adjacent parts occurs; may be simple or compound
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CLASSIFICATION BY ANATOMIC REGION

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SYMPHYSIS
Fracture in the region of the central incisors that runs from the alveolar process through the inferior border of the mandible

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PARASYMPHYSEAL
Fractures occurring within the boundaries of vertical lines distal to the canine teeth.

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Right mandibular parasymphysis fracture.

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BODY
From the distal symphysis to a line coinciding with the alveolar border of the masseter muscle (usually including the third molar).

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Right sagittal mandibular body fracture and left parasymphysis fracture.

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ANGLE
Triangular region bounded by the anterior border of the masseter muscle to the posterosuperior attachment of the masseter muscle (usually distal to the third molar)

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Right mandibular body fracture. Left mandibular angle fracture going through tooth #17.
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RAMUS
Bounded by the superior aspect of the angle to two lines forming an apex at the sigmoid notch

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Right mandibular ramus and left mandibular parasymphysis fractures.

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CONDYLAR PROCESS
Area of the condylar process superior to the ramus region.

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Right mandibular condylar fracture.

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CORONOID PROCESS
Includes the coronoid process of the mandible superior to the ramus region.

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ALVEOLAR PROCESS
Region that normally contains teeth

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Mandibular sagittal symphysis fracture and dentoalveolar fracture.

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