Dental abnormalities

• malposition
• fragile
• hyper/hypo calcificiation
• decays
• periodontal disease

direct

indirect (by antagonists teeth)

mastication (foreign body)

extraction

• subluxation - slightly mobile → observation
• luxation with intrusion → extraction / observation
• luxation with extrusion → extraction
• avulsion → leave it (Øreplantation)

• fissures of enamel or dentin without loss of substance → Ø treatment
• pentrating into pulp📷 (complicated) → dental treatment

1. Horizontal: cervical, median or apical 📷
• cervical + median → extraction
• apical → apicocectomy 📷
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Apicocectomy is typically done under local anesthesia, and an incision is made in the gum to access the root. The damaged portion of the root is then carefully removed, and the area is thoroughly cleaned and sealed to prevent further infection. Finally, the gum is stitched back into place to promote healing. The goal of an apicoectomy is to save the tooth and alleviate any pain or discomfort caused by the root fracture.

2. Vertical 📷→ extraction

periodontal lesion (peridontal disease stage 3 or 4 📷) → no mobility + pain at percussion → Øtreatment

1. Subluxation 📷→ slight etrusion, slight mobility, pain → observation
2. Partial Luxation 📷→ lost anchor → reposition + immobilization📷
3. Avulsion = Total luxation (tooth out) 📷→ tooth replacement → 4weeks immobilization

analgesics

AB

Oral hygiene

HIV-Tetanus prophylaxis

1. Median (btw. central incisors)
2. Paramedian (betw. incisor + cainine)
3. Lateral (canine - third molar)
4. Angle (after thrid molar)
5. Ramus
6. Condylar apophysis
7. Coronoid apophysis

• non-specific fracture signs
• edema
• bruising/hematoma
• abrasion + wound
• deformations + discontinuity
• abnormal movement
• anesthesia
• crepitus
• trismus (occlusion on bite exam)
• ↓movement transmission to TMJ
• Le Bourg maneuvers
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Lebourg maneuver: Palpation asc. rammus (of mandible) 📷→ pain felt in front (chin) Palpation chin → pain felt in asc. ramus
• intraoral damage: interdental spacing, mucosa bruise, hematoma, mobile teeth
• saliva w/ blood

1. Median → Harmonia movement betw. incisors → minimal secondary dysplacement (due to symetrical muscle force)
2. Paramedian → Fracture line, displacement: prox. segment goes down, distal sigments goes up
3. Lateral → displacement (distal↑, prox↓), hemorrhage (artery involvement), hematoma of the floor → pushing tongue back → dysphagia, cant close mouth properly (occlusion modification)
4. Angle → If in front of muscl insertion (displacement as above ⇒ occlusion modified), if in the area of muscle insertion →Ødisplacement
5. Ramus → swollen parotid, pain, trismus (cant open mouth), frontal disocclusion → prox segment goes up, distal goes medially (two step occlusion), ↓sensitivity (inf damage alveolar nerve (D’alger)
6. Condylar → TMJ pain, preauricular pain, ear bleeding, ear pain
7. Coronoid → concom. zygomatic fracture, cant open mouth (Trismus), no occlusion

all muscles pull back → tongue pulled back as well into pharynx → asphyxia

Transmission of force: condylar

CT

callus in 4weeks

immediate: shock, hemorrhage, nerve damage

secondary (later): ST infection, bone-infection (osteomyelitis, osteitis), sepsis

Late: delayed consolidation, ankylosis of TMJ📷, constriction of the mandible , pseuoarthrosis

reduction + fixation

surgical reduction + fixation

surgical osteosynthesis with micoplates + microscrews

Manual 📷 or orthopedic 📷reduction followed by → Emergency 📷 or Orthopedic 📷 fixation