Emergency management of maxillary dentoalveolar fracture: A case report

Abstract

Dentoalveolar trauma occurs in relation to injuries of fall, road traffic accidents, sports injury or physical violence. There may be injury limited to the tooth, or may involve the periodontium around, or in severe cases, alveolar bone or oral mucosa may be traumatised. There can be myriad injuries of the same structure depending upon the severity of impact. The injuries of tooth most commonly being crown fractures, followed by root fractures, luxation or complete avulsion of the tooth. Every type of dentoalveolar injury requires a specific set of clinical protocols to be followed in order to successfully diagnose and manage the particular case.We hereby report a case of a 29-year-old male patient with a history of fall under the influence of alcohol, who had fallen flat on his face and had suffered intrusive luxation of permanent maxillary right central incisor and avulsion of permanent maxillary left central and lateral incisors. The exarticulated teeth still had slight soft tissue attachment to the socket. On the patients first visit to dental OPD, being a dental emergency, the avulsed teeth were immediately restored back into the socket under local anaesthesia after adequately irrigating and debriding the socket, followed by repositioning of the internally luxated tooth, so that all were in their correct anatomical position. After checking for occlusion, they were splinted in position with Erich’s arch bar and 26 gauge SS wire and after giving post-operative instructions patient was asked to follow up after 6 weeks. At 6 weeks, the affected teeth were found to be firm and so arch bar were removed. Patient was advised to follow up further. At periodic follow ups, the patient was asymptomatic and maintained adequate oral functioning of the injured teeth, thus with good patient compliance and proper diagnosis and treatment, dentoalveolar fractures can be managed successfully. The main purpose of this article is to lay emphasis on the timing of treatment of the dentoalveolar injuries. The earlier they are managed, the better is the outcome.

Evidence-based management of isolated dentoalveolar fractures: a systematic review

“…Data extraction and analysis were done for 26 studies. For simplicity and better insights, two groups were made based on age: the 2-12 years age group (pediatric) and the older than 12 years age group (adult) 16 - 41 . ( Tables 2 , 3 )…”

“…The pediatric population is more prone to falls during activities such as cycling 19 , 25 , 26 and playing 20 , 23 , 24 , 28 , 33 and to accidental falls at home 16 , 17 , 29 , 31 . In contrast, the adult population is susceptible to injuries due to falling under the influence of alcohol, assault, or sports-related activities 34 , 36 .…”