Trauma to the teeth and facial skeleton
Injuries to the teeth and their supporting structures
Types of injury
Other injuries
• Displacement of an underlying developing tooth which may become dilacerated as a result
• Soft tissue injuries, such as:
Radiographic investigation
• Two views of the injured tooth from different angles, ideally at right angles to one another, but more usually with the X-ray tubehead in two different positions in the vertical plane.
• Small volume CBCT (if available) providing coronal, sagittal and axial images.
• Reproducible views to provide a base-line assessment and to allow subsequent follow-up evaluation
• Views of the chest and/or abdomen if a tooth or foreign body is thought to have been inhaled or swallowed, including:
Diagnostic information provided
The diagnostic information provided by these radiographs may include:
• The type of injury to the teeth
• The degree of displacement of the tooth fragments
• The stage of root development
• The condition of the apical tissues
• The presence, site and displacement of alveolar bone fractures
• The condition of adjacent or underlying teeth
Radiographic interpretation
The expected radiographic features indicating a fractured root are shown in Fig. 29.1 and include:
• A radiolucent line between the fragments
• An alteration in the outline shape of the root and discontinuity of the periodontal ligament shadow.
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
As shown in Fig. 29.4 the radiographic appearances can be influenced by:
• The position and severity of the fracture
• The degree of displacement or separation of the fragments
• The position of the film and X-ray tubehead in relation to the fracture line(s).
It is for these reasons that a minimum of two views, from two different angles, is essential if small volume CBCT is not available.
Skeletal fractures
• The site and direction of the fracture line(s)
• The degree of displacement and separation of the bone ends
• The relationship of teeth to the fracture line
• The location of associated foreign bodies in hard and soft tissues
• The presence of coincidental or contributory disease
• The alignment of the bone fragments after treatment
• Healing and the identification of post-trauma complications including infection, non-union or malunion.