FRAKTUR

DENTOALVEOLAR

Choirunnisa Nur Humairo

PPDGS IKGA
Mei 2020
 Background
Traumatic
Traumatic Injuries on dentofacial complex of children may
occur due to motor vehicleinjuries
or domestic accidents. It may cause Avulsion

Intrusion

Luxation

Dentoalveolar
fracture
Soft Tissue
Laceration (Lips and
Gums)
 Background

Factors to be
considered in the
definitive
treatment of the
dentoalveolar
injury include:
 Clinical Findings

Early Allow rapid

Managed Facilitate the
Pediatric reduction healing and
rapidly and normal
Facial and fixation return to
the earliest growth and
Fractures of fractured normal
time development
fragment function
 Clinical Findings

easy fabrication, maintenance of

Current methods However, the maintenance of normal occlusion,
of stabilizing splinting methods only passive force good OH, easy
surgical arch bars
dentoalveolar must meet on the teeth, lack removal
fractures specific criteria of irritation to soft
tissues

Can be modified according to child’s particular

stage of anatomical, physiological, or psychological development
Bone structure:
elastic Children vs
Adult Healing
Faster Wound
Comparison
Healing

Immobilization
time is shorter
(2 weeks)
 Fracture Unerupted permanent teeth-> ORIF (Open
reduction internal fixation) -> trauma

Management in early re-establishment of the pre-injury skeletal

Children anatomy is essential to facilitate normal growth
of the craniofacial complex

Inter Maxillary Fixation: cant tolerate,

deciduous teeth -> ekstrusi
Partially erupted teeth -> incomplete root

Reduction:
guiding elastic, orthodontic wire, digitally
pressure on alveolar bone and teeth

Fixation: dental wiring, arch bar, Composite

Resin
 Case Report#1
 A 7 y.o. girl had a history of trauma on face due to road traffic
accident. She complained of face swelling and pain upon closing
mouth
Objective Examination:
 Oedema of the face and upper lip
 IO: palatal dislodgment of the fractured fragment involving the
permanent right and left central incisors. The fractured segment
was mobile and tender on palpation. The permanent left central
incisor showed grade three mobility(figure 2).
 Severe trauma, bleeding and mobility were present which
prevented the dentoalveolar segment fracture being treated with
traditional splinting methods.
 Case Report#1
• Under local anaesthesia, upper and lower dental arch
impressions were made using alginate impression
material and casts were obtained.
• An open-cap acrylic splint was fabricated on the
maxillary cast using the sprinkle-on technique.
• A modified approach to splinting was planned.
• Four holes were made in the right and left permanent
central incisor areas on the buccal aspects of the splint
to facilitate passage of a 26-gauge stainless steel wire
(figure 3).
• Similarly holes were made on the incisal edge of the
right and left central incisors on their labial aspect.
 Case Report#1
• The fragment was reduced using digital pressure, and
the prefabricated, custom-made splint was seated in
position.
• The splint was secured in place using interdental wires
(26-gauge SS wire) running horizontally through the
holes made in the splint and the teeth.
• The splint was cemented in position using Glass
Ionomer Cement (GC Fuji Type1 luting cement)
• Given instructions for soft diet and good oral hygiene.
• A 5-day course of antibiotic and analgesic was also
prescribed.
 Case Report#1
• The child was recalled on a weekly basis to ascertain stability of the
splint and the presence of other symptoms.
• Splint removal was carried out at the end of 3rd week.
• The consolidation of the fracture was confirmed clinically and
radiographically.
• Satisfactory occlusion and healing was observed.
• Mobility of the left central incisor reduced considerably.
• The holes on the teeth were restored with composite restorative
material(Filtek Ultimate,3M ESPE)
• The child’s parents were instructed to report immediately in case of any
pain or discomfort in the region. The patient is still under regular recall.
Case Report #2 • Seorang anak laki-laki umur 1 tahun datang ke UGD
Sardjito, rujukan Swasta
CC: perdarahan pada rongga mulut dan kegoyahan
pada gigi depan bagian bawah setelah terjatuh dari
tangga rumah saat bermain.
• Pada anamnesa pasien tidak mengalami pingsan,
muntah serta tidak memiliki riwayat penyakit sistemik.
• Objektif:
EO: tidak adanya kelainan.
IO: malposisi gigi 71, 72, 81, 82 ke arah labial dengan
luksasi derajat 2, perdarahan sudah berhenti, tampak
hematom di gingiva lingual regio 71, 72, 81, 82.
Case Report #2• Rö PA (Postero anterior) : garis fraktur horizontal pada
alveolar regio 71, 72, 81, 82.
• Terdapat malposisi gigi 71, 72, 81, 82 serta gambaran
gap pada apeks gigi 71, 72, 81, 82.
• Lab pemeriksaan darah: batas normal.
• Berdasarkan pemeriksaan klinis dan radiologis
mengarah pada diagnosa fraktur dentoalveolar
tertutup tanpa komplikasi pada region 71, 72, 81, 82
Case Report #2
• TP: reduksi dan fiksasi dengan cap splint akrilik
menggunakan metode sirkum mandibular wiring dengan
GA.
• Rongga mulut pasien dicetak untuk mendapatkan model
kerja, kemudian hasil cetakan tersebut dibuat cap splint
akrilik dengan posisi gigi disesuaikan dengan posisi normal
• Setelah anestesi, dilakukan tindakan aseptic pada daerah
operasi ekstra dan intra oral.
• Gigi rahang atas dan bawah dioklusikan untuk
mendapatkan oklusi sentrik.
• Reduksi secara manual dengan penekanan tangan sampai
didapat oklusi normal
• Cap splint akrilik difiksasi menggunakan 2 buah ikatan kawat
dengan metode sirkum mandibular wiring pada region
parasimfisis dekstra dan sinistra
• Medikasi Ampisilin 125 mg/6 jam, paracetamol 125 mg/8
jam, dexamethasone 1,25
mg/8 jam, dan setelah 2 hari pasien dipulangkan.
• Case Report #2
• Kontrol H+7 dan H+14:
tidak terdapat peradangan, dan cap splint akrilik
terpasang dengan baik, serta banyak terdapat food
debris.
• Setelah 3 minggu cap splint akrilik dan sirkum
mandibular wiring dilepas dengan sedasi. Pada gigi 71,
72, 81, 82 sudah tidak dijumpai kegoyahan gigi, dengan
oklusi normal.
• Kontrol minggu ke 6:
gigi telah stabil tanpa kegoyahan, oklusi normal, dan
tidak terdapat infeksi
 Conclusion
• Routinely, the use of acrylic cap splint are used in stabilizing mandibular fractures, as they can be
stabilized by use of circum-mandibular wires, like case #2.
• Case #1: A modified method of wiring to secure the maxillary splint in place was used in this particular
case, thus facilitating adequate stabilization of the fractured segment. The interdental wiring technique
employed is innovative and holds the splint in place in a secure manner. Moreover, the wires also do not
interfere with occlusion or chewing.
• Case #1 and #2: Cap splint akrilik avail support from the adjacent teeth, but also from bone. They are easy to
fabricate, simpel, effective, minimally invasive, are economical.
Thank You