The influence of teeth in a fracture line on infection is not easy to determine due to interaction with other factors. The study was performed in the Department of Oral and Maxillofacial Surgery, Vinayaka Mission's Sankarachariyar Dental College, and included a group of patients with mandibular fracture in the dentate region.
The sites of fractures in the mandible included symphysis, parasymphysis, body, and angle Figs. On these criteria, 50 patients from to were selected for this study. The postoperative follow-up period was 14 to 18 months with a mean of 16 months.
The data collected from the patients included preoperative and postoperative radiographs, which included panoramic radiographs Figs. The age of the patients ranged from 18 to 48 years with a mean of 29 years. In total, 62 fractures occurred in 50 patients. Treatment modalities included open reduction and internal fixation with conventional stainless steel 8 , 10 , 11 miniplates 2.
Maxillomandibular fixation was used only intraoperatively to help in achieving occlusion. Patients were administered intravenous ampicillin Ampoxin, Unichem Laboratories, India mg, metronidazole Flagyl, Piramal Healthcare, India mg, and intramuscular diclofenac sodium Voveran, Novartis India Ltd, India 50 mg postoperatively, which varied between 5 and 7 days.
They were also prescribed an antiseptic mouthwash Clohex 0. Reddy's Laboratories, India chlorhexidine for a week's time. Degree of displacement of fracture 7. Position of fracture in relation to the apical foramen and the lateral periodontium of the involved tooth into four groups Fig. Ltd, China Fig. It was done in the mandibular teeth, and teeth not in direct line of fracture were taken as controls.
Maxillary teeth were taken as controls in patients who had bilateral mandibular fractures. The teeth taken as controls showed good response, and there was no change in vitality during the follow-up. There were 13 cases of type 2 fractures in the parasymphysis region based on the relationship of the fracture line to the periodontium, which constituted Type 1 was the most severe type and included 8.
Parasymphysis fractures constituted the majority with On testing the pulp vitality, 4 of 50 patients Fig. Three patients had their teeth in the fracture line extracted between 4 and 6 weeks after surgery as the fracture sites were infected. One patient reported with infection in relation to the fracture line after 1 year. The teeth in the fracture line that had no response included three patients with mandibular third molars and one patient with mandibular lateral incisor Fig.
N, no response; M, minimal response; G, good response; preop, preoperative; postop, postoperative; SS, stainless steel. Pulp vitality responses in presurgical and immediate postoperative post OP stages. Relationship of the degree of displacement of fracture to pulp vitality response in immediate postoperative post OP stage. From the analysis, it is concluded that there is close relationship between the presurgical response and immediate postoperative response.
Those who had no response presurgically showed only minimal response immediately after surgery. Correct repositioning of fractured fragments is made quicker and easier if the tooth in the line of fracture is conservatively managed.
The teeth provide occlusal reference and posterior stop. They have a stabilizing effect and do not impede bone healing. If extracted, they increase the risk of fracture contamination and may sometimes be difficult to suture.
Pulp changes like pulp fibrosis and acute pulpitis may be noted in teeth that respond to electronic pulp tester. The loss of vitality may also be reversible as vascular and neural recoveries are possible. The vitality of teeth improved in all patients except four for whom the teeth in the fracture line were extracted as they reported with infections.
The disposition and the presence of teeth do not directly influence complications but are influenced by the anatomic location of the fracture. One likely reason for nonvitality nearer to fracture line can be the presence of screws used for fixation of fractures. The number of screws can be limited if and when the fractures are fixed using three-dimensional plates.
The fracture displacement showed some significance in determining pulp vitality. Fractures with gross displacement had pulp vitality with no response in the presurgical stage. In comparison, hairline fractures did not influence pulp vitality. Extractions of teeth in the line of fractures in a few cases tend to displace the fracture segments. However, after the analysis, it was proved that a tooth in the fracture line showing no response in the presurgical stage resulted in infection of the fracture site.
Hence, in such cases, it would be appropriate to proceed with extraction of such teeth followed by the management of fractures. In conclusion, according to our study, a tooth that shows no response on pulp vitality testing should be advised for extraction to avoid further complications in patients presenting with mandibular fracture.
Read article at publisher's site DOI : Craniomaxillofac Trauma Reconstr , 14 2 , 17 Sep Cited by: 0 articles PMID: Kheirallah M , Ozzo S. Dent Traumatol , 05 Jun Dent Traumatol , 33 2 , 19 Jan Cited by: 4 articles PMID: Taysi M , Yildirim S. This data has been text mined from the article, or deposited into data resources. To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.
Cited by: 21 articles PMID: The principal aim of this study was to propose a framework which could be applied in a number of different cases, so that practitioners could analyze and prepare the treatment withmore certainty. In order to avoid limits of stress analysis, our future research will be directed to incorporating fatigue and fracture theory which could give us more information about complex process of tooth weakening.
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Commonly, there are impacted wisdom teeth associated with mandibular angle fractures. However, any fracture involving the jaw's dentate areas can involve erupted teeth in the fracture line. The surgeon can either remove the offending tooth or leave it in place if it is thought not to compromise the result of fracture treatment. Any fracture that involves the periodontal ligament space of an erupted tooth should be considered an open contaminated fracture, requiring administration of systemic antibiotics, at least until the fracture has been reduced and stabilized.
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