Case Presentation

Department of Oral Medicine, Diagnosis and

Radiology
PRESENTED BY:
MAMTA GURUNG
10TH BATCH, BDS
KDCH
CASE HISTORY
Patient’s Information:
 Name: Prabin Tamang
 Regd. No.: 73774
 Age/Sex: 23/M Date: 2076/01/04
 Occupation:
 Marital Status: Unmarried
 Address: balaju
 Telephone No.: 9818226571
CHIEF COMPLAINT

 The patient complains of fracture in upper front teeth region

following RTA (Road Traffic Accident) trauma since 3 days.
HISTORY OF PRESENTING ILLNESS

 Patient gives history of trauma (collision of front teeth to rock)

under alcohol influence.
 Bleeding from gums present, no loss of consciousness.

 No difficulty in breathing and mouth opening.

 Patient also gives history of pain on the same tooth which is

sudden on onset, intermittent.
 Aggravates on having food and relieves on its own.
 Duration
 Speech problem

 Progression

 Relieving factors

 Previous treatments and medications

MEDICAL HISTORY

 Bike accident 3 days back.

 Drugs :

 1.flexon

 2.bipilin

 3.ampicillin+cloxacillin
DENTAL HISTORY

First dental visit.

FAMILY HISTORY

 Nothing Relevant Reported

PERSONAL HISTORY

 Patient brushes once a day daily with fluoridated toothbrush.

 Patient consumes mixed diet.

 Patient has a habit of smoking 2 sticks cigarettes per day since

1 year.
 Patient also has a habit of drinking alcohol 3-4 times a week.
EXTRA ORAL EXAMINATION

 Temporomandibular Joint: Bilaterally synchronous movement,

clicking or popping sounds heard on both sides.
 No TMJ deviation and deflection.
 Lymph nodes: Non palpable and non tender.
 Mouth opening: 53 mm.
 Facial profile: Convex
 Facial symmetry: No gross asymmetry noticed.
INTRA ORAL EXAMINATION

 Soft tissues:
 Gingiva: pink, firm and resilient.
 Generalized bleeding on probing.

 Pocket wrt 17, 18, 26, 27, 37, 38, 46, 47, 48.

 Pus draining sinus wrt 16

 Hard Tissues:
 Plaque: ++
 Spacing on 12, 13

 Decay wrt 16, 27, 28, 38, 46, 48

 Fracture wrt 21, 22

 Grade I mobility wrt 22

 Angle’s class I molar relation.

 TFO (Trauma Formed Occlusion)

PROVISIONAL DIAGNOSIS

 2. Ellis class 3 fracture wrt 12

 4. Dental caries wrt 16, 27, 28, 38, 46, 48

 5. Chronic generalized gingivitis

 8. Angle’s class I malocclusion with TFO present.

INVESTIGATION

 Radiology
 IOPA wrt 12

 OPG
 Pathology:
 11 reveals horizontal radiolucency on the middle third of the
root indicating horizontal fracture.
 12 reveals horizontal radiolucency on the cervical third of the
crown.
 OPG reveals coronal radiolucency indicating loss of coronal
structure and radiolucency in furcation indicating remaining root
stump on 16.
 OPG reveals horizontal bone loss and interdental bone loss.
 28 reveals distocervical radiolucency approaching pulp.
FINAL DIAGNOSIS

Ellis class 3 fracture wrt 12

 Chronic irreversible pulpitis wrt 16

 Impacted wt 18
TREATMENT PLAN

1. Endo-opinion wrt 12
 2. Surgical consultation for laceration and suture.

 3. Restoration wrt 16, 27, 28, 38, 46, 48

 4. Surgical consultation wrt 18

 6. Ortho-consultation for TFO

FRACTURES OF THE TEETH
 Tooth fracture is a common injury which may arise in a variety of
situations, the most common of which is sudden severe trauma.
This is usually a fall, a blow, automobile road traffic accident or
any of a large number of incidences in which children especially
are frequently involved.
 Some cases of fractures occur when a tooth is weakened by a
large restoration, leaving thin walls or unsupported cusps which
give way under the stress of mastication.
 Teeth which have had root canal therapy are often described as
being somewhat brittle and susceptible to fracture.
ELLIS CLASSIFICATION OF TOOTH FRACTURE

 CLASS 1: Simple fracture of the crown involving little or no

dentin.

 CLASS 2: Extensive fracture of crown involving considerable

dentin but not dentinal pulp.

 CLASS 3: Extensive fracture of crown involving cosiderable

dentin and exposing dentinal pulp.
 CLASS 4: Traumatized teeth become non-vital with or without
loss of crown.

 CLASS 5: Teeth lost as a result of trauma.

 CLASS 6: Fracture of root with or without loss of crown.

 CLASS 7: Displacement of tooth with or without fracture of a
crown or root.

 CLASS 8: Fracture of crown en mass and its replacement.

 CLASS 9: Traumatic injuries to deciduous teeth.

FIGURE: ELLIS CLASSIFICATION OF TOOTH FRACTURE
BENNETT’S CLASSIFICATION OF TOOTH FRACTURE

 CLASS I: Traumatized tooth without coronal or root fracture.

A: Tooth formed in alveolus.
B: Tooth subluxed in alveolus.

 CLASS II: Coronal fracture.

A: Involving enamel.
B: Involving enamel and dentin.
 CLASS III: Coronal fracture with pulp exposure.

 CLASS IV: Root fracture.

 A: Without coronal fracture.
 B: With coronal fracture.

 CLASS V: Avulsion of teeth.

FIGURE: BENNETT’S CLASSIFICATION OF TOOTH FRACTURE
EXTRUSION
 Extrusion is defined as partial displacement of a tooth axially
from the socket.
 The periodontal ligament usually is torn.
 Clinical examination reveals a tooth that appears elongated and
is mobile.
 Radiographic findings reveal an increased periodontal space
apically.
 It can be treated by stabilizing it with a flexible splint for 2
weeks. If pulp necrosis is anticipated, root canal treatment is
indicated.
CLINICAL FEATURES
 Fractures of dental crowns most frequently involve anterior
teeth.
 Uncomplicated fractures that involve both the enamel and
dentin of permanent teeth are more common than complicated
fractures that include the pulp.
 In contrast, complicated and uncomplicated fractures occur with
near equal proportions in the deciduous teeth.
 The exposed dentin is usually sensitive to chemical, thermal and
mechanical stimulations.
 In deep fractures, the pink blush of the pulp may be appreciated
through the thin remaining dentin wall.
 The exposed pulp is sensitive to most forms of stimulations.
 Horizontal root fractures occur more commonly in central
incisors and result from the direct application of the traumatic
force to the face, alveolar processes, or teeth.
 In contrast, vertical fractures usually involve the molar teeth in
adults.
 Endodontically treated posterior teeth that have not been
restored with a full coverage restoration are also at risk.
 The mobility of the fractured tooth crown relates to the level of
the fracture. That is, the closer the fracture plane is located to
the apex, more stable the tooth is.
 Fractures of the root may occur with the fractures of the alveolar
process and often are not detected. This situation is most
commonly observed in the anterior region of the mandible
where root fractures are frequent.
IMAGING FEATURES
 Imaging provides information regarding the location and extent
of the fracture and the relationship of the fracture plane and
fragment to the pulp chamber.
 The stage of root development of the involved tooth also can be
assessed.
 Horizontal fractures of the dental root may occur at any level and
involve one or all of the roots of the multirooted teeth.
 Most of the fracture confined to the root occur in the middle
third of the root.
MANAGEMENT
 The sharp edges of enamel that results from an uncomplicated
fracture should be smoothened and may require restoration for
cosmetic reasons.
 Treatment of complicated crown fractures of permanent teeth may
involve pulp capping, pulpotomy or pulpectomy, depending on the
stage of root formation.
 If a coronal fracture of a deciduous tooth involves the pulp, it is
usually best treated by extraction.
 Endodontic therapy is performed when evidence of pulpal necrosis
exists.
 When the fracture occurs in the root, the prognosis is poor, and
the extraction is indicated unless the apical portion of the root
fragment can be extruded orthodontically and restored.
 The roots of the fractured deciduous teeth that are not badly
dislocated may be retained with the expectation that the will be
normally resorbed.
 Single rooted tooth with vertical fractures must be extracted.
 Multirooted tooth may be hemisected, and the intact remaining
half of the tooth may be restored with endodontic therapy and a
crown.
REFERENCE

 Oralradiology principles and interpretation by Stuart C.

White and Michael J. Pharoah ( 1st edition)
 Shafer’s textbook of oral pathology (8th edition)
THANK YOU