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Complex maxillary fractures: role of buttress reconstruction and immediate bone grafts.

Between 1978 and 1984, 558 patients with complex facial fractures have been treated. One hundred and seventy-one of these patients have had complex Le Fort fractures of the maxilla. In this group of patients, the importance of direct anatomic reconstruction of the anterior maxillary buttresses has been assessed. Complete exposure of the injured buttresses will facilitate assessment of the exact fracture pattern. Direct fixation of the medial and lateral maxillary buttresses on each side, in combination with immediate bone-graft reinforcement or replacement of comminuted or missing buttresses, will facilitate the reconstruction of even the most severely injured maxilla in one stage. This approach is combined with similar reconstructive techniques in other areas of the craniofacial skeleton. Associated mandibular fractures are managed with rigid internal fixation utilizing A-O techniques. The use of these techniques dramatically facilitates airway management and simplifies the treatment of the edentulous patient, the patient with bilateral condylar neck fractures, and those patients with sagittal splitting of the maxilla and palate. The use of both internal craniofacial suspension wires and external craniofacial suspension devices has become largely unnecessary, and reconstruction of even the most complex injuries in one stage with minimal complications and secondary deformities is made possible.

Bone Transplantation↗

Reattachment of a fractured maxillary tooth: a case report.

A 14-year-old male patient reported with a horizontal fracture of almost the entire crown of a maxillary incisor, extending subgingivally at the palatal side. After root canal therapy and electrosurgery, the tooth fragment was reattached using a total-etch dentin-bonding system and a hybrid composite. Due to enamel cracks and the necessity for more retention, the labial surfaces of the teeth were veneered with a micro-filled composite. The clinical situation of the reattached teeth was confirmed successful by radiographic and photographic assessment after 1, 3, 6, and 12 months. The restoration of an anterior tooth with original tooth fragment in young patients has advantages over conventional composite or prosthetic restorations. However, reattached teeth with fracture extending subgingivally, require long-term follow-up.

Adolescent↗

Treatment of root-fractured maxillary incisor with Thermafil obturator.

This case report describes the treatment of a maxillary left central incisor with intra-alveolar horizontal root fracture in the middle of the root. The pulp of the coronal segment was necrotic and endodontic treatment was performed. Instrumentation of the root canal through the fracture line was carried out and the tooth was obturated with Thermafil in order to bring about a union of the fragments. At the 24-month follow up examination the tooth was functionally and esthetically normal. Radiographically no pathosis was evident in the periapical or fracture areas.

Adult↗

Treatment and prognosis of a vertically fractured maxillary molar with widely separated segments: a case report.

This is a report of the treatment and prognosis of a maxillary second molar exhibiting a complete vertical crown-root fracture. The buccal and palatal segments were widely separated by as much as 2 mm and were immobile. To restore this tooth, it was essential to bring the segments into close apposition. This was accomplished by application of orthodontic elastics to the tooth crown in combination with a wire splint. After approximately 1 month of continuous use of the orthodontic elastics, the dislodged segments were suitably repositioned close to their original positions. The tooth was then endodontically treated and restored with a cast complete crown. The restored tooth has been functioning well, with periodic periodontal maintenance, for more than 3.5 years, indicating a promising prognosis.

Adult↗

Reattachment of a fractured maxillary incisor crown--case report.

Management of traumatic injuries to the teeth is a challenge to the practising dentist. It has no prescriptive method for occurring, possesses no significant predictable pattern of intensity or extensiveness and occurring at times when dentists are least prepared for it. It may not only leave physical scars but also a psychological impact on its victim. Yet, more than half of all children traumatize either their primary or permanent teeth before leaving the school, coupled with the dynamic panorama of sporting activity worldwide and the significant increase in violence among the populations. Tooth trauma and its management loom as a major challenge to the dental practitioner. A case of a 11 year old boy with Ellis Class 3 traumatic injury to the maxillary left central incisor is reported. A pulpectomy was performed followed by reinforcement and reattachment of the crown fragment and restoration with composite resin.

Accidental Falls↗

[Anxiolysis vs. intravenous conscious sedation during maxillary fracture splinting in local anesthesia].

For the conservative treatment of mandibular fractures with arch bars under local anaesthesia we used two forms of premedication in 140 patients: 1. an analgetic sedation with pethidine 1 mg/kg body weight and promethazine 0.5 mg/kg body weight i.m. (n = 70 cases) 2. an anxiolytic sedation with midazolam 0.05-0.1 mg/kg body weight i.v. (n = 70 cases). The effect of the premedication was measured retrospectively by the mean amount of local anaesthetics used during splinting. It could be noted that the mean consumption of local anaesthetics was significantly lower in the midazolam-group than in the pethidine/promethazine-group. The postoperative subjective assessment of the operation by the patients is better under anxiolytic than under analgetic sedation, too.

Adolescent↗