Fracture of the tooth: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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The most common type of traumatic tooth injury is a fracture of the tooth at various levels. There are: a fracture of the tooth at the level of the dentinal dentin (without exposing the pulp), at the level of the near-pulp dentin (the pulp is visible) and fracture of the crown with damage to the pulp.
As a result, various forms of pulpitis, periodontitis and (subsequently) radicular cysts arise. It depends on the strength and direction of the impact, the level of damage to hard tissues and pulp, the age of the child, the degree of root formation, the safety of the neurovascular bundle, the time elapsed since the injury.
[What causes a fracture of the tooth?
The most common acute injury of permanent teeth occurs at the age of 8-13 years (79%) with a maximum frequency at the age of 9-10 years (32%). The main causes of tooth fracture: accidental fall or stroke in the street during the game (30%), household trauma at home (16%), at school (15%), sports injury (14%), trauma during the fight (14%), road accident (6%). Sometimes (5%) patients can not remember the exact cause of the injury.
Symptoms of a tooth fracture
The front teeth of the upper jaw (93%) are damaged; the teeth of the right half of the upper and lower jaws are slightly more likely to be injured than the teeth of the left half (respectively 53% and 47%). The oblique fracture of the tooth (76%) predominates over the transverse, the fracture of the medial angle of the crown (84%) occurs much more often than the distal one.
Fracture of the tooth causes children a lot of suffering, since at the same fracture slit either passes near the pulp, or crosses it, causing the development of acute pulpitis.
Diagnosis of a fracture of the tooth
The diagnosis of a nosologic form of the disease resulting from trauma is based on data from anamnesis, objective examination of the oral mucosa and teeth, and clinical examination.
With a fracture of the root, a pattern of acute traumatic pulpitis and periodontitis develops, and in the case of a fracture of the crown, pulpitis.
On the intraoral contact radiograph, the plane of the fracture is seen as a narrow line or an oblate oval. In rare cases, the fusion of root fragments is noted, which on serial X-ray patterns is determined in the form of a gradual "disappearance" of the fracture line; After a few months at the site of the fracture, the muff-shaped thickening of the root is seen. The growth of fragments of the root of the tooth is usually prevented by an emerging infection.
Treatment of a fracture of the tooth
Untimely or irrational therapeutic tactics for acute trauma of teeth in children can lead to morpho-functional changes in the tooth pulp and periodontal, the loss of the injured tooth.
The prognosis and indications for the choice of treatment of tooth fracture depend on many factors. It is necessary to determine the functional capacity of the pulp, the condition of the tooth root and periodontal. Radiography is carried out to assess the condition of periapical tissues, the stage of development of the root, the elimination of its fracture, and subsequent monitoring of the results of treatment. Electrodontodiagnostics is used to determine the viability of the pulp in the dynamics. It should be borne in mind that its indicators depend on the degree of formation of the root of the tooth. In intact teeth with unformed roots, they are 20-60 μA.
In case of traumatic pulpitis, it is important to keep the functional pulp of the tooth (especially in the teeth with incomplete formation of the root and periodontal), which ensures the prevention of destructive changes in periapical tissues. Therefore, special importance in children should be given to the biological method of treatment. To this end, after the antiseptic treatment of the injured tooth with a sterile turbine boron, a groove is created along the entire fracture plane (for better fixation of the therapeutic substance and hermetic bandage). In order to increase the plastic function of the pulp and the formation of a replacement dentin, the fracture line is covered with a biological agent of odontotropic action. The therapeutic paste is fixed with evicryl without preliminary etching of the enamel. In the absence of spontaneous pain, pain from Cold irritants, negative reaction to percussion, normalization of indicators of electrodontometry, restoration of the tooth crown with composite material is carried out. With contraindications to the biological method, a vital amputation or vital extirpation is performed (taking into account the stage of development of the root).
In the treatment of traumatic periodontitis of the tooth with incomplete root formation, it is necessary to perform a 2-stage root canal filling. In the first stage (unformed root and periodontium), a paste containing calcium hydroxide (Calxil, AH-Plus, Sealapex) is used as the root seal. After the completion of the formation of the root and periodontal (the second stage), which is determined radiologically, the root canal is repaired with a permanent filling material.
When the root of a gangrenous tooth fractures, it is removed, and the defect of the dentition row is replaced by a temporary removable prosthesis made of plastic. If a dairy intact tooth has been injured , the problem of its removal is decided depending on the degree of displacement of the fragments: with a significant displacement, the coronal fragment should be immediately removed and the apical fragment left, since it is very difficult to remove. In case of a fracture of the permanent tooth, and also if you want to keep the milk tooth, use plastic mouthguards (for milk teeth) or a Shelhorn bandage (for permanent teeth).
When a tooth fracture in the upper third of the root in children aged 10-14 years is recommended before fixing to resect the tip of the root of the tooth (i.e., remove the broken off part of it), and the canal sealed.
If the fracture occurred in the region of the neck of the tooth, the root is usually retained as the basis for the pin tooth.
As L. P. Syraţka points out, the results of treatment of a radicular cyst of traumatic origin obtained in her practice testify to the possibility of conservative therapy in children. For medicamentous treatment of the root canal, it is advisable to use preparations of the group metronidazole (metrozhil, trihomonotsid). As a root seal - containing calcium hydroxide paste with gutta-percha pins.
All children with acute dental trauma should be on dispensary records. Repeated examinations are carried out after 3 days, 1 week, 1, 3, 6, 12, 18 months after the end of treatment and include an objective examination, electro-odontodiagnostics in dynamics, and after 1 and 1.5 years - radiography. The criteria for removal from dispensary for teeth with unformed roots is the complete completion of their growth; for teeth with formed roots in the presence of periapical changes - restoration of bone tissue in the lesion.