CLINICAL MANAGEMENT OF INJURIES TO THE MAXILLA, MANDIBLE, AND ALVEOLUS

Abstract

Facial bone and especially mandibular fractures are injuries in which first aid and management of late complications require dental professionals, and consequently all dentists should be familiar with the modern principles of their treatment. Tooth involvement is common in mandibular and maxillary fractures and can require more treatment than does the jaw fracture. Nonsurgical treatment of bone fractures involves immobilization, which for the facial bones is achieved with maxillomandibular fixation (MMF) using dental fixed arch bars. Hence, associated tooth injuries are difficult or impossible to treat during immobilization, so that some treatment is necessary beforehand (for example, coverage of exposed dental areas, temporary filling of crown fractures, repositioning of luxated teeth, and endodontic treatment if the pulpal vascular supply is lost in the accident). Operative treatment of mandibular and/or maxillary fractures nevertheless involves some disadvantages and risks of complications. Teeth on the line of a mandibular fracture should not be extracted as a first-aid measure unless they impair repositioning of the jaw fragments. MMF can be avoided by means of direct internal fixation, which in principle allows treatment of associated dental injuries.