Change of an alveolar shoot – violation of integrity of an alveolar part of a bone. Patients complain of the expressed pain syndrome in the injured jaw, strengthening of morbidity at a smykaniye of teeth, swallowing. During survey reveal grazes, wounds in okolorotovy area. A mucous membrane of an oral cavity edematous with signs of ushiblenno-fragmentary damages. The diagnosis "a change of an alveolar shoot" is made on the basis of complaints of the patient, the yielded clinical examination, results of a X-ray analysis. Treatment of a change of an alveolar shoot consists in surgical processing of the damaged sites, a repozition, fixing of the broken-off fragment, a bone immobilization.
Change of an alveolar shoot
Change of an alveolar shoot – damage with full or partial violation of integrity of an anatomic part of a bone of the top (lower) jaw bearing on itself teeth. In stomatology the change of an alveolar shoot of the top jaw meets much more often than lower. It is caused not only by features of a structure of a bone tissue, but also a ratio of jaws among themselves. Compact plates of the top jaw thinner. Besides at an ortognatichesky bite the top cutters block the lower teeth, protecting them from traumatizing.
Foreteeth of the top jaw are open at blow. The maximum injuring force is also the share of them. Changes of an alveolar shoot, combined with violation of integrity of an apikalny third of roots, diagnose seldom. At children most often reveal changes of an alveolar shoot aged from 5 up to 7 years that is caused by existence in a bone of follicles of second teeth. The Distalny bite in combination with the vestibular provision of the top cutters increases risk of a travmatization of an alveolar shoot.
Carry injuries, blows, falling from height to the main reasons for changes of an alveolar shoot. Osteomyelitis, a fibrous osteitis, malignant new growths, radikulyarny cysts lead to weakening of structure of a bone owing to what the change of an alveolar shoot can arise even at influence of small forces. Character of shift of the damaged fragments is influenced by draft of muscles, the area of an otlomk, kinetic energy of blow. If the line of application of force passes in the sagittalny plane, forward , formed as a result of a change of an alveolar shoot, is displaced in a mouth. In case of violation of integrity of side department of a jaw the mobile fragment moves in the direction of the median line and inside.
At patients with deep occlusion and lack of side teeth the damage put from below to the area of a chin leads to the shift of the forward site of the top jaw of a kpereda, kinetic energy of blow is transferred to a bone tissue through the lower cutters. The change of an alveolar shoot in the site of painters arises owing to traumatizing by a narrow subject of the zone located between the lower jaw and a malar arch. Refer a nasal cartilage, a malar arch and a bone to the anatomical structures protecting an alveolar shoot of the top jaw from a change. The lower jaw is strengthened by a podborodochny hillock and slanting lines.
Distinguish the following types of changes of an alveolar shoot:
- Partial change. On the roentgenogram define violation of integrity only of an external compact plate.
- Incomplete change. Diagnose damage of all layers of a bone tissue. There is no shift of fragments.
- Complete fracture. At interpretation of the roentgenogram reveal an arc-shaped enlightenment of a bone tissue (two vertical lines are connected by horizontal).
- Splintered change. Consists of several otlomk which are crossed diversely.
- Change with defect of a bone. The full separation of the damaged site of a bone tissue is observed.
Changes of an alveolar shoot divide also into changes without shift and with shift.
At a change of an alveolar shoot patients complain of intensive spontaneous pain which amplifies in attempt to close teeth. Saliva swallowing is also followed by morbidity. At patients with a change of an alveolar shoot of companies it is half-open. In fabrics of okolorotovy area reveal single or multiple grazes, wounds. Against the background of an edematous mucous oral cavity diagnose ushiblenno-fragmentary damages. At a change of an alveolar shoot with shift under the bleeding mucous membrane there is a region of the broken-off site of a bone.
As a result of hemorrhage the transitional fold is maleficiated. The bite at patients is broken because of the shift of the broken-off fragment. At a smykaniye the okklyuzionny contact is defined only on cutting edges and the chewing surfaces of teeth of the damaged site. Teeth are mobile, vertical percussion positive. At an incomplete change of an alveolar shoot the full or driven dislocations of teeth are a cause of infringement of occlusion. At a change of an alveolar shoot often diagnose bleeding from a laceration mucous or zubodesnevy connection. At children's age the damaged displaced fragment of an alveolar shoot may contain rudiments of second teeth that leads further to their death.
Diagnosis of a fracture an alveolar shoot includes collecting complaints, fizikalny survey, a radiographic research. During clinical inspection the dentist reveals a swelling of soft fabrics, violation of integrity of integuments of a prirotovy zone. Opening of a mouth is complicated. On a red border of lips, and also on a mucous oral cavity define ushiblenno-lacerations. The bite is broken. The complete and partial dislocations of teeth which are followed by bleeding can be observed. Pathological mobility of teeth of the damaged bone fragment is noted. Vertical percussion of teeth of the displaced site, and also those which border on the line of a change, positive.
The Palpatorny research at a change of an alveolar shoot is high-informative. Due to identification of mobile points at the shift of the damaged fragment in the sagittalny and transverzalny planes it is possible to reproduce the line of a change clinically. Pressing on an alveolar shoot is followed by morbidity. Loading symptom positive. Results of a X-ray analysis are solving "a change of an alveolar shoot" at diagnosis. At patients with damage of an alveolar part in a picture reveal an enlightenment of a bone tissue with uneven borders, in a form, reminding an arch. Due to more dense structure of a bone tissue the change of an alveolar shoot of the lower jaw has more accurate contours. When carrying out a computer tomography along with violation of integrity of a bone it is possible to define an arrangement of the wound channel in soft fabrics, existence and exact localization of a hematoma.
EOD use for definition of a condition of a pulp of teeth of the damaged fragment. Diagnostics is carried out twice. At the first research indicators of sensitivity of a pulp are, as a rule, lowered. Repeated inspection in dynamics in 2 weeks helps to define further tactics of the stomatologist as viability of a pulp can be restored. It is normal of EOD 6 of a mk, value in the range of 20-100 mk speaks about a pulpitis, indicators of EOD 100 of a mk signal about a pulp necrosis, development of periodontitis above.
The change of an alveolar shoot needs to be differentiated with injuries of soft fabrics and with other fractures of bones of maxillofacial area. Clinical examination is conducted by the maxillofacial surgeon.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Treatment of a change of an alveolar shoot includes elimination of a pain syndrome, antiseptic processing of the damaged fabrics, a manual repozition of otlomk, an immobilization. For the purpose of anesthesia carry out conduction anesthesia. At a change of an alveolar shoot with shift make audit of a wound, smooth keen edges of a bone and take in mucous tightly or close a bone wound a yodoformny bandage.
The displaced fragment is established in the correct situation under control of okklyuzionny ratios. For an immobilization most often use the smooth tire bracket manufactured of an aluminum wire. It is bent from the shchechny surface of teeth. On condition of lack of destructive periapikalny changes of a bone tissue and pathological mobility of teeth of the intact site the tire is fixed to 3 teeth on both sides from the line of a change of an alveolar shoot. The one-maxillary bracket is established at the expense of adhesive systems and light-cured composite material or by means of metal ligatures which need to be changed every week.
If at a change of an alveolar shoot in the site of painters there is only one support for fixing of the tire, the number of steady teeth increase to 5. For achievement of more resistant immobilization use podborodochny I will forgive. In case of the driven dislocation of forward department of the top jaw apply a one-maxillary steel bracket which is tied ligatures to healthy teeth. The displaced fragment is connected to the tire elastic elastic bands. If at a change of an alveolar shoot in basic sites teeth are absent, manufacture the tire of quick-hardening plastic. In the first days appoint antibiotic treatment, a hypothermia. As medicines for carrying out antiseptic processing use broths of herbs, medicines on the basis of a hlorgeksidin of a biglyukonat.
If fangs are not in the line of a change of an alveolar shoot, the forecast favorable. The one-stage repozition and an immobilization allow to reach formation of a bone callosity within 8 weeks. At the late address of patients terms of treatment are extended, the list of medicines for performing anti-inflammatory and antibacterial therapy extends, osteosynthesis options are narrowed, risks of development of post-traumatic osteomyelitis, a false joint increase. For reposition of rigid fragments use additional devices to extra oral and intra oral extension.
If along with a change of an alveolar part diagnose violation of integrity of fangs, the forecast adverse. It is not possible to reach consolidation in most cases. As a result of violations of an innervation and traffic sequestration and rejection of the broken-off fragment is observed.