Journal List > J Korean Assoc Oral Maxillofac Surg > v.36(4) > 1032406

Mo, Yoo, Choi, Sul, Kim, and Lee: The conservative care by early endodontic drainage of infected teeth in the line of a mandibular fracture: report of a case

Abstract

The management of teeth in the line of a mandibular fracture is controversial despite the general agreement that most of these teeth can be preserved. Teeth should be retained if bony attachments are adequate for survival, the tooth is sound and important in maintaining fixation of the fractured segment of bone. Teeth should be removed if they are loose and interfere with the reduction of fragments, are devitalized and potentially a source of wound infection, are damaged beyond their usefulness or may become devital and interfere with healing by becoming infected. However, tooth removal will increase the level of trauma, extend the severity of the wound and require expensive prosthetic treatment. Therefore, it is very important to conserve infected teeth in the line of a mandibular fracture through early primary endodontic treatment (pulp extirpation, canal enlargement and canal opening drainage) and splinting. The basic principles underlying the treatment of pulpless teeth are those underlying general surgery. Therefore, debridement of the infected wound (pulp extirpation and canal enlargement), drainage (canal opening) and gentle treatment of the tissues (occlusal reduction and teeth splinting) are the principles of surgery. This is a representative case report of conservative care by the early endodontic drainage of infected teeth in the line of a mandibular fracture.

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Fig. 1.
Initial view of the infected tooth #42 in the line of a mandibular symphysis fracture.
jkaoms-36-309f1.tif
Fig. 2.
Initial dental panoramic view.
jkaoms-36-309f2.tif
Fig. 3.
Primary wiring and endodontic drainage view of #42 and labial incision and drainage view for the prevention of infection of a mandibular symphysis fracture.
jkaoms-36-309f3.tif
Fig. 4.
Lingual incision and drainage (sutured rubber strip) view for the prevention of infection of a mandibular symphysis fracture.
jkaoms-36-309f4.tif
Fig. 5.
Closed reduction view of arch bar application and intermaxillary fixation in a mandibular fracture
jkaoms-36-309f5.tif
Fig. 6.
Maintenance view of the sutured lingual rubber strip drain.
jkaoms-36-309f6.tif
Fig. 7.
Follow-up check of dental panoramic view in 3 weeks.
jkaoms-36-309f7.tif
Fig. 8.
Endodontic treatment view on #42 tooth.
jkaoms-36-309f8.tif
Table 1.
Factors predisposing to infection of mandibular fracture site
• Local factors
1. Poor oral hygiene and periodontitis
2. Devitalized and infected teeth in the area of the fracture
3. Hematoma in fracture area
4. Delayed immobilization with moving open wound
5. Lymphatic stasis due to direct injury
6. Edema and local tissue damage
7. Destruction of periosteum
8. Foreign bodies in wound
9. Devitalization and abscess of fractured teeth
• General factors
1. Age
2. Malnutrition
3. Debilitating disease
4. Constitutional disease (diabetes, blood dyscrasia)
5. Anergy
Table 2.
Indications and contraindications of extraction on teeth in the line of a mandibular fracture
• Indications
1. Loose tooth
2. Interfered tooth with reduction of bone fragments
3. Devitalized tooth
4. Tooth of a source of infection
5. Interfered tooth with healing by becoming infected
6. Damaged tooth beyond usefulness
• Contraindications (Tooth should be retained)
1. Tooth of adequate bony attachment for survival
2. Sound and important tooth in maintaining fixation of fractured bone segments
Table 3.
Contemporary indications of extraction on tooth in the line of a mandibular fracture
1. The tooth is loose
2. The tooth is grossly carious or periodontally involved
3. More than 50 percent of the root is exposed in the fracture line
4. Adequate reduction is mechanically blocked by its retention
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