Radiographic Interpretation of

Dental and Maxillofacial Trauma

By

Dr. Ahmed M. Bakry Lecturer of Oral Radiology, Faculty of Dentistry, Minia University

Radiographic signs of fracture:

1- The presence of a radiolucent line (usually sharply

defined) within the anatomic boundaries of the structure.

2- A change in the normal anatomic outline or shape of the

structure.

3- A defect in the outer cortical boundary, which may

appear as a deviation in the smooth outline, a gap in the

outer cortical bone, or a step-like defect.

4- An increase in the density of the bone, which may be

caused by the overlapping of two fragments of bone.

Concussion

Avulsion Luxation

Fracture

Concussion

Crushing injury to the vascular structures at the

tooth apex and to the periodontal ligament,

resulting in inflammatory edema. Only minimal

loosening or displacement of the tooth occurs

Concussion

Widening of the periodontal ligament space Reduction in the size of the pulp chamber and pulp canals Increase in the width of the pulp chamber and canals Peri apical lesion Internal root resorption may occur

Luxation

Dislocation of the articulation of the tooth.

Such teeth are both abnormally mobile and

displaced

Luxation

Widening of the periodontal ligament space Slight elevation of the tooth may not be radio graphically apparent. Depressed position of the crown of an intruded tooth is often apparent Peri apical lesion

Avulsion

•Complete displacement of a tooth from the alveolar process. •Teeth may be avulsed by direct trauma when the force is applied directly to the tooth, or by indirect trauma . •Avulsion occurs in about 15% of traumatic injuries to the teeth.

Avulsion

lamina dura of the empty socket is apparent. New bone replacing the socket may be very dense and radiopaque and may appear similar to a retained root .

Fractures of the teeth

Radiograph provides information

regarding the location and extent of the

fracture and the relationship to the

pulp chamber as well as the stage

of root 0development of

the involved tooth

Le Fort I fracture:

The fracture line passes

above the teeth, below

the zygomatic process,

and through the maxillary

sinuses and tuberosities

to the inferior portion of

the pterygoid processes.

Le Fort II fracture:

• Separates maxilla from

base of skull.

• Fracture line extends

through lacrimal bones,

floor of orbit, through

zygomaticomaxillary

suture.

Le Fort III fracture :

• Fracture line extends

through nasal bones,

frontal process of maxilla,

across the orbit, and

zygomatico-frontal suture,

separates pterygoid plates

• May involve mandibular

fracture

• Unilateral fractures involving the

zygoma are of two types:

zygomatic arch fractures, in

which just the arch is fractured

and zygomatic complex

fractures, in which the zygomatic

bone is separated from its frontal,

maxillary, and temporal

connections.

• Bilateral zygomatic fractures

occur in association with Le Fort

II and III fractures.