Trauma

What injuries do we treat?
Subluxated teeth
Avulsed teeth
What are the possible treatments for teeth that were lost, knocked out, or came out of their socket?
Fractured teeth
Dentoalveolar fracture
Mandibular fractures
Maxillary fractures
Cheek bone fractures
Lacerations

What injuries do we treat?
We treat all forms of oral and facial related injuries. These include teeth displacements, dentoalveolar fractures, mandibular fractures, maxillary fractures, cheek bone fractures, orbital bone fractures, nasal fractures and all oral/facial lacerations (mucosa and skin). Dr. Kazemi received extensive training in management of traumatic injuries at the Washington Hospital Center, a level I trauma center, and he is on staff at both Suburban Hospital and Washington Hospital Center.

Subluxated teeth
Subluxation refers to partial displacement of a tooth in response to trauma. Here are the important considerations in managing subluxated teeth:

  • Root fractures are ruled out by X-ray.
  • Possible dentoalveolar fractures are evaluated.
  • Soft tissue is evaluated for possible lacerations or de-gloving injuries and closure.
  • Local anesthesia is given along with IV sedation or nitrous oxide sedation
  • Displaced teeth are reduced digitally and aligned into proper position and occlusion.
  • Teeth are splinted and maintained for about four weeks.
  • Endodontic evaluation should be done within one to two weeks and initial root canal treatment completed, if appropriate.


Avulsed teeth
There are two treatment options:

  1. Re-implant the tooth and try to save it. This has only a 25 to 40 percent chance of success in adults even under best circumstances. It is more predictable in children between ages 6 and 8.
  2. Replace the lost teeth with immediate dental implants — today’s treatment of choice with a prognosis of 98 percent or above.

Patients should:

  • Be instructed to only handle the tooth by its crown. Do not touch its root.
  • Place the tooth in a small container with milk. If not available, then place the tooth inside of their cheek. Saliva is a good medium and will keep the root surface healthy.
  • Come immediately to our office within 30 to 45 minutes for possible re-implantation.
  • If the tooth is contaminated, fractured, or has been out of its socket for longer that 30 minutes, re-implantation is not recommended.


What are the possible treatments for teeth that were lost, knocked out, or came out of their socket?
Immediate implant placement: This is done if the supporting bone is relatively healthy and undamaged from the injury. Dr. Kazemi is also a specialist in dental implants.
Bone graft: If bone was significantly damaged or lost during injury, an immediate implant may not be possible. In this case, bone grafting material may be placed to build up the supporting bone and prepare it for implants after healing for four to six months.
No treatment: In more severe injuries, it may not be possible to place an implant or bone graft. The site may be irrigated, cleaned, and sutured. Implant placement may be initiated in two to three months.
Temporary tooth: A transitional or temporary tooth can be made within days of injury to help patients return to work or school.

Fractured teeth:
Depending on the degree of fracture, fractured teeth may be saved, but they require immediate attention. The various types of fracture and treatment are:

  • Mild to moderate tooth fracture involving enamel/dentin — if there are no root fractures, and the supporting bone is intact, a fractured tooth involving only its enamel or dentin without pulp exposure can be restored with bonding materials. If it is a deep fracture, a root canal treatment must be done first. If it is a superficial fracture, it may be restored, but the pulpal health must be re-evaluated later by an endodonitst.
  • Teeth with deep fractures require immediate extraction — the supporting bone should be evaluated carefully at the time and treated accordingly. Immediate implants may be placed if the bone is relatively healthy and intact. A provisional restoration may be fabricated within a day or two. Implants may be restored permanently after three to six months of healing.


Dentoalveolar fracture
Dentoalveolar fractures involve teeth and the supporting bone. Treatment is generally geared toward closed reduction and repositioning with splinting for four to six weeks. Endodontic evaluation should be initiated within two weeks. Depending on the severity of the fracture, extractions may be necessary if repositioning and splinting offer poor prognosis. It is best to preserve the bone within the fractured segment for future implant placement. Bone grafting may be done at this stage if necessary and appropriate.

Mandibular fractures
Mandibular fractures may involve the symphysis, body, angle, ramus, or condylar regions. Treatment consists of closed or open reduction to establish proper occlusion and placement of inter-maxillary fixation. Internal fixation with plates and screws is indicated for unfavorable fractures as well as some involving multiple fractures. The inter-maxillary wire fixation is generally maintained for six weeks, unless the fracture has been internally fixated with stronger plates. Open reduction and fixation can be done through oral or skin incisions depending on the site and type of fracture.

Maxillary fractures
Maxillary fractures, also known as mid-facial fractures, may involve the entire maxilla (Lefort I) along with segmental fractures in various forms. Treatment consists of closed or open reduction to establish proper occlusion and placement of inter-maxillary fixation. Internal fixation with plates may be necessary and can be performed if appropriate. In addition to maxillary fractures, mid-facial trauma may also involve zygomatic (cheek bone) or orbital bone fractures.

Cheek bone fractures
Cheek bone — or zygomatic — fractures often result from mid-facial trauma and present as a flattening of the cheek region. This often extends to the orbital bone, causing significant swelling and ecchymosis around the eye. Treatment involves open reduction with internal fixation using micro-plates and screws.

Lacerations
We treat all forms of soft tissue injuries and lacerations to the mouth, face, or scalp. We use plastic closure techniques for an aesthetic result and to minimize scars. Patients are given precise wound care instructions, and sutures are generally removed in five to seven days.