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Les Traumatismes AlvéOlo Dentaires

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Les Traumatismes AlvéOlo Dentaires

  1. 1. LES TRAUMATISMES ALVEOLO-DENTAIRES Dr ludovic LAUWERS Dr Olivier SKRZYPCZYK 2 ème Journée de Médecine et Kinésithérapie du Sport En Artois-Bruaysis
  2. 2. LES TRAUMATISMES ALVEOLO-DENTAIRES <ul><li>Fracture Dentaire </li></ul><ul><li>Déplacement de la dent dans l’os </li></ul>
  3. 3. LES TRAUMATISMES ALVEOLO-DENTAIRES <ul><li>Fracture superficielle de la couronne dentaire </li></ul><ul><li>Fracture profonde de la couronne dentaire </li></ul><ul><li>Fracture de la racine </li></ul><ul><li>Fracture profonde de la racine dentaire </li></ul><ul><li>Luxation dentaire </li></ul><ul><li>Extrusion / Impaction </li></ul><ul><li>Expulsion </li></ul><ul><li>Luxation avec fracture de l’os Alvéolaire </li></ul><ul><li>… </li></ul>
  4. 4. ANAMNESE <ul><li>Où ? </li></ul><ul><li>risque de contamination, rappel antitétanique, médication </li></ul><ul><li>Quand ? </li></ul><ul><li>le pronostic est fonction des délais </li></ul><ul><li>Comment ? </li></ul><ul><li>* problèmes généraux : amnésie, inconscience, vomissement, maux de tête… </li></ul><ul><li>* problèmes locaux: </li></ul><ul><li>élément causal (résilience, forme) </li></ul><ul><li>vitesse et direction de l’impact </li></ul>
  5. 5. EXAMEN CLINIQUE <ul><li>Examen endo-buccal </li></ul><ul><li>Dents </li></ul><ul><li>* fractures </li></ul><ul><li>* fêlures (transillumination) </li></ul>
  6. 6. EXAMENS COMPLEMENTAIRES <ul><li>Examen radiographique </li></ul><ul><li>Fractures radiculaires (incidences multiples) </li></ul><ul><li>* fractures multiples </li></ul>
  7. 7. FRACTURES <ul><li>Localisation </li></ul><ul><li>* fractures coronaires </li></ul><ul><li>classe I : émail </li></ul><ul><li>classe II : émail, dentine </li></ul><ul><li>classe III : émail, dentine, effraction pulpaire </li></ul><ul><li>classe IV : supra crestale </li></ul><ul><li>* fractures radiculaires </li></ul><ul><li>classe V : sous crestale </li></ul><ul><li>classe VI : 1/2 racine </li></ul><ul><li>classe VI : 1/3 apical </li></ul>
  8. 8. FRACTURES CORONAIRES <ul><li>collage composite, surveillance </li></ul><ul><li>Dents vitales sans effraction pulpaire </li></ul>
  9. 9. <ul><li>Dents vitales avec effraction pulpaire </li></ul>FRACTURES CORONAIRES
  10. 10. <ul><li>Collage direct (risqué) </li></ul><ul><ul><ul><ul><ul><li>Fracture avec effraction pulpaire petite et récente </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Conditions anatomiques et physiologiques favorables </li></ul></ul></ul></ul></ul>FRACTURES CORONAIRES
  11. 11. FRACTURES RADICULAIRES <ul><li>Fracture verticale </li></ul><ul><li>* extraction </li></ul><ul><li>Fracture horizontale ou oblique </li></ul><ul><li>* traitement conservateur envisageable </li></ul>
  12. 12. FRACTURES HORIZONTALES <ul><li>Traitement d’urgence </li></ul><ul><li>* Réduction </li></ul><ul><li>* Contention </li></ul><ul><li>* Equilibration </li></ul><ul><li>Surveillance </li></ul>
  13. 13. FRACTURES HORIZONTALES Classe VI <ul><li>Traitement endodontique </li></ul><ul><li>* Pas de déplacement des fragments </li></ul>Traitement à l’hydroxyde de calcium (1an), barrière minérale
  14. 14. FRACTURES HORIZONTALES Classe V <ul><li>Extraction </li></ul><ul><li>Chirurgie parodontale </li></ul><ul><li>Traction orthodontique </li></ul>
  15. 15. Conserver ou Extraire ?
  16. 16. Traumatisme <ul><li>Fracture de 11 & 21 </li></ul>
  17. 21. Luxation dentaire <ul><li>luxation de 21 </li></ul>
  18. 22. Luxation dentaire <ul><li>extrusion de 11 </li></ul>
  19. 23. Luxation dentaire <ul><li>Réduction </li></ul><ul><li>Contention </li></ul><ul><li>Equilibration </li></ul>
  20. 25. Denta Scanner
  21. 26. Contention: Immédiate, semi-rigide, non traumatique, facile, esthétique, 10 jours EXPULSION Réimplantation Contention, équilibration surveillance
  22. 27. <ul><li>Pronostic: </li></ul><ul><li>Stade de maturation </li></ul><ul><li>(revascularisation dent immature) </li></ul><ul><li>Etat pulpaire et alvéolaire </li></ul><ul><li>Temps extra-oral </li></ul><ul><li>(mort cellulaire, résorption de remplacement) </li></ul><ul><li>Milieu de conservation </li></ul><ul><li>(milieu conservateur, milieu revitalisateur) </li></ul><ul><li>Thérapeutiques endodontiques </li></ul>EXPULSION
  23. 28. Traumatisme vélo <ul><li>Perte de 11 & 21 </li></ul>
  24. 30. <ul><li>Greffe osseuse </li></ul>
  25. 32. Traumatisme; chute de cheval <ul><li>Fracture de lefort I et lefort II impactée </li></ul><ul><li>Fracas mandibulaire </li></ul><ul><li>Perte de 33 et luxation 31 et 41  </li></ul>
  26. 36. CONCLUSION <ul><li>P rotection : casque, mentonnière, protège-dents… </li></ul><ul><li>R éaction : Consulter rapidement, conservation du fragment ou des éléments dentaires </li></ul><ul><li>O rientation: Spécialiste ou Service Hospitalier </li></ul>

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