A host of radiographic techniques are available to evaluate dentoalveolar trauma. Most can be readily performed in the dental office with available equipment. Most commonly a combination of occlusal and periapical radiographs are used. The radiographic examination should provide the following information.
1. Presence of root fracture
2. Degree of extrusion or intrusion
3. Presence of preexisting periapical disease
4. Extent of root development
S. Size of the pulp chamber and root canal
6. Presence of jaw fractures
7. Tooth fragments and foreign bodies lodged in soft
A single radiograph may not be sufficient to demonstrate
a root fracture.’ For a radiograph to demonstrate a
fractured root, the central beam of the x-ray must be parallel
to the line of fracture; otherwise the fracture may not be clearly seen (Fig. 23-6). Multiple views with differing vertical and horizontal angulations of the central ray may be necessary. Displaced teeth may show a widening of the penodontal ligament space or displacement of the lamina dura. Extruded teeth may demonstrate a conical periapical radiolucency (Fig. 23-7). Intruded teeth may show minimal radiographic findings because of the.continued close adaption of the lamina dura and the root surface.Frequently, however, intruded teeth show an absence of the periodontal ligament space.
Radiographic evaluation for foreign bodies within thesoft tissues of the lips or cheeks are taken with the radiographic film placed inside the soft tissues to be examined,
labial to the alveolus (Fig. 23-8, 11.). A reduced radiographic exposure time is used (approximately one third of normal). Foreign bodies in the floor of the mouth are viewed with cross-sectioned occlusal radiographs, also with reduced radiographic exposure time (Fig. 23-8, R).
Classification of Traumatic Injuries to the Teeth and Supporting Structures
Many systems are used for the description of dentoalveolar injuries, all of which have advantages and disadvantages. A relatively simple yet useful classification was presented by Sanders, Brady, and Johnson (BOX23-1).4 Their method is based entirely on a description of the injury
sustained during the traarnatic episode, describing the tooth structures invgJAtecl, the type of dsustained during the traarnatic episode, describing .