PMC4538768_01
Preoperative view of the limited mouth opening and soft tissue wounds of the case-study patient following a car accident.
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Initial physical examination showed abrasions and lacerations on the facial skin and the lips (Figure 1).
Cone beam CT views showing the fractures in the mandibular body.
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CBCT examination revealed a nondisplaced mandibular body fracture in the right second molar region, an oblique greenstick fracture on the left lingual side extending between the canine and first molar tooth, and a unilateral medially displaced subcondylar fracture on the right side (Figures 2-3).
3D, axial, and coronal views of the right condyle, showing the medially displaced subcondylar fracture.
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CBCT examination revealed a nondisplaced mandibular body fracture in the right second molar region, an oblique greenstick fracture on the left lingual side extending between the canine and first molar tooth, and a unilateral medially displaced subcondylar fracture on the right side (Figures 2-3).
Initial panoramic radiography showing mandibular body fractures, avulsed maxillary left lateral incisor, and maxillary right central incisor with horizontal root fracture.
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Avulsion of the maxillary left lateral incisor was verified by radiograph and a horizontal root fracture of the maxillary right central incisor was also detected (Figures 4 and 5).
Cross-sectional and coronal view of the horizontal root fracture.
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Avulsion of the maxillary left lateral incisor was verified by radiograph and a horizontal root fracture of the maxillary right central incisor was also detected (Figures 4 and 5).
(a) Vacuum formed splint used for functional repositioning. (b) Intraoral photograph showing the brackets attached to the maxillary posterior teeth. (c-d) Orthodontic elastics guide the patient into centric occlusion.
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A vacuum formed splint was fitted in the lower arch for functional repositioning of the mandible (Figure 6(a)). Arch bars that were cut to the appropriate size were bonded to vestibuloposterior parts of the splint using acrylic, and brackets were attached to the maxillary posterior teeth (Figure 6(b)). Orthodontic elastics (1/4 inch, medium strength) were used to prevent uncontrolled movements of the jaw within the first week of treatment (Figures 6(c)-6(d)).
Cone beam CT views of the mandible after 18 months.
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Clinical and radiological examination after 18 months revealed uneventful healing with reduction of the condylar head and remodeling of the condylar process following the conservative treatment and also complete healing of the mandibular body fractures (Figure 7).
Six-year follow-up findings. (a) Intraoral photograph showing the discoloration of the maxillary right central incisor, infraocclusion of both central incisors, and midline shift. (b) Panoramic radiograph showing internal resorption in the maxillary right central incisor and ankylosis of the left central incisor.
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Clinically, the maxillary central incisors were in infraposition, being more prominent in the left incisor than the right incisor (Figure 8(a)). Radiographic examination showed internal resorption on the maxillary right central incisor and ankylosis on the maxillary left central incisor (Figure 8(b)).