Alveolar ridge. Alveolar process and its pathologies Small number of natural openings

4. well developed lymphatic system;

135. What is the MOST likely reason for the low efficiency of infiltration anesthesia in the lower jaw?

1. jaw mobility;

2. abundant blood supply;

3. well developed lymphatic system;

Few natural openings;

5. large muscle mass around the lower jaw

136 Which of the following nerves is blocked during mandibular anesthesia?

1. buccal;

2. lingual;

3. nasolabial;

4. n. mandibularis

5. mandibular;

137. Which of the following nerves is blocked during mandibular anesthesia?

1. zygomatic-facial;

2. maxillary;

3. mandibular;

4. zygomatic-temporal

lower alveolar

138. All of the following nerves are blocked during torusal anesthesia, EXCEPT?

1. buccal;

2. lingual;

3. mental;

4. mandibular;

5. lower alveolar

139. Which of the following nerves is blocked during torusal anesthesia?

1. buccal;

2. nasolabial;

3. n. mandibularis

4. mandibular;

5. maxillary;

140. Which of the following nerves is anesthetized during torusal anesthesia?

1. lingual;+

2. nasolabial;

3. n. mandibularis

4. mandibular;

5. maxillary;

141. When performing which of the following anesthesias, the pterygo-mandibular fold is an anatomical landmark?

1. torusal;

2. mental;

3. mandibular anesthesia by extraoral method;

4. mandibular anesthesia by intraoral digital method;

Mandibular anesthesia by intraoral apodactyl method.

Topic № 5. Anesthesia of tissues during surgical interventions on the upper jaw. Phantom work.

142. Tuberal anesthesia causes blockade of the upper alveolar nerves:

1. rear;

2. medium;

3. side;

4. lower;

5. front.

143. A 20-year-old boy underwent anesthesia. At the same time, the following were anesthetized: the first, second, third large molars of the upper jaw, the periosteum of the alveolar process and the mucous membrane covering it from the vestibular side in the area of ​​these teeth, the mucous membrane and bone tissue of the posterior-outer wall of the maxillary sinus. What kind of anesthesia was performed by the doctor?

1. palatine;

2. incisive;

3. tuberal;

4. infraorbital;

5. infiltration.

144. A 40-year-old man came to the dental clinic for the purpose of sanitation of the oral cavity before prosthetics. It is necessary to remove 1.1,1.2 intact teeth, III degree of mobility, exposing the roots to 1/3 of the root length.

Which of the following should be blocked for painless tooth extraction?

1. superior posterior alveolar;

2. lower alveolar;

3. superior anterior alveolar; +

4. upper middle alveolar;

5. incisive branch of the inferior alveolar nerve.

145. For a 30-year-old man, for surgical intervention, the doctor performed anesthesia according to the following method: with the index finger of his left hand, he felt a protrusion along the lower edge of the orbit, stepped back 0.75 cm from it and marked the target point. With the thumb of the left hand, he took his lip up, made an injection along the transitional fold between 1.2 and 1.1 teeth, advanced the needle in the direction of the index finger, released an anesthetic solution.

Which of the following anesthesia was performed by a doctor?

1. incisive;

2. according to Weisblat;

3. tuberal;

4. infraorbital;

5. infiltration.

146. When removing 2.2 teeth, the doctor performed anesthesia, made an injection on the vestibular side at the level of 2.1 teeth (the cut of the needle is facing the bone), advanced the needle up to 2.3 teeth, and released an anesthetic along the way. The second injection of the needle was made from the palatal side, in the projection of the roots of 2.2 teeth. The solution is released under the mucosa without advancing the needle.

What kind of anesthesia did the doctor perform?

1. palatine;

2. incisive;

3. tuberal;

4. infraorbital;

Infiltration.

147. Objectively, in a 66-year-old woman: asymmetry of the face due to collateral edema in the region of the upper lip on the left, in the oral cavity: 1.2 tooth is destroyed to the gum level, changed in color, percussion is painful, in the projection of 1.1, 1.2, 1.3 teeth from the vestibular side of the alveolar the process is determined by the infiltrate, painful on palpation, the symptom of "fluctuation" is positive. On the intraoral radiograph: channel 1.2. the tooth is sealed by ¼, twisted, in the periapical tissues, a rarefaction of bone tissue with fuzzy boundaries is determined.

Which of the nerves is MOST appropriate to block for further treatment?

1. zygomatic and posterior superior nasal;

2. posterior superior alveolar and palatine;

3. middle upper alveolar and incisive;

4. large rocky and deep rocky;

bone skeleton periodontium are the alveolar process of the upper jaw and the alveolar part of the body of the lower jaw. The external and internal structure of the jaws has been sufficiently studied both at the macroscopic and microscopic levels.

Of particular interest are data on the structure of the bone walls of the alveoli, the ratio of spongy and compact substance. The importance of knowing the structure of the bone tissue of the alveolar walls from the vestibular and oral sides is due to the fact that none of the clinical methods can establish the normal structure of these areas and the changes occurring in them. In works devoted to periodontal diseases, they describe mainly the state of bone tissue in the area of ​​interdental septa. At the same time, based on the biomechanics of the periodontium, as well as on the basis of clinical observations, it can be argued that the vestibular and oral walls of the alveoli undergo the greatest changes. In this regard, consider the alveolar part of the dentoalveolar segments.

Alveolus has five walls: vestibular, oral, medial, distal and bottom. The free edge of the walls of the alveolus does not reach the enamel border, just as the root does not adhere tightly to the bottom of the alveolus. Hence the difference between the parameters of the depth of the alveoli and the length of the root of the tooth: the alveolus always has larger linear dimensions than the root.

The outer and inner walls of the alveoli consist of two layers of compact bone substance, which merge at different levels in differently functionally oriented teeth. The study of layered vertical sections of the jaws and the radiographs obtained from them (Fig. 4, 1, 2, 3) makes it possible to determine the ratio of compact and spongy substance in these areas. The vestibular wall of the alveoli of the lower incisors and canines is thin and consists almost entirely of a compact substance. The spongy substance appears in the lower third of the root length. In the teeth of the lower jaw, the oral wall is thicker.

The thickness of the outer compact substance is different both at the level of one segment and in different segments. For example, the greatest thickness of the outer compact plate is observed on the lower jaw from the vestibular side in the region of the molar-maxillary segments, the smallest - in the canine-maxillary and incisor-maxillary segments.

The compact plates of the walls of the alveoli are the main pillars that perceive and transmit, together with the fibrous structure of the periodontium, the pressure acting on the tooth, especially at an angle. A. T. Busygin (1963) revealed a pattern: the vestibular or lingual cortical plate of the alveolar process and, accordingly, the inner compact layer of the alveolar wall is thinner on the side of the tooth inclination. The difference in thickness is the greater, the greater the inclination of the tooth with respect to the vertical plane. This can be explained by the nature of the loads and resulting deformations. The thinner the walls of the alveoli, the higher the elastic-strength properties in these areas. As a rule, in all teeth, the walls of the alveoli (vestibular and oral) become thinner towards the cervical region; because in this zone the root of the tooth, as well as in the apical zone, makes the greatest amplitude of movements. The structure of the bone of the alveolar process depends on the functional purpose of the groups of teeth, the nature of the loads on the teeth and the axis of inclination of the teeth. The slope determines the nature of the loads and the occurrence in the walls of the alveolus of zones of concentration of pressure for compression or tension.

Cortical plates of the alveolar process from the vestibular and lingual (palatine) sides, the inner compact plate of the alveolus wall, as well as the bottom of the alveolus, have numerous feeding holes directed towards the root of the tooth. It is characteristic that on the vestibular and oral walls these openings are mainly closer to the edge of the alveoli and precisely in those areas where there is no spongy bone substance. Blood and lymphatic vessels, as well as nerve fibers pass through them. The blood vessels of the pericement anastomose with the vessels of the gums, bone, and medullary spaces. Thanks to these holes, there is a close connection between all tissues of the marginal periodontium, which can explain the involvement of periodontal tissues in the pathological process, regardless of the location of the pathogenic onset - in the gum, bone tissue or periodontium. A. T. Busygin indicates that the number of holes, their diameter are in accordance with the masticatory load. According to him, holes occupy from 7 to 14% of the area of ​​the compact plate, vestibular and oral walls of the teeth of the upper and lower jaws.

There are openings in various sections of the internal compact plate (Fig. 5) connecting the pericement with the bone marrow spaces of the jaw. From our point of view, these holes, being a bed for larger vessels, help relieve pressure on them, and therefore reduce the effects of temporary ischemia when teeth move under load.

The specific structure of the vestibular and oral walls of the tooth sockets, their functional significance in the perception of masticatory loads make it necessary to focus on the clinical assessment of their condition.

The cortical plate, its thickness and preservation throughout, as well as the spongy substance of the jaws, can be clinically assessed only from the medial and distal sides of the tooth using radiographs. In these areas, the radiographic characteristics coincide with the microstructure of the bone tissue of the jaws.

The alveolar parts of the jaws in the interdental spaces, like other walls of the alveoli, are covered with a thin compact plate (lamina dura) and have the shape of triangles or truncated pyramids. Isolation of these two forms of interdental septa is very important, since in the region of chewing teeth or in the presence of primary three and diastema, this is the norm for building bone tissue, however, provided that the compact plate is preserved.

The cortical plate on the lower jaw is thicker than on the upper. In addition, its thickness varies in individual teeth and it is always somewhat thinner towards the tops of the interdental septa. The width and clarity of the x-ray image of the plate changes with age; in children it is looser. Taking into account the variability of the thickness and the degree of shadow intensity of the cortical plate, its preservation throughout its entire length should be taken as the norm.

The structure of the bone tissue of the jaws due to the pattern of bone beams of the spongy substance, intersecting in different directions. In the lower jaw, the trabeculae mostly run horizontally, while in the upper jaw, they run vertically. There are small-loop, medium-loop and large-loop pattern of the spongy substance. In adults, the nature of the spongy substance pattern is mixed: in the group of frontal teeth it is finely looped, in the region of the molars it is coarsely looped. N. A. Rabukhina correctly believes that "the size of the cells is a purely individual feature of the structure of bone tissue and cannot serve as a guideline in the diagnosis of periodontal diseases."

There is more spongy substance in the alveolar process of the upper jaw than in the lower one, and it is characterized by a finer cellular structure. The amount of spongy substance of the lower jaw increases significantly in the region of the jaw body. The spaces between the bars of the spongy substance are filled with bone marrow. V. Svrakov and E. Atanasova point out that "spongious cavities are lined with endosteum, from which bone regeneration mainly occurs."

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X-ray method- one of the most important in the diagnosis and treatment planning of periodontal diseases. It is not the main one, since it does not always reveal periodontal pockets or the onset of destruction of the bone tissue of the alveolar process, especially from its vestibular surface, does not allow assessing the condition of periodontal soft tissues and the level of epithelial attachment. Nevertheless, periodontal radiography helps to detect a decrease in the height and type of resorption (vertical or horizontal) of the interdental septa, to assess the condition of the interradicular septum and alveolar ridge, the length and shape of the roots of the teeth, the continuity of the cortical plate, the pattern of bone beams, the width of the periodontal gap, the presence of subgingival dental deposits , defects in the dentition and during the restoration of teeth, as well as to establish the absence of contacts between them and to detect other pathological changes. The method is used to evaluate the effectiveness of the treatment.

To study the bone structure of periodontal tissues, various radiographic techniques are used, which can be divided into two groups: intraoral and extraoral.

Intraoral are divided into contact, bite, interproximal. The advantage of such techniques lies in the detailed image of the interdental septa, the area of ​​root furcation, the periodontal gap, and subgingival dental deposits.

They allow to detect pathological changes in the periodontal bone structure at the earliest stages.

However, due to possible projection distortions, not all contact radiographs are informative. Therefore, in periodontology, one should use an interproximal technique, or radiography with a parallel beam of rays, in which special film holders or an X-ray tube with a long localizer cone are used. The beam beam or central beam is directed perpendicular to the tooth and film. A clear, undistorted image of the interdental septa is obtained, although the tops of the roots of the upper premolars are not projected onto the film.

Of the many extraoral radiological techniques in periodontology, orthopantomography is more often used, which makes it possible to obtain a one-time image of the entire dentoalveolar system as a single functional complex without angular distortion.

An orthopantomogram allows you to establish the nature of the pathological process in the periodontium, its prevalence in terms of depth and extent, plan treatment, evaluate changes in tissues that have arisen during treatment, and manifestations of possible systemic diseases, see and analyze the state of the temporomandibular joint, paranasal sinuses, and much more. The disadvantage of the method is the fuzzy image of the frontal section of the upper and lower jaws, the inability to assess in detail the state of the periodontal gap of the teeth and bones. Therefore, the method is used as an additional to intraoral techniques.

Given the possibility of the appearance of deep interproximal, narrow, tortuous bone pockets and the difficulty in assessing the degree of destruction of the lingual (palatine) and vestibular wall of the alveolar process of the jaws, contrast X-ray examination is used to clarify the clinical picture. For this purpose, before radiography, gutta-percha pins or softened gutta-percha are inserted into periodontal pockets (in narrow spaces) (in cases of vestibular or lingual localization of wide bone defects).

The bone tissue of the alveolar process on the upper and lower jaws is different in its structure and density. On the upper jaw, it is distinguished by a uniform finely looped structure with a predominantly vertical direction of the bone beams. For the alveolar process of the lower jaw, the heterogeneity of its structure is typical: finely looped in the anterior section and with a larger pattern in the lateral ones. The direction of the bone beams is predominantly horizontal. The cortical plate of the alveolar ridge of the sockets on the radiograph is visible as a continuous, white stripe, most clearly visible in the region of the incisors. But in fact, it is perforated by many small holes that allow blood and lymphatic vessels to pass through, which connect the ligamentous apparatus of the tooth with the bone.

The maximum height of the interdental septa is limited by the line connecting the enamel-cement border of two adjacent teeth. Given a certain curvature of the jaw, the configuration of the alveolar ridge on the radiograph may not be even, but curved. The shape of the interdental septa in the lateral part of the jaw is trapezoidal or rectangular. In the anterior part of the jaws, the tops of the septa are triangular or dome-shaped.

Between the central incisors, there is often a bifurcation of the septum or the presence of a semilunar notch, especially with diastema or tremas. It must be remembered that the anatomical and radiological height of the interdental septum varies by 0-1.6 mm.

Depending on the age and degree of mineralization, the X-ray anatomical signs of the bone structure of the alveolar process of the jaws can vary and be misinterpreted.

Dental deposits. Supragingival calculus is usually localized on the lingual surface of the lower teeth and the vestibular surface of the upper molars. Due to the superimposed dense shadow of the hard tissues of the tooth, it is usually not visible on the radiograph until its amount is very significant. Subgingival calculus is visible on radiographs even at very low levels and appears as a small dense shadow on the lateral surfaces of the root in the interproximal spaces.

It is especially well defined on intraoral radiographs performed by a parallel technique. Discontinuity and fuzziness of the contour of the cortical plate is one of the early signs of the progression of chronic catarrhal gingivitis, its transition to periodontitis and indicates the onset of an apical decrease in the epithelial attachment, an inflammatory process in the bone tissue and the formation of a periodontal pocket. The disappearance of the cortical plate is noted first of all on the medial or distal surfaces of the septum, then in the area of ​​the apex of the septum.

The expansion of the periodontal gap in the form of a wedge in the region of the neck of the tooth from the medial and distal surfaces also indicates the appearance of a periodontal pocket and the onset of resorption of the bone tissue of the interdental septum. The top of this wedge is always directed towards the root of the tooth. At the same time, there is focal osteoporosis of the tops of the interdental septa.

Reducing the height of the interdental septa. For inflammatory changes in the bone structure of the periodontium, due to the influence of the microflora of the dental plaque, the horizontal type of resorption of the interdental septa is typical. But the level of reduction, its height in different parts of the jaw can be different and depend on the severity of the inflammatory process. Clinically, this type of resorption corresponds to the formation of gingival pockets.

In cases where there are other factors that provoke inflammation in the periodontium (traumatic occlusion, overhanging crowns, fillings, lack of a contact point, etc.), the vertical type of resorption of the interdental septa is more typical. This is a U-shaped shadow, localized from one or two surfaces of the tooth root, which is one of the walls of such a defect. Clinically, a bone pocket with 2-4 walls is always found. Attention should be paid to the horizontal lines running across the root of the tooth, the presence of which indicates partial or complete destruction of the vestibular or lingual part of the alveolar process.

The appearance of vertical dark ("finger-shaped") stripes in the center of the interdental septa is due to the deep penetration of the inflammatory process into the bone and is detected with a significant decrease in the height of the interdental septa and osteoporosis.

Periodontal abscess has no specific radiological signs, and radiography is a method that allows to clarify its localization, the degree of bone tissue destruction, the extent of the defect, and in some cases helps to make a differential diagnosis with a peri-apical abscess. The radiograph shows a Y-shaped defect in the bone tissue of the septum, surrounded by an intense and significant zone of osteoporosis. When a fistulous tract appears, it is possible to determine the presence or absence of an abscess communication with periapical tissues and clarify the methods of treatment by introducing a gutta-percha pin into it.

Occlusal trauma (primary) and parafunctions (bruxism) have a number of classical radiographic features: uniform expansion of the periodontal gap, primarily in the vestibular direction, excessive cement deposition in the apical third of the root, sclerosis of the bone tissue of the alveolar process in the periapical region. In case of attachment of a secondary occlusal injury (loss of adjacent teeth, poor-quality prosthetics, etc.), signs of inflammatory changes appear: a violation of the discontinuity of the cortical plate and the disappearance of the partitions, an uneven decrease in their height.

X-ray signs of occlusal injury must necessarily be compared with clinical symptoms (tooth mobility, the presence of facets on the tubercles, periodontal pockets, displacement of teeth) and with occlusion data. It is necessary to remember about the individual, age-related features of the width of the periodontal gap. In this case, one should rely on a comparative analysis of the patient's radiographs over time. X-ray changes in periodontal tissues in systemic diseases are described in the relevant section.

Radiological criteria for stabilization of periodontitis are evaluated along with clinical signs (lack of depression, pockets, tooth stability, perfect oral hygiene). The radiograph shows the absence of osteoporosis and progression of destruction, a clear contour of the interdental septa, in some cases the formation of a cortical plate on their tops.

When analyzing radiographs, misinterpretation of the data is possible due to projection distortions, technical defects in film processing, and overlaying of tooth shadows on interdental septa. Therefore, during surgical treatment, a greater destruction of the bone is often found than it was visible on the x-ray, which can change the planned plan and scope of the intervention.

A. S. Artyushkevich
Periodontal diseases

Dental alveolus and alveolar process. That part of the upper or lower jaw in which the teeth are fixed is called the dental or alveolar process (processus alveolaris). It consists of two walls: outer (buccal, or labial) and inner (oral, or lingual), which stretch along the edge of the jaw in the form of arcs (Fig. 96).

On the upper jaw, they converge behind the third large molar, and on the lower jaw they pass into the jaw branch. The space between the walls of the alveolar process is divided in the transverse direction with the help of bony partitions into a number of dimples - dental sockets or alveoli, in which the roots of the teeth are placed.

The bony septa that separate the tooth sockets from each other are called interdental septa (Fig. 97).

In addition, in the holes of multi-rooted teeth there are also inter-root partitions, dividing them into a number of chambers in which there are ramifications of the roots of these teeth (Fig. 98). Diagnosis

The interradicular septa are shorter than the interdental septa and extend from the bottom of the corresponding alveoli. The edges of the alveolar processes and interdental septa do not reach the neck of the tooth (cement-enamel border) a little. Therefore, the depth of the dental alveolus is somewhat less than the length of the root, and the latter protrudes slightly from the jaw bones. This part of the root of the tooth, under normal conditions, is covered by the edge of the gum (Fig. 99).

Both walls of the alveolar process on the buccal and lingual sides consist of a compact bone substance that forms the cortical plate of the alveolar process. It consists of bone plates, which in places form typical Haversian systems (Fig. 100).

The cortical plate of the alveolar process, dressed in the periosteum, without a sharp border passes into the bone of the jaw body. The thickness of this plate is not the same in different parts of the alveolar process. It is thicker on the lingual side than on the buccal side. In the region of the edges of the alveolar process, the cortical plate continues into the wall of the dental alveolus. The thin wall of the alveolus consists of densely arranged bone plates and is penetrated by a large number of Sharpei fibers. These fibers are continuations of the collagen fibers of the pericement. The wall of the dental alveolus is not continuous. It has numerous small holes through which blood vessels and nerves penetrate into the periodontal gap.

All gaps between the walls of the dental alveoli and the cortical plates of the alveolar process are filled with cancellous bone. The interdental and interradicular septa also consist of the same spongy bone. The degree of development of the spongy substance is not the same in different parts of the alveolar process. Both in the upper and in the lower jaw, it is more on the oral side of the alveolar process than on the vestibular side. In the region of the anterior teeth, the walls of the dental alveoli on the vestibular side almost closely adjoin the cortical plate of the alveolar process, and there is very little or no spongy bone here. On the contrary, in the region of large molars, the dental alveoli are surrounded by wide layers of cancellous bone.

The crossbars of the spongy bone, adjacent to the lateral walls of the alveoli, are located mainly in the horizontal plane.

In the region of the bottom of the dental alveoli, they take on a more sheer, parallel to the long axis of the tooth arrangement. Such an arrangement of the cancellous bone bars in the circumference of the dental alveoli contributes to the fact that chewing pressure from the pericement is transmitted not only to the wall of the dental alveolus, but also to the cortical plates of the alveolar process, or, in other words, to the entire periodontium.

The spaces between the crossbeams of the cancellous bone of the alveolar process and adjacent parts of the jaws are occupied by the bone marrow. In childhood and adolescence, it has the character of red bone marrow. In adults, it is gradually replaced by a yellow, or fatty, brain. The remnants of the red bone marrow are retained the longest in the cancellous bone substance in the region of the 3rd molar. The transformation of red bone marrow into yellow in different people takes place at different times. Sometimes red bone marrow persists for a very long time. So, Meyer observed large remnants of it in the alveolar process of a 70-year-old man.

A fracture of the alveolar process occurs as a result of the impact of a powerful traumatic factor on the jaw. This may be a blow with a fist or a heavy blunt object, a blow to the surface when falling, etc. As a rule, the walls of the maxillary sinus and the condylar process of the mandible are also damaged.

Anatomical features of the upper and lower jaw

Human jaws are divided into paired (upper) and unpaired (lower). They differ in their structure.

The bones of the upper jaw are involved in the formation of the nasal cavity, mouth, walls of the orbits and are tightly connected to the skull. Unlike the lower jaw, its parts are immovable. Despite the apparent massiveness, the bones are light in weight, since there is a cavity inside.

The jaw consists of a body and four processes:

• palatine connects to the zygomatic bone and is a support in the process of chewing;
• the frontal is attached to the nasal and frontal bones;
• the zygomatic separates the infratemporal part of the jaw, has a convex shape and four channels for the alveoli (recesses for the roots of the teeth), they contain large root chewing units;
• alveolar - on it there are holes for teeth, separated by walls.

The lower jaw is the only movable bone in the human skull; it is joined by the muscles responsible for chewing food. It consists of a body that includes two branches and two processes: condylar and coronal.

The tuberous side of the mental foramen is called chewing, and the pterygoid serves to attach the muscle of the same name. It contains the hyoid groove, which in some cases turns into a canal, and openings for the nerves.

For more details on the structure of the jaw, see the photo. However, the anatomical features of the jaw are individual. For this reason, sometimes a specialist with an impressive experience is not always able to identify pathologies.

Alveolar process - description

The alveolar process bears the teeth. It includes two walls: outer and inner. They are arcs located along the edges of the jaws. Between them are the alveoli. On the lower jaw, the corresponding formation is called the alveolar part.

The bone of the process consists of inorganic and organic substances. Collagen predominates - a substance of organic origin that gives plasticity. Normally, the bone must adapt to the constantly changing position of the tooth.

It consists of several elements:

• external, directed towards the cheeks and lips;
• internal, oriented to the sky and language;
• alveolar openings and teeth.

The upper part of the alveolar processes of the jaws decreases if it does not receive the necessary load. For this reason, its height depends on age, defects in the oral cavity, past diseases, etc.

Signs of a fracture of the alveolar process

A fracture of the alveolar process can be determined by the following symptoms:

• change in bite;
• speech disorder;
• difficulty chewing;
• sometimes - bleeding or blood in saliva;
• attacks of pain arising from above and below the jaw;
• increased pain when closing the teeth, the patient keeps his mouth half open;
• swelling of the inside of the cheeks;
• lacerations of the oral cavity in the area of ​​the cheeks and lips.

A few signs are enough to sound the alarm and immediately send a person to the hospital or call an ambulance. It is impossible to make a diagnosis and attempt treatment on your own.

Methods for diagnosing a problem

To start therapy, it is necessary to correctly diagnose. Fractures of the alveolar process are similar in symptoms to pulp injuries or bruises, therefore, a set of measures is necessarily carried out to identify the pathology.

First, an examination is carried out, during which the dentist is able to assess the general condition of the patient. It relies on the following features:

• the patient cannot open his mouth wide;
• redness around the lips;
• there are mucosal injuries;
• when the jaw is closed, violations of the dentition are visible;
• dislocations of incisors;
• bruising in saliva;
• mobility of large molars in the damaged area.

By palpation, the doctor finds moving points during displacement. After pressing on the alveolar process, acute pain appears.

To make a diagnosis, the patient needs to take an x-ray of the jaw. Damage to the alveolar process of the upper jaw in the picture has torn, intermittent edges. Due to differences in structure, a fracture of the other jaw in the region of the alveolar process has more distinct edges.

Computed tomography helps to determine where the hematoma is located. Electroodontodiagnosis shows the state of dental tissues, it is prescribed several times during the course of treatment.

Fracture treatment

The first thing to do is to put the broken section in the correct position. It is absolutely impossible to do this on your own. An exceptionally qualified doctor is able to perform this procedure and performs it under local anesthesia. After that, a smooth bus-bracket or splint-kappa is applied. The first is used when healthy teeth are preserved near the fracture. Fixation for a period of one to two months is recommended, depending on the severity of the fracture.

If the teeth have fallen into the fracture line, and the ligaments holding them in the alveolus have been damaged, they are removed. In another case, the viability of the pulp (the tissue that fills the tooth cavity) is checked. If she died, then she undergoes endodontic therapy (“treatment inside the tooth”, usually the pulp is removed, and the vacated space is filled with filling material). If the tissues are relatively healthy, they are constantly monitored and checked for their viability.

Wounds received along with a fracture of the alveolar process are treated, they are freed from small fragments. In some cases, stitches are applied.

Particular attention is paid to children whose permanent teeth are in the follicles. First, their viability is checked: if they are dead, then they are removed.

Treatment can be carried out both inpatient and outpatient, it depends on the severity of the injury. Approximately within a month after damage to the upper or lower jaw, the use of solid food is contraindicated. It is also necessary to closely monitor the hygiene of the oral cavity.

Recovery prognosis

Fractures of the alveolar process are divided into fragmentation, partial and complete. The prognosis is determined by the severity of the injury, its type, etc. Often, doctors rely on damage to the roots of the teeth when predicting.

The prognosis is favorable if the fracture line of the alveolar process does not affect the roots of the masticatory elements. In such a situation, a timely appeal to a specialist can reduce the period of formation of a bone callus (a structure that appears at the initial stage of bone fusion) to two months.

Late or incorrect treatment of a fracture of the alveolar process increases the likelihood of complications: osteomyelitis, false joint, etc. The recovery time is increasing, it is no longer possible to count on treatment for several months.

Accordingly, if damage to the alveolar process of the jaw has affected the roots of the teeth, the prognosis is unfavorable. In some cases, it is not possible to achieve complete fusion of the bones. After a fracture of the alveolar process, it is not recommended to eat solid food for several months. It is also necessary to carefully monitor oral hygiene.