Alveolar teeth proceeding. X-ray study in periodontology

The fracture of the alveolar process arises as a result of the impact of a powerful traumatic factor on the jaw. It can be a punch or a heavy stupid object, a blow to the surface when falling, etc. As a rule, the walls of the maxillary sinus and the mouse outflow of the lower jaw are also damaged.

Anatomical features of the upper and lower jaw

The jaws of a person are divided into a steam room (top) and unpaired (lower). They differ in their structure.

The bones of the upper jaw are involved in the formation of the cavity of the nose, mouth, the walls of the icing and tightly connected with the skull. Unlike the lower jaw, its parts are fixed. Despite the seeming massiveness, the bones have a slight weight, since the cavity is inside.

The jaw consists of the body and four processes:

• the sky is connected to the zicky bone and is supporting in the process of chewing;
• ottal is attached to the nasal and frontal bone;
• zkilova separates the shaking part of the jaw, has a convex shape and four channels for alveoli (recesses for teeth roots), they have large indigenous chewing units;
• alveolar - on it there are wells for teeth, separated by walls.

The lower jaw is the only mobile bone in the human skull, muscles responsible for chewing are joined. It consists of a body, which includes two branches and two processes: Miscellaneous and Corn.

The buggy side of the chiffer hole is called chewing, and the wingid serves to attach the muscle of the same name. It has an approaching furrow, which in some cases turns into a channel, and nerve holes.

Read more Jaw building See pictures. However, the anatomical features of jaws are individual. For this reason, sometimes a specialist with an impressive experience is not always able to identify pathology.

Alveolar process - Description

Alveolar process carries teeth. It includes two walls: outdoor and inner. They are arcs located along the edges of the jaws. There are alveoli between them. On the lower jaw, the appropriate formation is called the alveolar part.

The bone of the process consists of inorganic and organic substances. Collagen prevails - a substance of organic origin, giving plasticity. Normally, the bone must adapt to the ever-changing position of the tooth.

It consists of several elements:

• outdoor, directed towards the cheeks and lips;
• internal, sky-oriented and tongue;
• alveolar holes and teeth.

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

Signs of the fracture of the alveolar process

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

• change of bite;
• violation of speech;
• difficulty chewing;
• sometimes - bleeding or blood in saliva;
• bouts of pain, emerging from above and bottom of the jaw;
• strengthening pain in the closure of teeth, the patient holds a mouth in a semi-open state;
• swelling of the inside of the cheek;
• ripped wounds of the oral cavity in the cheek and lips.

Enough a few signs to score anxiety and immediately send a person to the hospital or call an ambulance. It is impossible to diagnose yourself and make treatment attempts.

Methods of diagnosis of the problem

To start therapy, you need to make a diagnosis correctly. Fractures of the alveolar process in symptoms are similar to pulp injuries or bruises, so a set of measures is carried out to identify pathology.

First examination, during which the dentist is able to assess the overall condition of the patient. It relies on the following signs:

• the patient cannot open the mouth wide;
• around the lips are noticeable redness;
• there are injuries mucous;
• when jaws are closed, dull row disorders are visible;
• dislocation of the cutters;
• bruises in saliva;
• mobility of large indigenous teeth in the damaged area.

Palpation by the doctor finds moving points when displaced. After pressing the alveolar process, an acute pain appears.

To diagnose, the patient needs to make a jaw x-ray. Damage to the alveolar tight jaw process in the picture has torn, intermittent edges. Due to the differences in the structure, the fracture of another jaw in the field of the alveolar process has clearer facilities.

Computer tomography helps determine where hematoma is located. Electrostontographicity shows the condition of the tooth fabrics, it is prescribed several times during the course of treatment.

Treatment of fracture

The first thing to be done is to put a broken portion into the correct position. It is absolutely impossible to do this. An exceptionally qualified doctor is able to carry out this procedure and performs it under local anesthesia. After that, the smooth tire-bracket or tire-kappa is superimposed. The first is used when healthy teeth are preserved next to the fracture. Recommended for a period of one to two months, depending on the severity of the fracture.

If the teeth hit the fracture line, and the bundles holding them in the alveoli were damaged, they are removed. In another case, the viability of pulp (tissue filling the tooth cavity) is checked. If it died, it is subjected to endodontic therapy ("treatment inside the tooth", usually a pulp is removed, and the vacant space is filled with sealing material). If the fabric is relatively healthy, there are continuous monitoring and verification of their viability.

Wounds obtained along with a fracture of the alveolar process are processed, they are freed from small fragments. In some cases, the seams are superimposed.

Special attention is paid to children who have constant teeth are in follicles. First, their vitality is checked: if they are dead, then delete.

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

Forecast for recovery

Fractures of the alveolar process are divided into fragmentation, partial and complete. The forecast is caused by the severity of injury, her appearance, etc. Often, doctors relieve damage to the roots of the teeth during forecasting.

The forecast is favorable if the alveolar fracture line does not affect the roots of the chewing elements. In such a situation, the timely appeal to the specialist reduces the formation of bone corn (structure that appears at the initial stage of the bone splicing) to two months.

Late or improper treatment of a fracture of an alveolar process increases the likelihood of complications: osteomyelitis, false joint, etc. The time of recovery increases, it is already impossible to count on treatment for a long time.

Accordingly, if damage to the alveolar process of jaws affected the roots of the teeth, the forecast is unfavorable. In some cases, it is not possible to achieve full bones. After a fracture of the alveolar process, the use of solid food for several months is not recommended. It is also necessary to carefully monitor the hygiene oral cavity.

The dental system of man is complex in its structure and is very important in its functions. As a rule, each person pays special attention to the teeth, since they are always in sight, and at the same time often ignores the problems associated with the jaw. In this article we will talk to you about the alveolar process and find out what function it performs in the dental system, which injuries are subject to, and how correction is carried out.

Anatomical structure

Alveolar process is an anatomical part of the human jaw. The processes on the upper and lower part of the jaws are located, to which teeth are attached and consist of the following components.

1. Alveolar bone with osteoni, i.e. Walls of dental alveoli.
2. Supporting alveolar bone filled with spongy, quite compact substance.

Alveolar process is subject to osteogenesis of tissues or resorption processes. All these changes must be balanced and balanced. But there may also be pathologies caused by the constant restructuring of the alveolar lower jaw process. Changes in alveolar processes are associated with plasticity and adaptation of the bone to the fact that the teeth change their position due to development, teething, loads and operation.

Alveolar processes have different heights, which depends on the age of a person, diseases of the teeth, the presence of defects in the dental rows. If the process has a small height, then the dental implantation cannot be carried out. Before such an operation, special bone plastic is carried out, after which the implant fastening becomes real.

Injuries and fractures

Sometimes people occur fractures of the alveolar process. Alveola is often broken as a result of various injuries or pathological processes. Under the fracture of this area of \u200b\u200bthe jaw is a violation of the integrity of the structure of the process. Among the main symptoms that help the doctor, to determine the patient with a fracture of an alveolar tower of the upper jaw, distinguish such factors as:

• pronounced pain syndrome in the jaw region;
• soreness that can be transmitted to the palate, especially when trying to close his teeth;
• the pain that is enhanced when trying to swallow.

During the visual inspection, the doctor can detect wounds in the area near the mouth, abrasion, swelling. There are also signs of ripped damage and bruises of varying degrees. Fractures in the field of alveolar process of both the upper and lower jaws are several species.

Fractures in the field of alveoli may be accompanied by simultaneous fracture and dislocation of teeth. Most often, such fractures have an arcooked form. The crack comes from the crest in the interdental space, climbing up the bottom or upper jaw, and further - in the horizontal direction along the dental row. At the end, it sinks between the teeth to the ridge of the process.

How is the correction?

Treatment of this pathology provides for the following procedures.

1. Gradual elimination of pain with the help of conductor anesthesia.
2. Antiseptic treatment of tissues with brave of herbs or preparations based on chlorhexidine Bigluconata.
3. Manual reposition of fragments that were formed as a result of a fracture.
4. Immobilization.

The operation of the alveolar process involves an audit of injury, smoothing the sharp corners of the bones and fragments, stitching the mucous membrane or the closure of the wound with a special iodoform bandage. In the area where the offset occurred, the desired fragment is necessarily established. For fixing, a tire-bracket is used, which is made of aluminum. The bracket is attached to the teeth on both sides of the fracture. In order for immobilization to be rack and durable, apply chorean inference.

If the patient was diagnosed with a knocked out of the forefront of the upper jaw, then the doctors use one-grade steel bracket. It is needed to immobilize the damaged process. The bracket is attached to the teeth with ligatures using a tire with elastic rubber bands. This allows you to connect and put a fragment that shifted. In the case when there are no teeth in the desired plot for fastening, the tire is made from plastics that quickly harden. After installing the tire, the patient is prescribed with antibiotics and special hypothermia.

If the patient had atrophy of the Alveolar's upper jaw process, treatment must be carried out. In the area of \u200b\u200bthe alveoli, the processes of restructuring may be observed, especially if the tooth has been removed. It provokes the development of atrophy, the debris is formed, a new bone is increasing, which completely fills the bottom of the wells and its edges. Such pathologies require immediate correction both in the field of remote tooth and on the nurse, near the wells or on the site of former fractures, outdated injuries.

Atrophy may develop in the case of dysfunction of the alveolar process. The debris of the sky, provoked by this process, can have a different degree of severity of the processes of development of pathology, the reasons that led to it. In particular, periodontalosis has pronounced atrophy, which is associated with the removal of teeth, the loss of the functions of the alveoli, the development of the disease and its negative influence on the jaw: the sky, dental rows, gums.

Often, after removing the tooth, the reasons that caused this operation continue to continue to influence the process. As a result, general atrophy of the process that is irreversible, which is manifested in the fact that the bone decreases. If there is prosthetics on the site of a remote tooth, it does not stop atrophic processes, but, on the contrary, enhances them. This is due to the fact that the bone on stretching begins to negatively react, the rejection of the prosthesis. He presses on bundles and tendons, which enhances atrophy.

The situation can worsen the situation, due to which the incorrect distribution of chewing movements occurs. The thrust of Alveola takes on this, which continues to be destroyed further. With extreme atrophy of the upper jaw, the sky becomes solid. Such processes are practically not affected by the sky alerts and the Buds Alveola.

The lower jaw is amazed more. Here the process can disappear in general. When atrophy has severe manifestations, it comes to the mucous membrane. This causes infringement of vessels and nerves. You can detect pathology using X-ray. The debris of the sky is formed not only in adults. In children in 8-11 years, such problems may arise at the time of the formation of a replaceable bite.

The correction of the alveolar process in children does not require serious surgical intervention. It is enough to carry out bone plastic, transplanting a piece of bone to the right place. Within 1 year, the patient must undergo a regular inspection of a doctor to appear bone tissue. In conclusion, we bring to your attention a video where the maxillofacial surgeon will demonstrate to you, how the bone plastic of the alveolar process is performed.

Alveolar ridge - Anatomical part of the jaw, carrying her teeth. There are both on top and on the lower jaw. There are actually alveolar bone with osteoni (wall of dental alveoli) and supporting alveolar bone with compact and spongy substance.

Alveolar processes consist of two walls: outdoor - peeled, or luminous, and internal - oral, or the paternal, which are located in the form of an arc along the edges of the jaws. On the upper jaw, the walls are converged behind the third large native tooth, and on the lower go to the branch of the jaw.

In the space between the outer and inner walls of the alveolar processes there are cells - dental wells, or alveola (alveolus dentalis), in which teeth are placed. Alveolar processes appearing only after teething, almost completely disappear with their loss.

The alveolar process is part of the upper and lower jaws, covered with a thin cortical layer. The outer compact plate forms the vestibular and oral surface of the alveolar bone. The thickness of the outer cortical plate is non-etinak on the upper and lower jaw, as well as in various sections of each of them. The internal compact plate forms the inner wall of the alveoli.

On the X-ray picture, the cortical plate of the alveoli is presented in the form of a dense line, unlike the surrounding layer of spongy bone tissue. On the edge of the alveoli, the inner and outer plates are closed, forming a comb alveoli. The alveoli crest is located 1-2 mm below the enamel-cement tooth connection.

Bone Between adjacent alveoli forms interlimoolar partitions. The inter-vololar partitions of the front teeth have a pyramid shape, in the region of the side teeth, trapezoid.

Alveolar bone It consists of inorganic and organic substances, among which the collagen prevails. Bone tissue cells are represented by osteoblasts, osteoclasts, osteocytes. These cells are involved in the continuous process of resorption and osteogenesis of the tissue.

Normally, these processes are balanced, and they underlie the continuously flowing rearrangement of the alveolar bone, which characterizes the pronounced plasticity and adaptation of the bone to changes in the position of the tooth in the process of its development, teething and the entire functioning period.

To assess the degree of resorption of bone tissue, should be considered:
- difference of cortical plate thickness;
- microhardness of the jaw bone;
- petristanity of the structure;
- Direction of bone beams.

Distinguish several parts of the alveolar process:
- outdoor - addressed to the opposition of the oral cavity, towards the lips and cheeks;
- internal - facing a solid sky and language;
- partwhere the alveolar holes are placed (wells) and the teeth directly.

The upper part of the alveolar process is called the alveolar comb, which can be clearly observed after the loss of teeth and overgrowing alveolar wells. In the absence of a load on the alveolar comb, a gradual decrease in its height occurs.

The bone fabric of the alveolar process throughout the human life undergoes changes, since the functional load on the teeth changes. The height of the process is different and depends on many age factors, dental diseases, the presence of defects in the dental row.

Small height, that is, the insufficient volume of the bone tissue of the alveolar process is a contraindication for dental implantation of teeth. In order to fix the implant, it becomes possible, carry out bone plastic.

Diagnostics of the alveolar process is possible by means of an x-ray study.

Those parts of the upper and lower jaws in which the teeth are strengthened are called dental, or alveolar, processes. Distinguish the lamellar itself alveolar bone With osteoni (wall of dental alveoli) and supporting alveolar bone with compact and spongy substance.

What is alveolar process?

Alveolar proceedings Consist of two walls: outdoor, or lip, and internal - oral, or the paternal, which are located in the form of an arc along the edges of the jaws. On the upper jaw, the walls are converged behind the third large native tooth, and on the lower go to the branch of the jaw. In the space between the outer and inner walls of the alveolar processes there are cells - dental wells, or alveola (Alveolus Dentalis) in which teeth are placed. Alveolar proceedings, appearing only after teething, almost completely disappear with their loss.

Tooth alveola Separated by bone partitions, called interdental partitions. In addition, there are still intercane partitions from the bottom in the wells of multi-corne teeth. alveola and separating branching the roots of these teeth.

Intercane partitions shorter interdental. So the depth of bone tooth alveola Somewhat smaller corty length. As a result, part of the root of the tooth (the level of the cement-enamel border) protrudes from the jaw and (normally) covered by the edge of the gums.

Structure of alveolar bones

The outer and inner surfaces of the alveolar processes consist of a compact substance of the plate bone forming the cortical plate (plate of the compact bone substance) of the alveolar process. Bone plates plates form typical osteon here. Cortical plates Alveolar processes covered with perioste, without sudden boundaries, pass into the bone plates of the bodies of the jaws. On the pagan surface cortical plate Thicker (especially in the region of the lower molars and primoles) than on the peel.

In the region of the edges of the alveolar process cortical plate continues to the wall of the dental alveola.

The thin wall of the alveoli consists of tightly located bone plates and permeated with a large number of chapes periodontal fibers. Stepka dental alveola It is not solid. It has numerous holes through which vessels and nerves penetrate in the periodontal. All intervals between the walls of the dental alveol cortical plates Alveolar process filled with spongy substance. Of the same spongy bone, intersubolic and intercane partitions are constructed. The degree of development of the spongy in different departments alveolar reproduction Nonodynakova. Both on the top and on the lower jaw more on the oral surface alveolar reproductionthan per vestibular. In the field of the front teeth of the wall of the tooth alveol On the vestibular surface, almost closely adjacent to cortical plate Alveolar process. In the field of large indigenous teeth alveola Surrounded by wide layers of spongy bone.

The crossbars of the spongy bone adjacent to the side walls alveol, oriented mainly in the horizontal direction. In the field of the bottom of the dental alveol They take a more vertical location. This contributes to the fact that chewing pressure from a periodonta is transmitted not only on the wall alveola, but also on cortical plates alveolar reproduction.

The gaps between the cross-substance crossbars of the bone of the alveolar process and the adjacent parts of the jaws are filled with bone marrow. In child and youthful age, it has the character of a red bone marrow. With age, the latter is gradually replaced by a yellow (or fat) bone marrow. The remains of the red bone marrow are held longer in the spongy substance in the third molars.

Physiological and reparative restructuring of the alveolar process and the wall of the dental alveoli. Bone tissue dental alveoli and alveolar reproduction Throughout life is exposed to a constant restructuring. This is due to the change in the functional load falling on the teeth.

With age, the teeth are erased not only on chewing surfaces, but also on the approximal (addressed to each other). It depends on the presence of physiological mobility of the teeth.

At the same time there are a number of changes in the wall alveola. On the medial side of the Alveola (in the direction of which the tooth moves and has the greatest pressure on it) the periodontal slot is narrowed, and the wall alveola Receives signs of resorption with the participation of osteoclasts. On the distal side of it, the periodontal fiber is stretched, and in the wall alveola The activation of osteoblasts and the deposition of coarse fiber bone occurs.

Even more restructuring in the bone alveola It is manifested in orthodontic interventions associated with the movement of the tooth. Wall alveolaLocated in the direction of force, tests pressure, and on the opposite side tension. It has been established that the bone resorption occurs on the side of the increased pressure, and on the side of the thrust - the neoplasm of the bone.

Alveolar elevations - Skulian bone

1. Skulent bone, OS Zygomaticum. Forms most of the lateral I of the wall of the orbit and part of the zoomy arc. Fig. A, B.
2. Lateral surface, Fades Lateralis. Fig. BUT.
3. Temple surface, Fades Temporalis. Forms most of the front wall of the temporal fox. Fig. B.
4. FEBIC SURFACE, FADES ORBITALIS. Facing the cavity of the orcap. Fig. A, B.
5. Temple process, Processus Temporalis. Directed back and, connecting with a zicky process of temporal bone, forms a zilly arc. Fig. A, B.
6. Opported process, Processus Frontalis. It is connected to the front-end bone of the same name. Fig. A, B. 6A Eye Education, Eminentia Orbitalis. A slight elevation at the lateral edge of the orbit. The place of attachment of the lateral bundle of the century. Fig. A, B.
7. [Regional tubercle, tuberculum marginale]. It is usually located at the rear edge of the frontal process. Place the beginning of the tlet - poralis. Fig. A, B.
8. Sculproinatural hole, Foramen ZygomaticoorBitale. Located on the ordown surface. He leads to a channel containing a zilly nerve. Fig. A, B.
9. Skullic hole, Foramen Zygomaticofaciale. Located on the lateral surface of the bone. The location of the sculular branch of N.zygomaticus. Fig. BUT.
10. Bottle opening, Foramen Zygomaticotemporal. Located on the temporal surface of the bone. The place of exit of the boring branch N.zygomaticus. Fig. B.
11. Lower jaw, mandibula. Fig. In, g, d.
12. Lower jaw body, Corpus Mandibulae. The horizontal part of the bone from which its branches begin. Fig. IN.
13. Lower jaw base, Basis Mandibulae. Lower body. Fig. IN.
14. Choining Symphysia, Symphysis Mandibulae (Mentalis). The plot of connective tissue located between the right and left half of the lower jaw. Oveakers in the first year of life.
15. Choosing ledge, protuberantia metalis. Located on the middle of the body surface of the lower jaw. Fig. IN.
16. Choosing tuberculosis, tuberculum metale. Farmer elevation located on both sides of the chores. Fig. IN.
17. Gnation, GNation. Middle of the lower edge of the body of the lower jaw. Used with cephalometry. Fig. In, g.
18. Choosing hole, Foramen Mentale. The place of outlet of the chore nerve. Located at the level of the second premolar. Point of finger pressed third branch of triple nerve. Fig. IN.
19. Kosy Line, Linea Obliqua. It starts from the branch of the lower jaw and passes along the outer surface of the body. Fig. IN.
20. Digastrica Fossa DigaStrica. Located on the inner surface of the body of the lower jaw at the lower edge, the lateral of the chin. Place attachment M.Digastricus (Venter Anterior). Fig. G.
21. Choir ass, spina metalis. Located on the middle of the inner surface of the body of the lower jaw. The place of the beginning of the chore-tongue and chore-ply-speaking muscles. Fig. G.
22. Maxillo-lift line, Linea Mylohyoidea. It goes to diagonal from top to bottom, in the back. The place of attachment of the maxillary-speaking muscle. Fig. G.
23. [Lightweight roller, Torus Mandibulars]. Located above the maxillary-speaking line, at the premolars level. Can prevent the installation of dentures. Fig. G.
24. Subject Pedaging, FOVEA sublingualis. The recess for the salivary gland, located in front and above the maxillary-speaking line. Fig. G.
25. Subnomandibular fossa, FOVEA submandiBulars. The recess for the salivary gland is located below the maxillary-speaking line at the rear half of the body. Fig. G.
26. Alveolar part, Pars Alveolaris. The upper body of the lower jaw. Contains dental alveoli. Fig. IN.
27. Alveolar arc, Arcus Alveolaris. Arcuid free edge of the alveolar part. Fig. D.
28. Dental Alveola, Alveoli Dentales. Cells for the root of teeth. Fig. D.
29. Intervalolar partitions, Septa Interalvelararia. Bone plates between dental alveoli. Fig. B, D.
30. Intercane partitions, septa interradicularia. Bone plates between the roots of the teeth. Fig. D.
31. Alveolar elevations, Juga Alveolaria. Elevation on the outer surface of the lower jaw corresponding to the dental alveoloam. Fig. B, D.

Actually alveolar bone (The wall of the dental alveoli) is a thin (0.1-0.4 mm) bone plate that surrounds the root of the tooth and serves as a place attaching the periodontal ligament fibers. The latter penetrates it in the form of tasking (Shareyevskiy) fibers, which determine its allocated, usually directed at an angle to the axis of the tooth root. On its surface, a lot of holes are revealed, (triggering, or folkmann, channels, through which blood and lymphatic vessels and nerves penetrate), as a result of which it is sometimes called a lattice plate (Lat. Lamina Cribrosa, English CRIBRIFORM Plate).

Histologically actually, the alveolar bone consists of a typical plate bone tissue, in which osteons, insert and general plates are available. It also meets a special type of bone tissue, which is called a beam bone (English. Bundle Bone), as the beams of periodontal ligament fibers are attached to it. The beam bone has some features compared to a conventional lamellar. It is characterized by a smaller content of collagen fibrils and more - the main substance, (this is associated with this darker

it is on painted histological sections), as well as a higher concentration of mineral substances. The beam bone is either the only version of the bone tissue of the alveoli wall, or is located on top of the usual plate bone tissue, distinctly separated by the line of distinction. The beam bone is most pronounced in the dynamic tuning areas, in particular, when teething the teeth and their movement (for example, on the distal surface of the alveoli with a physiological medial dental drift).

According to its biochemical composition, the bone tissue of alveolar processes does not differ from that in other areas of the skeleton: 45-50% of its mass is inorganic substances, 25-30% - organic, 25% - water.

Supporting alveolar bone includes:

(a) Compact bone, forming an outer - facial (vestibular, cheek or luminous) and the inner (pagan or oral or oral) wall of the alveolar process, also called cortical plates of the alveolar process;

(b) Sponewate bone, filling spaces between the walls of the alveolar process and the actual alveolar bone. Its traccules redistribute the forces acting on chewing movements to the actual alveolar bone, transmitting them to cortical plates, so their orientation corresponds to the direction of forces acting on the Alveola. Bone of bone trabecules are bone marrow spaces filled in childhood red, and in an adult yellow bone marrow. Often due to the characteristics of the location of the teeth in the alveolar proceedings and a significant thickness of the cortical plates, the alveolar bone is partially merged with cortical plates, and there is no spongy bone separating them.

Rearrangement of alveolar process

The bone tissue of the alveolar process, like any other bone tissue, has a high plasticity and is in a state of constant restructuring, or remodeling. The latter includes balanced bone resorption processes with osteoclasts and its neoplasm with osteoblasts. Continuous remodeling ensures the adaptation of bone tissue to the changing functional loads and occurs both in the wall of the dental alveoli and in the supporting bone of the alveolar process.