Abstract
Introduction: The avulsion of a tooth is defined as a complete displacement from its alveolus.[1] Dental avulsion of permanent teeth is considered one of the most severe and aggressive dental injuries. According to dental trauma studies in different populations, it comprises from about 0.5-7.75% of the total of dental injuries, being more frequent between 9 and 10 years of age [2–6]. The purpose of this study was to evaluate the success of existing protocols when dealing with dental avulsion.
Materials and methods: The informed consent in use was signed at the pediatric service of Clinica Universitária Egas Moniz. A 7-year-old female patient suffered craniofacial trauma with avulsion of the upper right central incisor (URCI) and enamel-dentin coronary fracture of the upper left central incisor (ULCI). The avulsed tooth, with open apex, was transported in milk and reimplanted after 16 hours. At Clinica Universitária Egas Moniz pediatric emergency service, the URCI was carefully cleaned from non-viable tissue. It underwent extra-oral endodontic treatment with an apical MTA plug, filled with thermoplastic gutta-percha and later closed with composite resin. Subsequently, under local anesthesia, the clot was removed from the alveolus and irrigated with saline solution. The tooth was reimplanted into the socket and stabilized with semi-rigid splint to adjacent teeth for 4 weeks. The ULCI was sealed with glass ionomer and later restored with composite resin. The patient was medicated with amoxicillin and clavulanic acid for 8 days, being instructed to a soft diet and to avoid sports practice. Follow-up appointments at 7 days, 4 weeks with splint removal, 3, 6 and 9 months. At 3 months, the ULCI presented with necrosis, so endodontic treatment was performed. Last follow-up was at 18 months.
Results: Clinical evaluation after more than one year showed absence of clinical symptoms and radiographic images compatible with periapical health.
Discussion and conclusions: The URCI suffered ankylosis with radiographic loss of periodontal ligament space, and slight root resorption. These findings are in agreement with the expected complications in the literature. Similar studies agree that the prognosis of the treatment of this trauma is deeply influenced by on-site actions and care taken shortly after the accident [1–8]. However, the patient was allowed to maintain aesthetic, functional and physiological function, as well as preservation of the alveolar contour.
Figure 1.
vulsion of the URCI; non-complicated fracture the ULCI.
Figure 2.
Removal of the cloth and cleaning of the alveolus; pulpal aspect of the URCI before endodontic treatment.
Figure 3.
Reimplantation of the URCI and splinting.
Figure 4.
Endodontic treatment of the ULCI.
Figure 5.
Follow-up at 18 months.
References
- 1.Veras SR de A, Bem JSP, de Almeida ECB, et al. Dental splints: types and time of immobilization post tooth avulsion. Journal of Istanbul University Faculty of Dentistry. 2017;51(3 Suppl 1):S69–S75. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Glendor U, Halling A, Andersson L, et al. Incidence of traumatic tooth injuries in children and adolescents in the county of Västmanland, Sweden. Swed Dent J. 1996;20(1-2):15–28. [PubMed] [Google Scholar]
- 3.Andreasen JO, Andreasen FM. Avulsions. In:Andreasen JO, Andreasen FM, Andreasen L, editors. Textbook and colour atlas of traumatic injuries to the teeth. 4th ed. Oxford, UK: Wiley Blackwell; 2007. p. 444–488. [Google Scholar]
- 4.Cho SY. Dental luxation and avulsion injuries in Hong Kong primary school children. Hong Kong Med J. 2015;21(4):339–344. [DOI] [PubMed] [Google Scholar]
- 5.Eyuboglu O, Yilmaz Y, Zehir C, et al. A 6-year investigation into types of dental trauma treated in a paediatric dentistry clinic in Eastern Anatolia region, Turkey. Dent Traumatol. 2009;25:110–114. doi: 10.1111/j.1600-9657.2008.00668.x [DOI] [PubMed] [Google Scholar]
- 6.Mesquita GC, Soares PBF, Moura CCG, et al. A 12-Year Retrospective Study of Avulsion Cases in a Public Brazilian Dental Trauma Service. Braz Dent J. 2017;28(6):749–756. doi: 10.1590/0103-6440201701610 [DOI] [PubMed] [Google Scholar]
- 7.Yamashita FC, Previdelli ITS, Pavan NNO, et al. Retrospective study on sequelae in traumatized permanent teeth. European Journal of Dentistry. 2017;11(3):275–280. doi: 10.4103/ejd.ejd_85_17 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Andersson L, Andreasen JO, Day P, et al. Guidelines for the Management of Traumatic Dental Injuries: 2. Avulsion of Permanent Teeth. Pediatr Dent. 2017;39(6):412–419. [DOI] [PubMed] [Google Scholar]