Advertisement

European Archives of Paediatric Dentistry

, Volume 9, Issue 3, pp 153–159 | Cite as

A combined avulsion and root fracture/avulsion trauma with ten years review

  • S. B. MisraEmail author
  • K. J. Toumba
Case Report

Abstract

Background: The management of trauma involving anterior permanent teeth can be very complicated, particularly when more than one type of injury occurs. In some instances the advised treatment for one type of injury may conflict with that of another. In the present case a child had an avulsion and a root fracture/avulsion. Case Report: A patient, aged 14 years at the time of the injury in 1998, had a root fracture avulsion of the maxillary right permanent central incisor (11) and an avulsion of the maxillary left permanent central incisor (21). The management strategies were conflicting with regards to the type and duration of splinting. The dilemma of either having flexible splinting (10 days) for avulsed teeth as opposed to rigid splinting for root fractured (12 weeks) teeth was an important clinical decision since the patient had sustained both injuries together. Treatment: The patient had semi-rigid splinting of 11 for 4 weeks and 21 was released from the splint at 8 days. Initial root canal therapy was carried out using non-setting calcium hydroxide and both these teeth were obturated with gutta percha. The teeth had an extra-alveolar period of 90 minutes and were placed in milk within 15 minutes of the trauma. Previous studies indicated that an extra-alveolar period of over 45 minutes leads to a poor long-term prognosis [Andreasen et al., 2004; Boyd et al., 2000] and this case is a rare example of long-term survival of 11 and 21. Follow-up: Regular clinical and radiographic reviews took place over ten years from the injury and both 11 and 12 are currently successfully functional in the arch.

Key words

Avulsion Root Fracture Dental Trauma 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Andreasen JO. Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in monkeys. Int J Oral Surg 1981;10:43–53PubMedCrossRefGoogle Scholar
  2. Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 2. Factors related to pulpal healing. Endod Dent Traumatol 1995a;11:59–68.PubMedCrossRefGoogle Scholar
  3. Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing. Endod Dent Traumatol 1995b;11:76–89.PubMedCrossRefGoogle Scholar
  4. Andreasen JO, Andreasen FM, Mejare I, Cvek M. Healing of 400 intra-alveolar root fractures. 2. Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics. Dent Traumatol 2004; 20:203–11.PubMedCrossRefGoogle Scholar
  5. Boyd DH, Kinirons MJ, Gregg TA. A prospective study of factors affecting survival of replanted permanent incisors in children. Int J Paediatr Dent 2000;10:200–5.PubMedCrossRefGoogle Scholar
  6. Bryson EC, Levin L, Banchs F, Abbott PV, Trope M. Effect of immediate intracanal placement of Ledermix Paste® on healing of replanted dog teeth after extended dry times. Dent Traumatol 2002;18:316–21.PubMedCrossRefGoogle Scholar
  7. Campbell KM, Casas MJ, Kenny DJ. Ankylosis of traumatized permanent incisors: pathogenesis and current approaches to diagnosis and management. J Can Dent Assoc 2005;71:763–8.PubMedGoogle Scholar
  8. Cvek M, Andreasen JO, Borum MK. Healing of 208 intra-alveolar root fractures in patients aged 7–17 years. Dent Traumatol 2001;17:53–62.PubMedCrossRefGoogle Scholar
  9. Perez F, Franchi M, Peli JF. Effect of calcium hydroxide form and placement on root dentine pH. Int Endod J 2001;34:417–23.PubMedCrossRefGoogle Scholar
  10. Qin M, Ge L, Bai R. Use of a removable splint in the treatment of subluxated, luxated and root fractured anterior permanent teeth in children. Dent Traumatol 2002;18:81–5.PubMedCrossRefGoogle Scholar
  11. Ram D, Cohenca N. Therapeutic protocols for avulsed permanent teeth: review and clinical update. Pediatr Dent 2004; 26:251–5.PubMedGoogle Scholar
  12. Schwartz O, Andreasen FM, Andreasen JO. Effects of temperature, storage time and media on periodontal and pulpal healing after replantation of incisors in monkeys. Dent Traumatol. 2002;18:190–5.PubMedCrossRefGoogle Scholar
  13. Sharma NK, Duggal MS. Replantation in general dental practice. BDJ 1994;176:147–51.PubMedCrossRefGoogle Scholar
  14. Trope M, Moshonov J, Nissan R, Buxt P, Yesilsoy C. Short vs. long-term calcium hydroxide treatment of established inflammatory root resorption in replanted dog teeth. Endod Dent Traumatol 1995;11:124–8.PubMedCrossRefGoogle Scholar
  15. von Arx T. Splinting of traumatized teeth with focus on adhesive techniques. J Calif Dent Assoc 2005;33:409–14.Google Scholar
  16. Welbury R, Kinirons MJ, Day P, Humphreys K, Gregg TA. Outcomes for root-fractured permanent incisors: a retrospective study. Pediatr Dent 2002;24:98–102.PubMedGoogle Scholar

Copyright information

© Adis International 2008

Authors and Affiliations

  1. 1.Dept. Paediatric and Preventive DentistryDivision of Child Dental Health Leeds Dental InstituteLeedsGreat Britain

Personalised recommendations