Multidisciplinary Approach to Delayed Treatment of Traumatic Teeth Injuries Involving Extrusive Luxation, Avulsion and Crown Fracture

Abstract

A 12-year-old boy with extrusion of the maxillary right central incisor, uncomplicated fracture of the left central incisor, avulsion of the mandibular right and left central incisors, and crown fracture of the mandibular right lateral incisor presented to the Kocaeli University Department of Pediatric Dentistry 20 days after sustaining the traumatic injuries. Orthodontic repositioning of the extrusive maxillary right central incisor was planned. Additionally, this tooth was necrotic and needed root canal treatment. The maxillary left central incisor and right mandibular lateral incisor were necrotic and needed root canal treatment. The orthodontic and endodontic treatments were successfully performed simultaneously. Restoration of the fractured mandibular right lateral incisor and maxillary left central incisor was completed with resin composite. Subsequent to orthodontic and endodontic treatment, prosthodontic rehabilitation was performed. At the two-year followup, the teeth appeared normal and the patient had no complaints.

Treatment of Extrusive Luxation in Permanent Teeth: Literature Review with Systematic Criteria

“…21 Studies indicate that pulp necrosis after extrusive luxation occurs in between 26 and 43% 24,25 of cases; this occurred in two studies selected for this review. 20,22 Andreasen and Pedersen 25 found a significantly higher level of necrosis in mature teeth pulp; however, Lee et al 24 reported the degree of extrusion to be the main factor responsible for the pulp necrosis and the endodontic obliteration, in the case of traumatic pulp extrusion.…”

“…According to the included studies, 12,[20][21][22] there is insufficient evidence that one type of treatment is a superior option, although there are favorable and unfavorable for each option proposed treatment points.…”

“…The most important points to be discussed were the degree of root development, the degree of tooth mobility, the maintenance of pulpal vitality, and the treatment time. Because there are more cases of orthodontic intrusion than intentional reimplantation for the treatment of late extrusive luxation, and due to the final results of each case, as in the study of Martins et al, 12 where tooth extruded at the end of follow-up showed change in chromatic crown and a slight extruded positioning, orthodontic therapy [20][21][22] appears to be safer compared with intentional replantation. 12 However, this small difference may not be important when comparing the practicality of endodontic access, financial issues, the number of visits, the time required for repositioning teeth, patient comfort, and esthetics, which can make intentional reimplantation a preferable approach to orthodontic therapy.…”

“…The absence of pulp vitality was detected in the works of Elbay et al, 20 Martins et al, 12 and Sübay et al 22 before treatment. In the study by Ebrahim and Kulkarni, 21 the pulp vitality before treatment was maintained, even after the conclusion of the case, and during the follow-up period.…”

Re-intervention on a restored fractured central incisor after one year of restoration replacement: from direct to indirect approach

“…The anterior tooth, involving enamel and dentin, is the most frequent tooth affected, in which the coral fractures represents 65-75% of all dental traumas. [1][2][3] According to a review, for the permanent dentition the crown fractures without pulp exposure is the most common injury described in most studies. 4 Also, the maxillary central incisor is the most frequently affect teeth.…”