Surgical repositioning of a traumatically intruded permanent incisor in a patient with rheumatic fever: case report

Abstract

Intrusive luxation of permanent teeth is a relatively uncommon type of injury to the periodontal ligament. However, it is one of the most severe types of dentoalveolar trauma. By definition, intrusive luxation consists of the axial displacement of the tooth into the alveolar bone, accompanied by comminution or fracture of the alveolar bone. Here we report the treatment management of a traumatically intruded immature permanent central incisor by surgical repositioning undertaken in a 10-year-old child with rheumatic fever 10 days after sustaining a severe dentoalveolar trauma. The intraoral examination showed the complete intrusion of the permanent maxillary right central incisor and the radiographic examination revealed incomplete root formation. Prophylactic antibiotic therapy was prescribed and the intruded tooth was surgically repositioned and endodontically treated thereafter. The postoperative course was uneventful, with both clinically and radiographically sound conditions of the repositioned tooth up to 3 years and 2 months of follow-up. These outcomes suggest that surgical repositioning combined with proper antibiotic prophylaxis and adequate root canal therapy may be an effective treatment option in cases of severe intrusive luxations of permanent teeth with systemic involvement.

Surgical extrusion as a treatment option for crown–root fracture in permanent anterior teeth: a systematic review

“…Higher incidence of resorption was also observed in case of endodontic treatment being performed prior to extrusion due to contamination by serum, blood, and saliva . Various other case reports and case series have shown no signs of root resorption after an average follow up of 1 year . Periapical pathologies and marginal bone height:‐ Normal periapical healing and resolution of radiolucency was seen in almost all reported case reports and case series . A study showed a minor loss of marginal bone height in one out of the 20 teeth treated .…”

“… Periodontal ligament spacing:‐ Normal periodontal contour was seen in most of the studies during the three‐month follow up . Restoration of normal form and function of the periodontium was seen in all the case reports and case series among the reviewed articles . Root resorption:‐ Although present in the few studies reviewed, root resorption was non‐progressive in nature . It was primarily associated with the surgical technique involving periapical surgery and stabilization by bone graft .…”

“…The case reports and case series described the outcomes of patients who underwent surgical extrusion as a treatment for fractured and intruded teeth due to trauma . Various other prospective and retrospective studies have shown that the surgical technique involving intra‐alveolar transplantation using simple extraction or extrusion was found to be successful in extrusion of teeth with crown–root fractures.…”

Intrusive Dislocation in Permanent Teeth: Review of Literature and Clinical Case Report

“…Intrusive dislocation is defined as the axial displacement of a tooth into the alveolus, affecting mainly the upper central incisors, followed by the upper lateral incisors and rarely occurring in the mandible teeth (Dias et al, 2009;Gupta, 2011).…”

“…Despite its low prevalence, which corresponds to 1.9 % to 3 % of all traumatic lesions, intrusive dislocation is considered one of the most severe forms, which can produce catastrophic damage to the alveolar bone, severe shearing, gingival fibers rupture, periodontal ligament cells destruction, as well as crushing of the apical neurovascular system (Erverdi & Kargül, 2002;Güngör et al, 2006;Dias et al;Gomes et al, 2013). This trauma can generate serious 1 Students of the Specialization Course in Endodontics, Brazilian Association of Dentistry -ABO / GV-Governador Valadares, MG, Brazil.…”