Multiple dentoalveolar traumatic injury: a case report (3years follow up)

Application of virtual technology to maximize esthetics and function in the restoration of anterior traumatic dental injuries

The restoration of multiple teeth with traumatic injury in the esthetic zone is complex. For the present patient, an intraoral scanner, a facial scanner, a jaw motion analyzer, and cone beam computed tomography were applied to collect patient data and establish a virtual dental patient. The virtual technology increased the accuracy of tooth- and implant-supported crowns in both appearance and occlusion.

Management of a Complex Dentoalveolar Traumatic Injury with Multiple Avulsions

Background

Dentoalveolar trauma is a major cause of tooth loss in children. Avulsion, luxation, crown, and root fracture are the injuries to primary and permanent dentition. The incidence of trauma for maxillary anterior teeth ranges for 4%-91%. Many case reports have been published regarding the treatment of trauma to anterior teeth; however, case reports comprising multiple avulsions including canines and premolars are rare in literature.

Method

After mouth rinsing was done with 2% betadine solution, the luxated teeth numbers 31 and 42 were repositioned into the tooth socket and were secured with the composite resin-wire splint. Tooth number 32 was extracted because it was disarticulated from the socket, and the socket was disrupted because of the alveolar fracture. The maxillary avulsed teeth could not be reimplanted because of the alveolar socket damage which was due to the alveolar bone fracture.

Results

The patient was reevaluated for the removable prosthesis in recall visits; the patient was well adapted to the appliance with no complaints regarding mastication and speech. The patient was advised to report periodically for further adjustments in the prosthesis and for radiographic evaluation.

Conclusions

This case report includes proper history taking, diagnosis, and treatment of a complex dentoalveolar trauma along with short-term prosthetic rehabilitation for improvement of aesthetics, phonetics, and mastication of growing child.

Fractured alveolar process displacement evaluation-Effect of the rigidity of wire-composite splints

BACKGROUNDS/AIMS

Traumatic dental injuries with bone fractures require rigid splinting. The degree of rigidity of the wire-composite splints can be challenging. The aim of this study was to evaluate the effect of the rigidity of different wire-composite splints on alveolar process displacement.

MATERIAL AND METHODS

A model was created using polystyrene resin to simulate the anterior maxilla, bovine incisors to simulate maxillary incisors, and polyether impression material to simulate the periodontal ligament. An alveolar process fracture was created, while maintaining the labial bone connection with the PDL. Four wire-composite splints (0.3, 0.6, 0.9, and 1.2 mm in diameter) were compared with models without splints and with no fracture (n = 5). The alveolar process displacement was measured (3 times per model/per splint type) at the fractured and adjacent central incisor regions using a deflectometer (Instron) under functional cycling and static loading (100 N). Data (μm) were analyzed using RM ANOVA, followed by Tukey's HSD test (α = 0.05).

RESULTS

The displacement at the region of the adjacent incisor was not influenced by the splint during static and cycling load (P > .05). The Tukey test demonstrated that the model without splints had significantly higher alveolar process displacement at the traumatized teeth than that of all other splint models (P < .001). Increasing the wire diameter from 0.3 mm to 0.9 mm significantly reduced the alveolar process displacement (P < .001). No difference was observed between the 0.9 mm (P = .123) and 1.2 mm (P = .219) wire-composite splints irrespective of the measured tooth regions.

CONCLUSIONS

The rigidity of the wire-composite splint significantly influenced the mobility of the fractured alveolar process. The use of at least 0.9 mm wire was effective in reducing the fractured alveolar process displacement to a level that was similar to the adjacent teeth.

Evaluation of cases of concussion and subluxation in the permanent dentition: a retrospective study

Objectives

This study evaluated the evolution of cases of concussion and subluxation through a retrospective study of 20 years.

Material and Methods

Were examined clinical and radiographic records of 1,309 patients who underwent treatment of dentoalveolar trauma in the discipline of Integrated Clinic of the School of Dentistry of Araçatuba, UNESP, of which we selected 137 whose patients had concussion and subluxation injuries, with average age of 23.3 (SD – 10.96). The variables collected were: gender, age, history of previous and actual trauma, treatments performed, the presence of necrotic pulp, and time elapsed until the same trauma. The concussion and subluxation groups were subjected to statistical analyses using the SPSS 16.0 version software (α=0.05), Chi-square, and t-tests.

Results

Of the 301 teeth involved, 49 (16.3%) suffered concussion and 252 (83.7%), subluxation, being the upper anterior teeth the most affected (75.1%) for both conditions. Subluxation and concussion traumas were more prevalent in men aged 10 to 20 years, most caused by cycling accidents (36.2%). There was a concomitant presence of crown fracture in 21% of cases of concussion and 34.7% of subluxation. Pulp necrosis was detected in 16.3% (concussion) and 27.1% (subluxation) (p=0.12), and most occurred within 6 months after the trauma (p=0.29). The pulp necrosis shows a positive correlation with motorcycle accidents (p=0.01), direct impact (p≤0.0001), crown fracture with pulp exposure (p≤0.0001), darkening of the crown (p=0.004) and spontaneous pain (p≤0.0001); and negative correlation with indirect impact (p≤0.0001).

Conclusions

Although concussion and subluxation traumas are considered of minor degrees, they must be monitored, since the possibility of pulp necrosis exists, and its early treatment favors a good prognosis.

Alveolar Bone Fracture: Pathognomonic Sign for Clinical Diagnosis

Aim:

Dental injuries, especially luxation and avulsion, are common. Dental trauma can cause alveolar bone fracture that can lead to tooth loss and malocclusion. Single tooth alveolar bone fractures are difficult to identify unless it protrudes through the overlying mucosa and can be visualized. Pain, malocclusion, and tooth mobility provide signs of suspected alveolar bone fractures. Integrity of the proximate alveolar bone should be examined for fractures where avulsion, luxation, or other tooth trauma is detected. Any suggestion of alveolar fractures should be further investigated with an appropriate radiograph.

Summary:

This case report shows a pathognomonic sign that detects and diagnosis single tooth alveolar bone fractures, i.e., a localized hematoma crossing the attached gingiva from the free gingival margin to the vestibular mucosa. This should serve as a warning for localized alveolar bone fracture.

A visualized hematoma and gentle, careful palpation may help detect covered fractures when the overlying mucosa is not perforated.

Treatment of multiple traumatized anterior teeth associated with an alveolar bone fracture in a 20-year-old patient: A 3-year follow up

Intrusive luxation is a type of recognizable luxation injury represented by a deeper axial displacement of the tooth toward the alveolar bone. Treatment strategies include waiting for the tooth to return to its position, immediate surgical repositioning, and repositioning through dental traction by orthodontic devices. The aim of this case report was to present the management of severe dental trauma and later restoration following IADT. A 20-year-old patient was presented after fainting at home four hours before, resulting in a dento-alveolar trauma. Clinical examinations revealed a traumatic intrusion, in 1.2, 1.1 and 2.1, uncomplicated crown fractures in 1.1 and 2.1 and a complicated crown-root fracture in 2.2. The diagnosis was confirmed with CBCT. Following IADT protocol, the emergency treatment consisted of the surgical repositioning and semi-rigid splinting using orthodontic wire-composite, replacing the buccal bone plate, and postoperative instructions to the patient regarding oral hygiene. After 2 weeks the root canal treated and filled with fiberglass posts in 1.2, 1.1, 2.1 and 2.2. Splint was removed after 4 weeks and the IADT reassessment protocol followed, with revisions at 6-8 weeks, 6 months, a year and annual reviews for 5 years. A year after the treatment, the traumatized teeth were restored with minimally invasive preparations of feldspathic ceramic. Esthetics and function were recorded with a 3-year follow-up period.

Key words:Intrusive luxation, dental trauma, crown-root fracture, dento-alveolar trauma, permanent tooth, CBCT.