Multidisciplinary solution for an avulsed upper central incisor: case report

Class III malocclusion with traumatic unilateral maxillary central incisor loss treated using orthodontic miniscrews: a case report

The present article reports the successful non-extraction orthodontic treatment using miniscrew anchorage in a patient who presented with maxillary left central incisor loss and unstable jaw movements. The chief complaints of the 23-year-old female patient were her protruding teeth and crowding of the mandibular anterior segment. The patient lost her maxillary left central incisor as a result of a traumatic injury during childhood. However, the crown was saved and attached to the adjacent teeth. The patient was diagnosed with a skeletal Class III and Angle Class III dental malocclusion. The jaw movements determined by a 6 degrees of freedom jaw movement recording system were unstable and irregular. Miniscrew anchorage was applied for distalisation of the maxillary right dentition and the mandibular dentition during non-extraction treatment. The maxillary left dentition was mesialised using miniscrew anchorage to close the space as a result of the lost maxillary left central incisor. After an active treatment duration of 36 months, the patient achieved a Class II molar relationship on the left side, a Class I on the right side, an optimal overjet and overbite, and a pleasing facial profile. Despite the asymmetric molar relationships, functionally stable and smooth jaw movements were established. The skeletal, occlusal and functional stability remained satisfactory after a 2-year retention period. In conclusion, miniscrew anchorage was valuable in supporting asymmetric tooth movement during non-extraction appliance treatment in a patient who presented with traumatic unilateral tooth loss.

What general medicine students of University of Rijeka know about dental avulsion?

INTRODUCTION

Injuries of decidouos and premanent teeth can be rather hard, esspecially in combinatin if they involve adjacent supportive tissue. Among all injuries, the loss of the teeth is considered the most stressful for both a child and its parents. Tooth injury usually involves soft tissue damage, which means severe bleeding. As parents often look for help from their family general practitioners, it is very important that general practitioner is acquainted with the first aid in order to preserve the tooth and enable further skeletal development.

MATERIALS AND METHODS

This study was carried out in the form of a questionnaire, which was distributed among general medical students at the Medical studies of the Faculty of Medicine of the University of Rijeka, Croatia. The study included 86 pre-doctoral students of the 3rd, 4th and 5th years of studies. The questionnaire consisted of 23 questions, which were related to demographics, personal experience in treating dental injuries, theoretical knowledge about dental injuries and their interest in additional training on the subject.

RESULTS

The results showed that only 32.6% of the students heard of 'tooth avulsion'. Replacement of the avulsed tooth in its original position in the jaw was considered by 77.6% of the students. In their entire education, 84.9% students didn't acquire any knowledge about dental injuries.

CONCLUSION

The study showed that medical students have very poor knowledge about dental injuries. Also, the vast majority of the students were neither informed nor educated about it during their studies.

Partial and total luxations of permanent teeth in children: Clinical management

Dentoalveolar trauma, very frequent during childhood and adolescence, generally results in tooth fracture and/or partial or total luxation. Management of the pulpal and periodontal aspects of these traumatic cases is complex. The prognosis is improved if treatment is initiated promptly. Multidisciplinary management of these situations and regular patient follow-up make it possible to detect complications quickly and take the necessary action to maintain the teeth as long as possible in a healthy periodontal environment that allows harmonious development and the application of appropriate treatment in adulthood.

Extraction of maxillary central incisors: an orthodontic-restorative treatment

Malformed central incisors with poor prognosis could be candidates for extraction especially in crowded dental arches. This case report refers to a 12-year-old boy who suffered from malformed upper central incisors associated with severe attrition. Upper lateral incisors were positioned palatally and canines were rotated and positioned in the high buccal area. The patient had class II malocclusion and space deficiency in both dental arches. Due to incisal wear and malformed short maxillary central incisors and the need for root canal therapy with a major crown build-up, these teeth were extracted. The maxillary lateral incisors were substituted. Thus the maxillary canines were substituted for lateral incisors and the first premolars were substituted for canines. In the lower dental arch the first bicuspids were extracted. Composite resin build-up was performed on the maxillary lateral incisors and canines. This allowed for the crowding and the malocclusion to be corrected. Subsequent gingivectomy improved the patient's gingival margins and smile esthetics one month after orthodontic therapy.

Management of chronic luxated central incisor with hopeless prognosis

Traumatic injuries are the most studied yet most challenging for a dentist. Extrusive luxation injuries are usually managed by repositioning tooth in the original position and pulp sensibility is evaluated at regular periodic intervals. However, when injuries are chronic, tooth is necrotic with compromised periodontal support, treatment is a challenge. Intentional replantation utilizing growth factors in fibrin rich network of platelet rich fibrin can be a treatment modality in such patients where other restorative modalities to establish function-esthetics rehabilitation is not possible.