Page 20 - DP Vol 19 No 2 HR_Neat

Multidisciplinary section

inter-disciplinary rehabilitation of

traumatic avulsed tooth with orthodontic

treatment and implants – A Case Report

inderpreet Singh, Nitin Garg and Prabhjot Kaur

AbStRACt
Dental avulsion is one of the most serious dental traumatic
injuries. When the tooth gets knocked out, the blood supply to
the pulp is interrupted and the periodontal ligament cells are
exposed to injuries caused by the external environment. In this
article, the Maxillary left central incisor had a history of avulsion
and replantation that subsequently evolved into generalized
external root resorption with Class II mobility and severe loss
of the supporting periodontium which was later replaced with
oral implant. The customized impression coping technique was
carried out to reproduce the emergence profile formed under
temporary prosthesis. Along the rehabilitation phase, class I
malocclusion with crowding and deep bite also was treated with
orthodontic braces treatment. Fig 1: Patient came with trauma; 21 was exfoliated and was
preserved in cotton
iNtRoduCtioN
Losing a tooth in early phase of life can become very disturbing for
1
someone. One such scenario is the case of traumatic avulsion. An
avulsed tooth occurs when a tooth is completely dislodged from
its socket due to dental trauma or surgery. Avulsion of permanent
tooth is the most serious dental injuries and the avulsed tooth
needs to be handled properly and re-inserted back into the socket
after appropriate treatment with suitable medium at earliest
2,3
within 30-60 minutes. Or the other options that are available for
replacement of missing teeth in such cases is removable or fixed
prosthesis (that includes bridges and implant prosthesis). 4

CASe RePoRt
A patient of accidental avulsion of upper left central incisor
walked into our clinic about 7 years back. Patient walked in at Fig 2: Immediately after splinting with adjacent tooth
evening rush hours with bruises over the face and incisor tooth
wrapped up in cotton. He was accompanied by his parents, they
looked anxious and worried. Patient and his parents were calmed
down and explained about all the possibilities after thorough
examination of wound site (Figure 1). Avulsed tooth was cleaned
with Saline and Gentamycin and reimplanted back into the
socket and splinting with adjacent teeth was done via ligature
5,6
wire (Figures 2 and 3). Attendants were informed about the
prognosis and recalled after four weeks for follow-up.Splint was
removed and pulp vitality test performed to check the vitality
of upper incisor. Tooth was found to be non-vital so root canal
7
treatment was planned and performed. Patient was asked to come
for regular follow-ups but he never ever came back again until Fig 3: Pretreatment and immediately after splinting IOPA
one fine morning after around 6.5-7 years, he walked in with
complaint of discolouration and movement of the treated incisor Upon discussion, patient said he also wants his mal-aligned teeth to be
(Figures 4 and 5). Clinical examination showed grade II mobility corrected. So, the final treatment plan that was formulated was as follow –
8
and on further radiographic evaluation IOPA revealed external 1. Orthodontic treatment
root resorption (Figure 6). His parents were called and all the 2. Extraction of upper left central incisor
different treatment modalities were told in depth to the patient. 3. Followed by immediate implant placement and temporisation
20 Dental Practice i March-April 2023 i Vol 19 No 2