A trauma story
02/10/2021
Riccardo Tonini
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This is the story of an injured upper right later incisor. Due a surgical approach, a lateral incisor root has been accidentally cut in two parts. In this case the approach has been only to take time and check continuously vitality, eventual root resorption and crown color.
Fig. 1
Preop images of the clinical case. The lateral incisor is extremely rotated and inclined
Fig. 2
Preop xray before segmental osteotomy
Fig. 3
Post op image and X-rays.
From the X-ray it was immediately noticed that the root was compromised and, at first, the vitality test was almost completely negative
Fig. 4
CBCT
A CBCT was requested for evaluating the level of the damage and the root resulted half cut almost at the apical level. Considering the uncertain situation, it has been decided to wait and do not make any root canal treatment, hoping that vitality of the tooth after 3 months would be positive.
Fig. 5
3-6-12 months follow up
After 3 months vitality was better and remained stable after 6 and 12 months.
No signs of resorption appeared on the root line
Fig. 6
18 months follow up
Vitality was stable and also no tooth discoloration occurred. The interesting thing was also that no signs of resorption appeared
Conclusions
Sometimes in Endodontics the best strategy is wait instead of action. This case would not have been easy to treat in a predictable way.
Bibliography
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Andreasen, J.O. (1980) A Time-Related Study of Periodontal Healing and Root Resorption Activity after Replantation of Mature Permanent Incisors in Monkeys. Swedish Dental Journal, 4, 101-110.
Andreasen, J.O. (1980) Analysis of Pathogenesis and Topography of Replacement Resorption (Ankylosis) after Replantation of Mature Permanent Incisors in Monkeys. Swedish Dental Journal, 4, 231-240.
Bishara, S.E. (1992) Impacted Maxillary Canines: A Review. American Journal of Orthodontics and Dentofacial Orthopedics, 101, 159-171. http://dx.doi.org/10.1016/0889-5406(92)70008-X
Epker, B.N. and Paulus, P.J. (1978) Surgical-Orthodontic Correction of Adult Malocclusions: Single-Tooth Dento-Osseous Osteotomies. American Journal of Orthodontics, 74, 551-563. http://dx.doi.org/10.1016/0002-9416(78)90031-3
Cheng, C.Y., Zen, E.C. and Su, C.P. (1997) Surgical-Orthodontic Treatment of Ankylosis. Journal of Clinical Orthodontics, 31, 375-377.
