The best implant is your natural tooth

Fig. 1

A 17 years old male patient with alleged history of car accident and injuries sustained to the anterior maxillary region. 

The patient had no relevant past medical history and was alert as well as responsive during the process of examination. Extra-oral examination revealed sever injury and swollen upper lip. On intraoral examination, The upper right maxillary central incisor (11) was missing and the marginal gingiva in the associated area was lacerated. The upper left maxillary central incisor (21) was extruded. 

Fig. 2

After local anesthesia administration, the avulsed tooth (11) was held by the crown, taking care that the root surface was not touched, the root surface was then gently rinsed with normal saline in order to remove any debris that had adhered to it. 

the alveolar socket was gently rinsed with normal saline. 

Then the avulsed tooth (11) was replantation in the socket with slight digital pressure in the correct position.

The extruded tooth (21) was repositioned in the socket correctly. 

Fig. 3

Flowable composite was placed at the respective spots and then the orthodontic wire was secured in place after light curing each tooth for 20 seconds. 

Oral analgesics and antibiotics ( amoxicillin 500mg + clavulanic acid 125mg twice daily and metronidazole 400mg thrice daily ) was prescribed for five days. 

He was advised to maintain a soft diet for two weeks along with the use of soft bristles toothbrush and 0.12% chlorhexidine mouth rinse for oral hygiene maintenance. 

Fig. 4

Two weeks after replantation, the orthodontic wire and flowable composite removed, then multiple isolation was applied with rubber dam by using two small wing clamps. 

Fig. 5

This photo show the pulp tissue after pulp extirpation. 

Fig. 6

The access cavity was done and the pulp tissue was extirpated then arbitrary WL determination was done with apex locator and confirmed with IOPA radiography. 

Since 50 size K file was freely passing through the apex, a decision for MTA plug was made.

Fig. 7

In this case the effect of the good irrigation is undeniable. As shown,  was the irrigation protocol that relied on a group of irrigating materials in an orderly sequence to ensure good chemical cleaning of the root canal system, as each of this materials have a specific function.

Sodium hypochlorite 5,25% ( NaOCl ): the main irrigating solution used to dissolve organic matter and kill microbes effectively (4)

Ethylenediaminetetraacetic acid (EDTA): is needed as a final rinse to remove the smear layer.(12-15) But it has been used in this protocol more than once to ensure that the dentinal tubules are open to grantee that NaOCl well reach every point of root canal system.

saline: used between these two irrigants to avoid the chemical interaction between them(5)

It was necessary to guarantee the safety and not to pass any of these materials beyond the root apex, also a Gauge 30, double side vented irrigating needle was used to deliver the irrigating material to each canal in depth shorter than the working length by 3 mm.(6)   

The activation of irrigant was done by using an ultrasonic activator, the duration of each activation last for 20 sec.(7)

The image shows the tooth after complete the irrigation protocol

Fig. 9

In the same session after the positioning of 4-5 mm of MTA into the apical area the canal was fill with guttaperca.

And this radiography show the final result. 

The patent was informed about possibility of root resorption or ankylosis. 

Fig. 10

Clinical image after three months 

Fig. 11

Three months recall