Case report: a combined avulsion and root fracture/avulsion trauma with ten years review.

BACKGROUND: The management of trauma involving anterior permanent teeth can be very complicated, particularly when more than one type of injury occurs. In some instances the advised treatment for one type of injury may conflict with that of another. In the present case a child had an avulsion and a root fracture/avulsion. CASE REPORT: A patient, aged 14 years at the time of the injury in 1998, had a root fracture avulsion of the maxillary right permanent central incisor (11) and an avulsion of the maxillary left permanent central incisor (21). The management strategies were conflicting with regards to the type and duration of splinting. The dilemma of either having flexible splinting (10 days) for avulsed teeth as opposed to rigid splinting for root fracture (12 weeks) teeth was an important clinical decision since, the patient had sustained both injuries together. TREATMENT: The patient had semi-rigid splinting of 11 for 4 weeks and 21 was released from the splint at 8 days. Initial root canal therapy was carried out using non-setting calcium hydroxide and both these teeth were obturated with gutta percha. The teeth had an extra-alveolar period of 90 minutes and were placed in milk within 15 minutes of the trauma. Previous studies indicated that an extra-alveolar period of over 45 minutes leads to a poor long-term prognosis [Andreasen et al., 2004; Boyd et al., 2000] and this case is a rare example of long-term survival of 11 and 21. FOLLOW-UP: Regular clinical and radiographic reviews took place over ten years from the injury and both 11 and 21 are currently successfully functional in the arch.