Lost and found! Tooth fragment reattachment after 8 Mo of trauma.

Thorough clinical and radiographic evaluation of patient following orofacial trauma is indispensable for a successful outcome, and when the tooth fragment is available in a good condition, then fragment reattachment is the best choice of treatment.

CASE PRESENTATION

A 16‐yr‐old patient reported with a complaint of swollen lower lip for past 1 month. Patient's medical history revealed trauma to front tooth 8 months ago. Figure 1 shows diffuse swelling on the right side of the lower lip with a scar. A nontender mass was palpable underneath the scar. Figure 2 reveals an Ellis class II fracture with tooth 21. Occlusal film (Figure 3) showed the presence of a suspected radiopaque mass resembling a tooth fragment. IOPA of tooth 21 (Figure 4) showed no evidence of damage to the pulp and the periodontium. After proper consent, the fragment was located using a 25 gauge 20‐mm short needle (Figures 5 and 6). The retrieved fragment was checked for approximation with the fractured tooth 21 (Figure 7) and was subsequently stored in normal saline (Figure 8). After suture removal, slight beveling of the fractured edge was done and an adhesive system (Adper Single Bond Plus, 3M ESPE) was used to reattach the tooth fragment with composite resin (Z‐100, 3M ESPE).1, 2 (Figures 9, 10, 11) .

Figure 1

Extraoral lip swelling

Figure 2

Ellis class II fracture with tooth 21

Figure 3

Extraoral radiograph of lower lip

Figure 4

IOPA of tooth 21

Figure 5

Fragment location using a 25 gauge needle

Figure 6

Blunt dissection showing tooth fragment

Figure 7

Approximation of tooth fragment

Figure 8

Wound closure done

Figure 9

Approximation of tooth fragment with sticky wax

Figure 10

Reattachment of tooth fragment

Figure 11

Post‐op IOPAR

Thorough clinical and radiographic evaluation of patient following orofacial trauma is indispensable for a successful outcome, and when the tooth fragment is available in a good condition, then fragment reattachment is the best choice of treatment.

CONFLICT OF INTEREST

There are no conflicts of interest.

AUTHOR CONTRIBUTIONS

First author: examined the patient, addressed the chief complaint, located the tooth fragment, and helped in surgical retrieval of the same. Second Author: reattached the tooth fragment. Third Author: edited and proofread the manuscript. Fourth Author: reattached the tooth fragment.