Biological Self-Repair of Periodontium and Pulp in a Pediatric Patient with Trauma and Extrusive Luxation -A Case Report.

In a general dental practice and in dental institution, traumatic emergency cases report for dental and orofacial injuries in children. This case report discusses a trauma case involving luxation of maxillary incisor tooth, treatment has been done and review of literature in regard to this. Copyright:

CASE REPORT

A 10-year-old girl was referred after fallen injury. On clinical examination dental trauma, lip injury, and swelling of upper anterior tooth was noticed [Figure 1]. After radiographic investigation, it was found that left upper central incisor (21) was traumatized and there was an extrusive luxation in the tooth [Figure 2].

Figure 1

Pre-operative clinical picture showing dental trauma, lip injury, and swelling of the upper anterior tooth

Figure 2

Pre-operative radiographic image showing extrusive luxation of 21

Treatment plan was prepared to treat the extrusive luxation in the left upper central incisor by biological approach under local anesthesia. After giving local anesthesia, the tooth was gently pushed back into the socket. The soft tissue viscosity helped the tooth to be placed in socket though there was edema of socket and upper lip. Oral medication of amoxicillin and paracetamol was given for five days. The tooth was in position when reviewed after four weeks and there was exhibition of sensitivity in the tooth. Stabilization of tooth was deferred purposefully [Figures 3 and 4].

Figure 3

Post-operative clinical picture showing healing of lip injury and upper anterior tooth

Figure 4

Post-operative radiographic image shows stabilized 21

DISCUSSION

According to Spinas et al.,[1] treating dental luxation injuries is challenging for the clinician. Dental luxation accounts for 18–33% of injuries to permanent teeth and can be addressed using different therapeutic approaches. The authors concluded that orthodontic technique are commonly used to treat dental intrusions, in case of extrusive and lateral luxation injuries, it is confined to the stabilization phase. Among the various possible pulp consequences, many authors consider only pulp canal obliteration (PCO) and pulp necrosis (PN), often tending to overlook physiological healing (pulp survival) and the possible development of PN after PCO. There is, therefore, a clear need for new high-quality clinical studies of this topic based on systematic and data collection.

Espinas et al.[2] conducted a study to analyze the chosen diagnostic and therapeutic approach for repositioning and splinting methods and the risk, frequency, and timing of the onset of PCO and PN following extrusive luxation in young patients with permanent dentition. The study confirmed that prophylactic endodontic treatment is not appropriate for immature teeth affected by extrusive luxation injuries, given the extreme rarity of PN in teeth already affected by pulp obliteration.

Espinas et al.[3] studied that there is no-single therapeutic approach for treating dental pulp responses such as PCO. some authors still recommend preventive endodontic treatment whereas others choose not to intervene, to avoid causing possible iatrogenic complication. They concluded that PCO is a physiological pulp response associated with a traumatic event usually a luxation injury.

According to these authors pulp obliteration takes a year or later after PN occurs earlier than a year, so preventive endodontic treatment is inappropriate and can cause serious iatrogenic damage.

International Association of Dental Traumatology (IADT) has developed guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions in this article.[4] These guidelines represent the best current evidence based on literature search and expert opinion. In this first article, the IADT Guidelines cover the management of fractures and luxation of permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.

CONCLUSION

Minor injuries with minimum dislocation from socket in developing permanent anterior teeth can be treated as a biological self-repair of periodontium and pulp. By refixing and repositioning the teeth in the socket with gentle finger pressure after anesthetizing the region. A biological self-repair opportunity of periodontal and pulp occurs. Wherever satisfactory repositioning is not possible a stabilization of injured tooth is necessary to enhance healing.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.