Dental trauma is one of the most relevant kinds of emergency in pediatric dentistry and it involves about 25% of young patients. Thankfully, it is often the orthodontist who first examines a trauma. Among the different types of dental injuries, dental luxation is one of the most complex, due to the consequences it may have in the long run. Luxation of a tooth is a displacement, in a non-axial direction, combined with a damage of periodontal ligament and contusion or fracture of the alveolar bone. Moreover, it’s frequently associated with pulp damage.
The case
This particular case is not a standard one, since, from the time of trauma to the first observation, only two hours had passed, which would have been soon enough for a manual reduction.
Fig.1
Unfortunately, the deflection curve of the NiTi wire had “dragged” the lateral incisor and the central contralateral incisor, making it impossible to manually reposition the teeth.
Fig.2
Back in March 2009 a 13 years old boy came to our office after he was kicked in his face kicked during a soccer game. At first he was unable to close his mouth because of the palatal displacement of the upper right central incisor.
Fig.3
From the occlusal view, we could verify that the space between the right lateral incisor and the left central incisor was not the same available before the injury. After we analyzed the possible causes, we removed the wire and we noticed a large deformation, which was probably caused by the force of the impact.
Fig.4
In order create some contact between upper and lower jaw, we built resin bite blocks up, directly on the bicuspid.
Fig.5
To enlarge the space between lateral and central incisors, in order to correctly reposition the tooth, we inserted a light-force spring on the NiTi 0,016 wire, between the right lateral incisor and the left central incisor. After that we used a ligature through the vertical bracket slot on the right central incisor, in order to stabilize it. After 3 weeks the tooth had returned to his ideal position in the alveolar bone, and we used that same NiTi wire as a flexible splint.
Fig.6
Here you can see the X-ray images throughout time, showing a slight shortening of the root length. On the other hand, no other signs of pulpal disease appeared, and the vitality test was always positive.
Fig.7
At the end of the orthodontic treatment, there was no clinical sign of dyschromia or gingival disease.
Fig.8
A correct management of dental trauma allows to obtain a good and stable healing over time.
Conclusions
The IADT (International Association of Dental Trauma) provided well defined guidelines in dental trauma treatment, and by following these guidelines, it is possible to reach a stable result. Nevertheless, analyzing each aspect of the injury allows to optimize the treatment plan for each patient, and to understand how forces and their direction can outline the different trauma treatment outcome.
Bibliography
1. Diangelis AJ et al. Guidelines for the Management of Traumatic Dental Injuries: 1. Fractures and Luxations of Permanent Teeth.
Pediatr Dent. 2017.
2. Lambert DL. Splinting rationale and contemporary treatment options for luxated and avulsed permanent teeth. Gen Dent. 2015 Nov-Dec;63(6):56-60.
3. A Manual. J. O. Andreasen et AA. Traumatic Dental Injuries. 2011, WileyBlackwell.
4. www.dentaltraumaguide.org
