Tooth avulsion – case report

Abstract

Introduction: Dental trauma has a high prevalence, mainly among young patients. It can eventually lead to tooth loss, affecting the individual’s self-esteem and social relationships and that’s why it is considered a public health problem [1,2]. The objective of this clinical case is to demonstrate some consequences of an avulsed permanent tooth and its resolution.

Materials and methods: Male patient, 13 years old, suffered avulsion of upper right central incisor. According to the patient, the tooth was wrapped in paper for about 1h30m, before being reimplanted in the alveolus at the hospital. The tooth was stabilized using flexible splint. After one year the patient was observed at the Clínica Universitária Egas Moniz, presenting mobility II, pulp necrosis and external root resorption. After obtaining informed consent, the endodontic treatment was performed. In the first session intra-canalar medication with calcium hydroxide was used and the splint was removed. After 15 days the canal obturation was performed using Gutta-percha and Sealapex™ cement. One week later, the crown was restored and there was a reduction of mobility. After one month the tooth presented mobility I.

Results: The reimplantation of the avulsed tooth in the alveolus associated with endodontic treatment proved to be an excellent option for this type of trauma, presenting aesthetic as well as functional results in a three-month follow-up.

Discussion and conclusions: Some authors report that dental avulsion is one of the most serious lesions that depend on the prognosis and the attitude taken directly after the trauma [1–3]. The immediate reimplantation of the tooth in the alveolus is described as a treatment of choice. The condition of the periodontal ligament cells of the avulsed tooth depends on the storage environment and extra-oral duration. After an external exposure of 60 minutes, the cells are no longer viable making their prognosis highly unfavorable. Studies suggest the use of a flexible splint for about two weeks and endodontic treatment. Reimplantation may have a high success rate, but some of the teeth may be lost a posteriori [3]. In this case, the prognosis of the avulsed tooth should be considered unfavorable since it was transported in an unsuitable vehicle (dry) and reimplanted about 90 minutes after the trauma. However, in a 3-month follow-up, the tooth presented decrease of the apical lesion, interruption of root resorption, aesthetics and a satisfactory function.