Clinical Management of Malreplanted Central and Lateral Maxillary Incisors after Avulsion: A 24 Months Follow Up

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One of the most common dental emergencies we facing are dentoalveolar traumatic injuries1. Dental traumatic injuries include wide range of problems from enamel fracture to complete tooth loss which may have considerable functional, esthetic, speech and psychological effects specially on children affecting their quality of life and self confidence1,2.
The most common type of dental injuries is enamel-dentin crown fractures that comprise %26-%76 of all permanent tooth injuries4. In this type of injury, enamel or an enamel-dentin fracture without pulp involvement take place5.
Conversely intrusion is a rare injury that accounting for only %0.3 to %1.9 of all permanent tooth injuries6. In this type of injury, apical displacement of tooth into the alveolar bone with apical direction exists. This can result to compression of periodontal ligament and commonly leads to a crushing fracture of the alveolar bone5.
Avulsion also is a relatively rare injury that represents about %0.5 to %3 of all dental injuries and seems the most severe one6-8. Avulsion was described as complete displacement of tooth out of socket5,9. The weakest outcomes of dentoalveolar trauma are related to avulsion with finally %73-%96 loss of the replanted teeth10. Therefore avulsion is a real dental emergency and proper management in the time of injury can determine the ultimate prognosis7.
External inflammatory root resorption (EIRR) is a common complication following intrusion and replantation6,11. Current treatment protocol for progressive EIRR is chemomechanical preparation of the canal and placing a long term dressing of calcium hydroxide (CH) in the canal. Despite high success rate with this method, its adverse effects that discussed in previous articles leads t...

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...orption, we decided to do CEM cement obturation of the canal space of tooth #8, 9, 10 to arrest the inflammatory root resorption. In recall visits external root resorption of teeth #8, 9, 10 ceased, and the resorption lacunae were repaired with new cementum without radiographic signs of replacement resorption at any of the follow-up sessions which would suggest the potential ability of CEM cement to be used as a root canal filling material in immature teeth. Periodic radiographic and clinical recalls are necessary to ensure long-term success.
In conclusion, in this case of complicated traumatic injuries, the progressive IERR was controlled using CH dressing for 3 months and then obturation with CEM cement. Therefore successful treatment could be depending on CH or CEM cement. Further clinical studies with longer follow-up periods and larger samples are recommended.

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