Cases reported "Tooth Avulsion"

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1/26. Conservative treatment of severely luxated maxillary primary central incisors: case report.

    The treatment and follow-up evaluation of two orally luxated maxillary primary central incisors in a three-year-old girl is described. The injured teeth were displaced into a cross-bite with their mandibular opposing teeth. They were repositioned shortly after the injury and splinted with composite resin for two weeks. oral hygiene instructions and antibiotic therapy were prescribed. Two weeks after the injury a necrotic pulp was removed and the root canals filled with a resorbable paste. Thirty months after the injury, the teeth and the surrounding tissues were clinically and radiographically asymptomatic and physiologic root resorption could be noted. The permanent successors erupted soon after natural exfoliation of the injured primary teeth. Only mild hypocalcified defects were observed on the permanent incisors.
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2/26. A multidisciplinary approach to the treatment of an intruded maxillary permanent incisor complicated by the presence of two mesiodentes.

    Treatment of a traumatically intruded maxillary incisor with an immature apex remains controversial. Treatment options include observation, surgical repositioning, or orthodontic forced eruption. Likewise, the ideal timing of surgical removal of a mesiodens is highly controversial: immediate versus delayed intervention. The complications associated with untreated supernumerary teeth include: overretention of primary teeth, delayed eruption of permanent incisors, rotations, impaction, diastema, pulp necrosis and root resorption. Less common sequelae include enlarged follicular sacs, cystic degeneration and nasal eruption. This paper describes another risk factor associated with delayed removal of a mesiodens previously not mentioned in the dental literature, namely potential complications arising from a traumatic injury, in particular intrusion, of the maxillary permanent incisors.
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3/26. Bone-like tissue growth in the root canal of immature permanent teeth after traumatic injuries.

    Following a severe traumatic incident to permanent immature teeth, the growth of calcified tissue in the pulp space may occasionally occur. This calcified tissue may be diffuse or in intimate contact with the dentine. It has been suggested that a wide open apex, severe damage to the root sheath, and the absence of infection are only some of the predisposing factors leading to this metaplasia of pulp tissue into bone-like tissue. Five cases are described.
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4/26. Investigations on a cell culture medium for storage and transportation of avulsed teeth.

    Non-physiologic storage of avulsed teeth leads to a high incidence of root resorption, resulting in poor prognosis. This study investigated the suitability of specially composed cell culture media for storage of extracted teeth for up to 48 hours. Autoradiographic investigations revealed that the proliferative activity of periodontal ligament (PDL) cells of teeth stored in cell culture medium for up to 48 hours increased with storage time. Studies on proliferation of PDL cells after storage of teeth in different media for up to 24 hours demonstrated that the proliferative activity is dependent on the composition of the medium. Immunohistochemical investigations with markers for cell proliferation revealed that pulp cells of extracted immature teeth show numerous proliferations after storage for up to 24 hours in a special cell culture medium but few proliferations after storage in Hanks Balanced Salt Solution (HBSS). The investigations indicate that a special cell culture medium can preserve cell viability of PDL cells adhering to extracted teeth for at least 48 hours. The in vitro results are confirmed by a case presented: After storage of two upper central incisors for 36 hours in the cell culture medium the teeth could be successfully reimplanted after extraoral insertion of titanium posts into the root canal (auto-alloplastic reimplantation). Clinical and radiological follow-up examinations for 12 months revealed normal periodontal healing.
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5/26. Decoronation of an ankylosed tooth for preservation of alveolar bone prior to implant placement.

    A 12-year-old patient sustained avulsions of both permanent maxillary central incisors. Subsequently, both teeth developed replacement resorption. The left incisor was extracted alio loco. The right incisor was treated by decoronation (removal of crown and pulp, but preservation of the root substance). Comparison of both sites demonstrated complete preservation of the height and width of the alveolar bone at the decoronation site, whereas the tooth extraction site showed considerable bone loss. In addition, some vertical bone apposition was found on top of the decoronated root. Decoronation is a simple and safe surgical procedure for preservation of alveolar bone prior to implant placement. It must be considered as a treatment option for teeth affected by replacement resorption if tooth transplantation is not feasible.
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6/26. Conservative management of an intruded immature maxillary permanent central incisor with healing complication of pulp bone.

    Traumatic intrusion injury of permanent teeth is serious with multiple complications possible associated with the pulp, periodontal ligament, alveolar bone and Hertwig's epithelial root sheath. The optimal treatment for the management of an intrusion injury has not yet been determined. A case is presented involving the conservative management of an immature maxillary permanent central incisor intrusively luxated by allowing for re-eruption and orthodontic extrusion two weeks later. After a follow-up period of ten months, the intruded tooth continued to show a mobility of grade one, without metallic percussion tone or infra-occlusion, which confirmed periodontal ligament healing. Although the intruded tooth failed to respond to dry ice testing, no other signs of pulp necrosis were evident and the colour of the intruded tooth was within normal limits throughout the follow-up period. However, complications of healing of Hertwig's epithelial root sheath occurred, causing in-growth of bone and periodontal ligament into the root canal.
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7/26. Laser Doppler flowmetry for monitoring traumatized teeth.

    Laser Doppler Flowmetry (LDF) has been shown to be valuable in monitoring revascularization of immature incisors following severe dental trauma. Several investigators have demonstrated the ability of LDF to record blood flow signals from vital tooth pulps. In this case report, LDF was used for a 7-year-old child patient following a severe luxation of tooth #9. During follow-up examinations the traumatized tooth was unresponsive to traditional vitality testing during the first 6 months; however, LDF indicated that revascularization had occurred much sooner. Until recently, CO2 ice has been the most effective method for sensitivity testing in trauma cases such as presented here. In this case, LDF gave us the assurance that we could defer invasive care during a critical time period when root canal therapy might have been initiated for this child patient.
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8/26. Different treatment outcomes of two intruded permanent incisors--a case report.

    Intrusive luxation involves the displacement of the tooth apically into the alveolar socket. This type of injury represents a very complex wound, involving disruption of the marginal gingival seal, alveolar bone, periodontal ligament fibers, cementum and the neuro-vascular supply to the pulp, which results in severely compromised healing and possible complications. The case presented is a report of a 60-year-old lady who fell and intruded her two maxillary central incisors. The healing outcomes of the two central incisors were markedly different from each other even though they sustained similar injuries.
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9/26. A two-probe laser Doppler flowmetry assessment as an exclusive diagnostic device in a long-term follow-up of traumatised teeth: a case report.

    The reliability of laser Doppler flowmetry in a two-probe assessment of pulpal blood flow is well known. The purpose of this case report was to determine its use as an exclusive and reliable tool for tooth vitality diagnosis in a long-term follow-up. As a result of a traumatic injury to a 24-year-old Caucasian female, tooth pulp vitality was studied in six maxillary front teeth over 30 weeks using two-probe laser Doppler flowmetry and current sensitivity tests. A similar assessment was repeated after 228 weeks. Confronted with an alveolar bone fracture with a tooth in the fracture line, one intrusion and several luxated teeth, current sensitivity tests are found not to be as reliable indicators of revascularisation, as significant results are obtained later (7 weeks) than using laser Doppler flowmetry tests (1 week). A pathway with ischaemia (3 weeks), hyperaemia (7 weeks) and restored blood supply in the pulp measured by laser Doppler flowmetry tests was found and avoided endodontic treatment. Teeth vascularisation evolved normally (228 weeks). Despite a strong indication in all sensitivity tests for endodontic treatment, the use of laser Doppler flowmetry tests was clear, more reliable than sensitivity tests and exclusive, as denervation was postponed and pulp vascularisation evident.
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10/26. Obliteration of pulp canal space after concussion and subluxation: endodontic considerations.

    Concussion and subluxation injuries to permanent teeth lead to obliteration of the pulp canal space in 3% to 11% of cases, depending on the severity of the injury and the developmental stage of the tooth. Obliteration of the pulp canal space may make root canal treatment necessary because of the development of apical periodontitis or for cosmetic reasons. If carefully executed, root canal treatment in teeth with an obliterated pulp canal space is highly successful and may act as a basis for internal bleaching.
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