Restoration of Long Standing Traumatized Teeth: A Case Report (original) (raw)
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Curēus, 2024
Traumatic injuries to maxillary incisors often result in complex dental complications, such as pulp necrosis and periapical pathology, particularly in young patients. Traditional root canal treatments may prove insufficient, especially for immature teeth requiring apexification. Regenerative endodontic treatment (RET) presents a promising alternative, aiming to eliminate infection while fostering root development and tooth vitality. This case report illustrates the successful management of a necrotic-infected traumatized maxillary incisor in a seven-year-old girl using RET. The treatment involved a meticulously planned protocol comprising disinfection, induction of bleeding, and placement of a calcium-enriched mixture (CEM) cement plug, followed by composite restoration. Remarkably, despite the initial detection of an endodontic lesion in the postoperative radiograph, the clinical outcomes remained aesthetically pleasing, with subsequent radiographs revealing regression of the apical lesion and complete tooth maturation over the seven-year follow-up period. This case highlights the efficacy and feasibility of RET using CEM in managing infected, traumatized teeth, emphasizing its potential for long-term healing and functional restoration. The absence of tooth discoloration further underscores the benefits of utilizing specific materials and protocols.
Analysis of Root Canal Treated Primary Incisor After Trauma
2012
The low number of clinical studies of traumatized teeth submitted to root canal treatment is completely out of proportion to the seriousness that dental trauma imposes on children in early years. Aim. This study evaluates the outcomes of root canal treatment (RCT) in traumatized primary incisors and identifies the predisposing factors associated with therapy success. Methods: This is a retrospective study conducted with all dental records of 704 patients who had one or more teeth with traumatic injuries. Patients with irreversible pulp changes in primary teeth leading to RCT with a 24 month follow-up met the inclusion criteria. Results: Twenty-five maxillary incisors of 17 children were evaluated. The children's age at the time of therapy ranged from 24 to 72 months (mean 47.3). Pulp necrosis was the most common disorder (84.0%) and pre-operative periapical lesions were observed in 52.0%. Coronal discoloration was found in 48.0%. The roots were filled with ZOE paste (68.0%) or Guedes-Pinto paste (32.0%). Overall RCT success rate was 68.0%. The absence of pre-operative periapical lesions (p =0.02) and pathological root resorption (p = 0.02) presented positive association with therapy success. Success was not associated to filling paste (p = 0.49), filling extent (p = 0.44), of discoloration (p = 0.39) nor the patients' age (p = 0.59). Conclusions: RCT was considered successful in 68.0% of the cases at the 24 month follow-up. Failure of RCT in traumatized primary incisors was associated with pre-operatory periapical lesions and pathological root resorption. The filling paste, the filling extent and the patient's age were unrelated with therapy success.
A Review on Endodontic Management in Traumatized Permanent Teeth
The majority of accidents affect children and adolescents, often when root development of the injured teeth is not completed. Teeth with immature root development, necrotic pulps, and apical periodontitis present multiple challenges for successful treatment. The infected root canal space cannot be cleaned and disinfected with the standard root canal protocol using an aggressive procedure with endodontic files.After the disinfecting phase of treatment has been completed, filling the root canal is difficult because the open apex provides no barrier for containing the root filling material without impinging on periodontal tissues.Even after successfully completing the endodontic procedure, the roots of these teeth are still thin and have a significant risk of subsequent fracture.These problems can be managed using a disinfection protocol that minimizes root canal instrumentation, by stimulating the formation of a hard tissue barrier or providing an artificial apical barrier to allow for optimal filling of the canal, and by reinforcing the weakened root against fracture both during and after an apical barrier has been provided.
Analysis of root canal treated primary incisor after trauma: two year outcomes
The Journal of clinical pediatric dentistry, 2012
The low number of clinical studies of traumatized teeth submitted to root canal treatment is completely out of proportion to the seriousness that dental trauma imposes on children in early years. This study evaluates the outcomes of root canal treatment (RCT) in traumatized primary incisors and identifies the predisposing factors associated with therapy success. This is a retrospective study conducted with all dental records of 704 patients who had one or more teeth with traumatic injuries. Patients with irreversible pulp changes in primary teeth leading to RCT with a 24 month follow-up met the inclusion criteria. Twenty-five maxillary incisors of 17 children were evaluated. The children's age at the time of therapy ranged from 24 to 72 months (mean 47.3). Pulp necrosis was the most common disorder (84.0%) and pre-operative periapical lesions were observed in 52.0%. Coronal discoloration was found in 48.0%. The roots were filled with ZOE paste (68.0%) or Guedes-Pinto paste (32.0...
Complex endodontic and conservative treatment of a traumatized central incisor
2014
Objectives: The functional recovery of a tooth with open-apex already endodontically treated is possible thanks to the materials, such as the MTA, able to produce an effective seal of the apex which can induce a restitutio-ad-integrum. A direct composite resin restoration may then provide a coronal seal immediate and effective in time, able to ensure a complete healing of the endodontic pathology. Materials and methods: The hereby-clinical case describes a combined approach (endodontic and conservative) for the aesthetic-functional recovery of a severely fractured upper incisor of a child of 11 years. Results and conclusions: At the control visit, after 12 months from the completion of the coronal restoration, a complete healing of periradicular bone tissue is observed through Rx. Clinical examination showed gingival tissue without inflammation and the probing depth is not increased, despite the presence of a cavity margin placed below the gingival margin.
Journal of evolution of medical and dental sciences, 2017
Utara with main complaint of discomfort on chewing or percussion and palpation in his left canine. The patient had a PFM fixed bridge from 11 to 23 on his anterior side and he reported that the bridge was made a few years ago. Radiographic evaluation revealed that there was radiolucent periapical involvement, widening of periodontal ligament space and disruption of the lamina dura. Clinical finding was sinus tract that release the suppurative pressure (Figure 1). DIFFERENTIAL DIAGNOSIS Differential diagnosis of the case was pulp necrosis, apical periodontitis, periapical abscess and gingival abscess. CLINICAL DIAGNOSIS Clinical diagnosis of the tooth was symptomatic periapical abscess. PATHOLOGICAL DISCUSSION The infection from the necrotic pulp in the root canal system formed tough biofilm as the defence and virulence system of mixed flora. Bacteria and their by-products infected all root canal system and invaded periapical area. The infection in the periapical area caused suppurative mechanism and created sinus tract to reduce the periradicular pressure. DISCUSSION OF MANAGEMENT On first visit, the tooth was trephinated and pus drainage was performed in order to relieve the intradental pressure. Root canal was instrumented to completion using SS K-file with step-back system started from size #25 and finished with size #55. Irrigation was performed with Sodium hypochlorite 5.25% and EDTA as chelating agent. The canal was dried and an intracanal inter-appointment dressing with pure calcium hydroxide powder mixture and glycerin was placed. Root canal therapy was applied as treatment for this case.
South African Dental Journal
Endodontic treatment of necrotic, immature teeth with open apices can present challenges to debridement, disinfection, and optimal obturation. These teeth may have widely flared canals and thin radicular dentinal walls that are susceptible to fracture. Management of the open apex can be performed using a mineral trioxide aggregate (MTA) apical plug. To ensure a better prognosis in such structurally compromised teeth, internal radicular reinforcement using fiber posts and a self-adhesive cement has been suggested. The present case report illustrates the management of a necrotic, immature maxillary right central incisor in a 10-year-old patient using the MTA apical barrier technique and canal reinforcement using a fiber post.
Esthetic and Functional Treatment of a Poorly Prognosed Traumatized Tooth
Case report , 2021
A correct diagnosis and appropriate emergency management of the avulsion injuries are crucial factors for the repair and healing of tooth and dentoalveolar tissues. Despite the treatment provided, replanted teeth may be eventually lost and demonstrate the poor outcome. An appropriate treatment option may be fiber‐reinforced composite bridges. This report presents a clinical case that involves the endodontic, surgical, and restorative management of a traumatized permanent lower central incisor with a large chronic apical periodontitis. Keywords: Actinomycosis, avulsion, dental trauma, fiber‐reinforced composite bridges
Post Endodontic management of a critically traumatized Central Incisor: An extreme save
IOSR Journals , 2019
The management of adult patients with traumatic injuries to their dentition poses a serious challenge in everyday general dental practice. For the rehabilitation of the complicated subgingival crown fracture of anterior teeth, multidisciplinary approach is often indicated. This report describes the restoration of an endodontically treated tooth ,with a complicated crown-root fracture along with crown prosthesis that extended below both the gingival cuff and the alveolar crest, by using remaining tooth tissue. The restoration was completed after root extrusion with a fiber post core, and porcelain crown. In order to expose the sound tooth structure for prosthodontic intervention, orthodontic extrusion was performed after endodontic treatment.Forced eruption may serve as an alternative treatment modality since its introduction in 1973.To avoid extraction of the involved teeth, the multidisciplinary approach was adopted and finally the teeth were restored prosthodontically. The final result was aesthetically satisfying and periodontically sound.