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Management of an Avulsed Central Incisor

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									  Management of an Avulsed
       Central Incisor

           Dr. Stephen Abrams
          Cliffcrest Dental Office
2995 Kingston Road, Scarborough, Ontario
               416-265-1400
  E Mail; dr.abrams4cell@sympatico.ca
          Background History
• 48 year old male fell face first on the floor after
  getting up from the couch.
• No history of heart problems, or alcohol
  consumption.
• Sustained bruises to the face, mouth and
  avulsed tooth # 21.
• Taken to hospital for treatment.
• Tooth located 3 hours later and then put in a
  glass of cold milk.
• Patient was seen in the office 15 hours later
Initial Photos
March 7, 2004
Radiographs
March 7, 2004
Tooth in Place & Incisal Edges
  Repaired March 7, 2004




 Incisal edges repaired with bonded composite (EPIC TMPT
 Parkell). Tooth 11 – 22 splinted with composite as well. Pin
 placed into incisal edge of 11 to retain large composite build up.
March 15, 2004
Radiograph of # 21 (Avulsed
  Tooth) March 12, 2004
March 22, 2004
 Radiographs
March 22, 2004
 Bony Sequestrum March 22, 2004




Mirror view bony sequestrum approximately 2 mm. tall and 4 mm. long removed
 Lingual view of # 21 April 27, 2004




Good tissue apposition on the lingual of # 21 where sequestrum was removed.
  Endodontic access initiated and Calcium Hydroxide placed in Tooth # 21
April 27, 2004 Splint Removed




Note good gingival tissue
adaptation around the teeth.
Radiograph May 17, 2004
Endodontic Treatment Completed
         June 8, 2004




    Trial File   Obturation with Thermafil
Photographs of June 8, 2004




  Periodontal tissue is healthy around teeth 11 – 22.
  There has been some minor recession on the lingual of
  tooth 21 following the removal of the bony sequestrum.
  There is no periodontal pocketing and the probing depth
  is 3 mm. with a firm soft tissue attachment.
         Issues & Concerns
• Need to monitor the vitality of tooth # 11
  and # 22. May need endodontic treatment
  in the future.
• No symptoms of pain on hot, cold or
  percussion on teeth 11 or 22.
• Need to monitor the teeth for any signs of
  resorption or ankylosis. If this were to
  occur then consider extraction and implant
  placement.

								
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