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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; firstname.lastname@example.org 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.
"Management of an Avulsed Central Incisor"