Lily, P See
| Lily, P See |
Lily, P See
Su-Min Lee, Bekir Karabucak
Endodontics, University of Pennsylvania School of Dental Medicine
Introduction
Traumatic dental injuries are common in children, the majority involving maxillary anterior teeth. Unfortunately, injury and loss of these teeth can have substantial and long-lasting cosmetic, functional, and psychosocial effects, especially in a growing individual. Tooth replacement becomes difficult as there are limited options that can accommodate growth. This case report details a commonly overlooked treatment option for the aforementioned scenario of anterior tooth replacement in a developing child.
Methods
A 9-year old child presented to the graduate Endodontic clinic at PDM three days after a bicycle accident. Clinical and radiographic examination of teeth #8 and #9 revealed horizontal mid-root fractures with positive responses to thermal testing, and tenderness to percussion and palpation. Following AAE guidelines, both teeth were splinted and continuously monitored. At 4 months, hard tissue formation was noted at the fracture line of tooth #9; however, an abscess had developed with complete bone loss surrounding the apex of the tooth #8 coronal fragment. Considering the hopeless prognosis of tooth #8 and an existing treatment plan for orthodontic extractions of premolars, autotransplantation was suggested and pulpectomy performed to treat the present infection. Upon adequate root development of donor tooth #28, transplantation of tooth #28 to the socket of tooth #8 was performed using a 3D replica. A direct resin veneer was placed at the one-month follow-up. Further follow-up was performed monthly up to 6 months, at 9 months, and 12 months.
Results
Post-transplantation, the child was able to confidently resume her normal livelihood and extracurricular activities. At the 12-month follow-up, both teeth #8 and 9 were asymptomatic, revealed negative responses to thermal testing, positive responses to electric pulp testing, and had normal responses to percussion and palpation. Radiographic examination revealed complete bone healing and normal physiological root development of tooth #28 in the transplanted site.
Conclusion
The transplanted premolar replaced the traumatized upper incisor both esthetically and functionally. The use of a 3D replica proved useful in the autotransplantation procedure by reducing both the extraoral time of PDL and the duration of the surgical procedure. In selected cases where a suitable donor tooth is available, autotransplantation is a viable option for the replacement of unsalvageable teeth.