01 Settembre 2021

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A new approach of permanent tooth avulsion in a growing patient

Clinical case

Antonio Gracco, Edoardo Conte, Alessandro Frezza, Sabina Saccomanno, Alberto De Stefani, Giovanni Bruno

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Objectives  Dental traumas frequently occur in young children and young adults. The maxillary incisors are the most commonly damaged teeth with a greater risk for central maxillary in­cisors, especially in children with increased overbite and overjet. In avulsions’ treatment of perma­nent teeth, the reimplantation of the same element is the first choice of treatment in most cases.

How­ever, there are contraindications to this therapeutic option, such as: delay of the operation, age, compli­ance, the patient’s oral health and the condition of the dental element. A recent therapeutic alternative described by Göllner et al. is a temporary rehabilitation using TADS pending a future implant in­sertion at the end of growth. In the following study the authors report a case of traumatic avul­sion of a maxillary central incisor rehabilitated using two orthodon­tic mini-screws inserted with a computer-guide technique.

Materials and methods  A 13-year-old male patient arrives at the dental clinic a week after the traumatic avulsion of the upper right central incisor due to a fall off the bi­cycle. A clinical and radiographic ex­amination shows a complete avul­sion of the upper left central incisor and an uncomplicated fracture of the incisal margin of the upper right central incisor, without soft tissues lesions. The cephalometric exam­ination highlights a normodivergent skeletal Class III (ANB: -2.1°; Wits Appraisal: -3.5 mm) with a reduc­tion of overjet and overbite (OB: 1.2 mm; OV: 1.4 mm). Two mini-screws have been using the Easy Driver technique (Uniontech, Parma, Italy).

Results  In this study the authors use two or­thodontic mini-screws and a tempo­rary resin prosthetic element of the frontal incisor. A CBCT has been prescribed to analyze possible frac­tures of the alveolar bone and to plan the computer guided insertion. In this way facilitates the precise and safe insertion of the mini-screws in the anterior hard palate area.

The two orthodontic mini-screws are placed in a parallel position af­fecting the two cortical bones to have greater stability. The manu­facturing of a temporary resin pros­thetic element of the frontal incisor fastened to the two mini-screws awaiting an implant-prosthetic re­valuation at the end of growth. The prosthetic rehabilitation of the upper right central incisor is sup­ported by the composite resto­ration of the incisal edge of the upper left central incisor.

Conclusions  Using this technique, even less ex­perienced operators have the op­portunity to easily insert the mini-screws and to fasten the device during the same appointment avoid­ing the riskier manual insertion. The benefits of this temporary treat­ment in growing young patients are: simplicity and safety of insertion of mini-screws; aesthetic result of the prosthesis; easy maintenance of proper hygiene; stability (absence of risk of decementation or loss of re­tention in mixed dentition).

Clinical significance  This clinical case shows an easy and fast method to manage a den­tal trauma. This method can be a choice for those patients having low disposable income. Moreover, it is useful in growing patients be­cause it can be adapted to the ver­tical growth of the jawbone.

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doi: https://doi.org/10.19256/d.cadmos.07.2021.08