01 Settembre 2021

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

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


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