DELAYED TREATMENT OF AVULSED YOUNG PERMANENT TOOTH IN TRAUMATIC DENTAL INJURY
DELAYED TREATMENT OF AVULSED YOUNG PERMANENT TOOTH IN TRAUMATIC DENTAL INJURY (A case report) Alfini Octavia1, Arya Adiningrat1, 2 1 School of Dentistry, Muhammadiyah Yogyakarta University, Indonesia 2 Graduate School of Oral Sciences, Tokushima University, Japan ABSTRACT Aim Tooth avulsion due to traumatic dental injury is a common problem among pediatric patients during their learning process and exploration in motor function, particularly when there is a delayed treatment. The aim of this case report is to present the prognosis of a delayed treatment of avulsed young permanent tooth after an extended dry extra-alveolar period and inappropriate storage condition. Methods A boy, 8 years old, came to dental clinic with avulsion of the upper right permanent central incisor. His tooth hit the terrace when he was playing ball. The parents found the tooth and threw it away into the dust bin. Three hours later after calling the dental clinic, his parents brought him to the clinic with his dried avulsed tooth. After examining the condition of the supporting tissues, the avulsed tooth was rinsed with saline solution until all contaminants were removed while the socket coagulum was flushed with the same solution. The tooth was replanted by gentle digital pressure, splinted using 0.6 stainless steel wire and fixed with composite. A broad spectrum antibiotic, Cefixime and NSAID Voltadex were administered for 5 days. The patient was vaccinated against tetanus. A week later, the pulp was extirpated before calcium hydroxide application. Finally, the root canal was filled with guttapercha and sealer-paste after 2 years. Evaluations were done using periapical radiographs and clinical controls after 1, 2 weeks; 1, 6 months; 1, 2 and 3 years. Results Even under suboptimal conditions, the treatment showed good progress along 3 years of observation without any poor clinical signs and patient discomfort. The tooth color is similar to the vital tooth. Periapical radiograph showed a shortened root, thickening of periodontal ligament, and formation of calcific bridge. The signs of root resorption and periapical pathosis could not be observed. Conclusion Good retaining tooth supporting tissue conditions, adequate medications, sufficient debridement with saline solution, rigid splinting and calcium hydroxide application are essential to support the treatment and the healing process of an extended dry extra-alveolar period and inappropriate storage condition of the avulsed tooth.