29: The fractured immature permanent incisor crown

29 The fractured immature permanent incisor crown

Summary

Shay is 8 years old. While saving a penalty for his school team he collided with the goalpost and sustained enamel-dentine-pulp and enamel-dentine fractures to his upper central incisors. How would you manage the injuries? Outline a follow-up treatment plan.

History

Complaint

The upper right and left permanent central incisors are fractured (Fig. 29.1).

image

Fig. 29.1 Trauma to the central incisors.

History of complaint

The injury was sustained during a game of soccer. There were no other injuries.

Medical history

Shay is a healthy boy with no history of illness. He has had all his vaccinations including a pre-school booster for tetanus.

Dental history

Shay is a regular attender at his dentist and has had local anaesthetic for a restoration.

image What specific questions would you ask and why?

Was there any loss of consciousness?
Was the fractured piece of tooth located?
A history of loss of consciousness together with a missing tooth fragment is an indication for a chest radiograph to check that there has not been inhalation of the tooth fragment.
When did the injury occur?
The time from the injury to presentation may affect the treatment options.
Did Shay cope well with his previous experience of local anaesthetic? The answer to this will dictate what treatment strategies will be possible.

Examination

Extraoral

image Why is the presence of lip swelling together with a mucosal laceration important?

This could indicate that the missing tooth fragment is retained in the lip.

image How would you demonstrate there was a fragment of tooth in the lip?

By soft tissue radiography using two views at right angles to each other. A simple anteroposterior view using a periapical film placed behind the lip and in front of the teeth, followed by a lateral soft tissue view using a lateral occlusal film (Fig. 29.2). Clinically, a fragment of tooth is often best located by ‘feel’ with a probe.

image

Fig. 29.2 Fragments of tooth in lower lip (different case).

Key point

Missing tooth fragments could:

• Be within the soft tissues if there is a laceration.
• Have been inhaled if there was loss of consciousness.

Intraoral

image What injuries are visible in Figure 29.1?

There is an enamel-dentine fracture of image and an enamel-dentine-pulp fracture of image of greater than 1 mm in diameter.

image Are the roots of image and image likely to have open or closed apices?

Open. Apices are not usually closed on upper permanent central incisors before the age of 11 years.

image How would you confirm apical status?

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 29: The fractured immature permanent incisor crown

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