30 The fractured permanent incisor root
Andrea is 12 years old. She was trampolining at school when she fell and sustained middle third root fractures of and . How do you manage this type of injury, and what do you advise her about the long-term prognosis for those teeth?
Andrea fell forward while on the trampoline at school and hit her teeth on the edge of the trampoline. Her mother arrives at the surgery soon after Andrea and her teacher. It appears Andrea was not being supervised on the trampoline and the foam protection was not in the correct position on the metal frame of the trampoline. Her mother is not very happy with the explanation by the teacher.
Is there any pain or discomfort while opening and closing the jaw? Absence of symptoms should rule out any condylar injury/fracture. When the force that produces an injury is significant then it should raise suspicion of a deeper underlying bony injury. Bony injury would be more likely in Andrea’s case compared to the scenario of root fractures on teeth that had been produced by less force.
What questions and examination would you complete regarding the swelling and bruising under the right eye?
Is there any double vision? Palpate the infraorbital margin for ‘stepping’ and then check for altered sensation over the distribution of the infraorbital nerve. Check that there is a full range of eye movements – especially upward gaze. Fracture of the infraorbital margin and infraorbital floor could lead to entrapment of the inferior oblique extraocular muscle preventing upward and outward movement of the globe of the eye.
Radiographs. Intraoral periapicals (Fig. 31.1) or an anterior occlusal view are needed to diagnose root fractures compared to luxation injuries. The upper lateral incisors should also be checked for injury. Consideration should also be given to taking radiographs of the lower incisors, which may also have received either direct or indirect trauma. Where there is no significant displacement of the coronal portion of a tooth with a root fracture, then an anterior occlusal radiograph will often detect root fractures that may not be so evident on periapical views. These radiographs will serve as baseline views prior to repositioning.