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Dental Tribune Middle East & Africa Edition | 3/2016 16 PaEDIatrIC Figure 11: A peripical radiograph taken one week post-op showed the correct positioning of the replanted tooth.Note theopenapex. Figure 12: Healing of the lip one month post-op. Someoedemaandscarringwerenoted Figure13:One-monthpostopafterremovalofthe splint.The toothwasresponsive toEC&EPT. Figure 14: One year follow up.The patient and parent were pleasedwiththeaestheticresult.21wasvitalandpositively responsive to EC & EPT.The tooth was non mobile and pro- ducedametallicsoundindicativeofankylosis. plannedTetanusbooster. Trauma follow-up appoint- ment (one-weekpost op) The aim of the visit was to review 12, 11,21,22andtoassesssofttissueheal- ing. The patient had no complaint whatsoever. Observations revealed a slight mobility of 21 and good heal- ing lower lip and buccal gingiva of 21 with good oral hygiene but some visible plaque on 22. The splint was intact. We obtained a periapical ra- diographof21, whichshowed it tobe in a favourable position (see Figure 11)withalargewide-openapex. At this appointment, and in the sub- sequent appointments (1, 3, 6, 9 and 12 months post-op) we completed a “Dental Trauma Stamp” (see Table 1 for an example) which included as- sessment for mobility, tooth colour (direct and transillumination), ten- derness to percussion (TTP), sinus presence, swelling presence, percus- sion sound, electric pulp tester (EPT), ethyl chloride (EC) and radiographic assessment. The latter was essential to assess for apical pathology, root resorption(internalandexternal),ar- rested/continued root development, pulp obliteration and replacement resorption/ankylosis. The dental trauma stamp was repeated at every visit.Ithelpsinassessingperiodontal ligament(PDL)andpulpalhealing. Trauma follow-up appoint- ment (one-monthpost op) The healing of the lip appeared satisfactory (Figure 12). We gently removed the dental splint (Figure 13) and a new dental trauma stamp was completed. Tooth 21 was +ve to EC & EPT suggesting possible revas- cularization, although this was not absolute. Subsequent appointments (at3,6,9and12monthspost op) Healing of the lip and periodontal soft tissues continued satisfactorily and the patient and mother were happy with the aesthetically pleas- ing result (one year follow up- see Figures 14, 15 & 16). A mouth guard was made to prevent further dental injuries to the same area. Dental car- ieswastreatedappropriately. However the dental trauma stamp revealed that tooth 21, despite re- maining vital (+ve to EC and EPT), non-discloured and asymptomatic, becameankylosed.At3months,ade- cision whether to initiate root canal treatment or not was debated, but no intervention was decided upon, as the tests suggested its vitality. The tooth was non -mobile and was producing a “crack plate metallic” sound on percussion. At 6 months, radiographically, there was evidence of replacement resorption (Figure 17 a,b&c).This worsenedat12months. Thistoothwillinevitablybelost. Discussion Traumatic dental injuries are com- mon, with between 6-34% of chil- dren aged 8-15 experiencing damage to their permanent teeth1 . Over ¾ of all traumatic oral injuries occur in childhood, and in the United King- dom,theproportionof12and15year oldswithanytraumaticdamagewas recently found to be 12% and 10% respectively2 . Traumatised teeth can have a significant clinical, aesthetic and social impact on a child as an in- dividual. Treatment of traumatised teeth usually requires extensive management, carrying a burden for the patient as well carers and health authorities in the long term. Avul- sionis the complete displacementof tooth out of its socket and the socket is found empty or filled with a blood coagulum3 . Avulsion accounts for between 0.5 to 3% of dento-alveolar trauma to permanent teeth4 . About 90% of replanted avulsed teeth will undergoankylosis1 . ◊Page15 ÿPage17