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Dental Tribune Middle East & Africa Edition | 3/2016 17 PaEDIatrIC Figure15:Palatalviewof21oneyearon.Notice the excellent gingivalhealing. Table1. Exampleof the“dental traumastamp”.Thiswas takenat oneweekpost op. Figure 16: Lip healing one year on showed excellent soft tissue healing and an aesthetically good out- comefollowing thesuturingof thelip. Figure 17 (a, b and c): Post op radiographs taken at 3, 6 and 12 months.They show lack ofPDLsomepulpalobliterationandreplacement resorption. According to British Society of Paediatric Dentistry (BSPD) guide- lines1 , factors to take into account in avulsed teeth are dry time (DT) and total extra alveolar time (EAT). In cases with less than 30 minutes DT and less than 90 minutes EAT, when stored in appropriate storage medium, replantation without dis- turbing the PDL is recommended plus splinting with flexible wire for 7-14 days. This case falls under this condition where the DT was 10 min- utes and EAT was 60 minutes. There is limited evidence regarding the benefit of systemic antibiotics on pulp healing. Prescription should be governed by clinical judgment. Af- ter evaluation of this patient’s type of trauma with the associated soft tissue injury and contamination, an antibiotic was prescribed as per International Association of Dental Trauma (IADT) guidelines3 . The GMP gave a tetanus booster due to the en- vironmental contamination of the tooth. For immature teeth like this case, no endodontic treatment was electively recommended due to an open apex, favorable DT and EAT, as we were hoping for continued tooth growth and 21 with pulpal regen- eration.Howeverwemustnotforget that the tooth was traumatised for a second time with two hours, thus this may have had an impact on the reduction of its prognosis. The tooth was carefully monitored to assess pulpal regeneration or necrosis. The tooth remained vital, however, it underwent ankylosis. Therefore, its prognosis was deemed poor, and its loss was expected. In children and adolescents ankylosis is frequently associated with infraposition5 . Dec- oronation may be necessary later when infraposition (>1mm) com- pared to its counterpart is seen5 . The outlinedoptions,inthelongterm,to replace21arehighlightedbelow. Long term treatment plan andfutureconsiderations Tooth 21 future treatment options availablewill: - Decoronation: Removal of the crownandretentionoftheroot. - Extraction and partial removable denture -Extractionandresinbondedbridge - Auto-transplantation of a premolar (ifcrowdingoccurs) - Osseo-integrated implant (after the ageof18years) Ashewasaveryactiveboyandloves playing football, and due to his den- tal history where he had a repeated history of trauma in the same tooth, in addition to his Class 2 Division 1 malocclusion with an overjet of 10mm, a custom fit mouth guard was fabricated to be worn while en- gaging in any contact sports. Overjet correction will be needed. The pa- tient was referred for an orthodontic and restorative opinion for planning of multidisciplinary treatment op- tions. Summaryandconclusion 21 was avulsed with a lip laceration. The tooth was replanted, splinted and the lip was sutured. The tooth suffered another trauma after two hours. Radiographic findings showedsignsofreplacementresorp- tion from 6 months post trauma. Clinically, 21 responded positively to EPT and EC tests, no other sign of in- flammation. Decoronation (removal ofthecrownandretentioniftheroot withsurgicalcoverage)willbeimple- mented. The lip healed favourably. The patient and his parents were warned about the poor long-term prognosis of 21 and alternative long treatmentoptionswerediscussed. References 1. Day, FP & Gregg TA. UK National Clinical Guidelines in Paediatric Dentistry. Treatment of avulsed per- manent teeth in children, (British Society of Paediatric Dentistry BSPD Avulsion Guidelines). www.bspd.org. uk.2012. 2. Children’s Dental Health Survey 2013. Executive Summary: England, WalesandNorthernIreland. 3. Dental Trauma Guide [Internet]. 2016 [cited 6 April 2016]. Available ToothNo(FDI) Diagnosis Colour Transillumination TTP Sinus Swelling Mobility Percussionsound EthylChloride ElectricPulpTester Radiographs Apicalpath ExternalInflammatory/Root Resorption InternalInflammatory/Root Resorption Replacement.Resorption /ankylosis Arrestedroot development Obliteration 12 11 21 22 concussion concussion avulsed concussion ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ + + ++ + - - - - - - - - n/a n/a slight n/a n/a n/a n/a n/a +ve +ve -ve +ve -ve +ve -ve -ve ✓ ✓ ✓ ✓ - - - - - - - - - - - - - - - - - - - - - - - - ◊Page16 from:www.dentaltraumaguide.com 4. Andreasen, JO, Andreasen, F & An- dersson, L. Textbook and Colour At- lasofTraumaticInjuriesoftheTeeth, 4th edition, Blackwell Munksgaard. 2007. 5. International Association of Den- tal Traumatology. Dental Trauma Guidelines,2012 DrGhadaHussain BDS(Dublin),BA (Dublin) Postgraduate Resident inPae- diatricDentistry, HamdanBin Mohammed CollegeofDental Medicine DrIyadHussein DDS(Damas), MDentSci (Leeds),GDCStat. Exam(London), MFDSRCPS(Glasg) ClinicalAssistant. ProfessorinPaedi- atricDentistry MohamedBinRashidUniversityof MedicalandHealthcareSciences Email:ghada.hussain@mbruac.ae UKSpecialist inPaediatricDentistry HamdanBinMohammedCollegeof DentalMedicine MohamedBinRashidUniversityofMedi- calandHealthcareSciences Email:iyad.hussein@mbru.ac.ae EFP societies celebrate biggest-ever European Day of Periodontology ByDTI MADRID, Spain: For the third time, the European Federation of Peri- odontology (EFP) celebrated the Eu- ropean Day of Periodontology on 12 May.Theeventhasgrownimmense- ly since its launch in 2014, with 20 national societies of periodontology across Europe taking part this year. The EFP-affiliated bodies organised a wide range of activities, includ- ing television and radio interviews, awareness actions in public spaces, and free periodontal screenings at universitiesanddentalsurgeries. With this year’s slogan, “Healthy gums for a better life”, the EFP and its affiliated societies aimed to raise awareness of gingival disease and its links to other diseases, such as diabetes and cardiovascular disease. In order to support this goal, the EFP launched a media campaign, includ- ing posters, press releases, images and a new visual identity, also pro- viding its members with informa- tionmaterialfortheevent. According to the EFP, at least 20 na- tional societies joined yesterday’s celebration by organising numerous events across Europe. The countries that took part were Austria, Azerbai- jan,Belgium,Croatia,Finland,France, Germany, Greece, Ireland, Israel, It- aly, Lithuania, the Netherlands, Por- tugal, Romania, Spain, Switzerland, Turkey,UkraineandtheUK. The Belgian Society of Periodontol- ogy invited all dentists in the coun- try to dedicate 12 May to periodontal screening. Moreover, it created a mi- ni-siteinFrenchandDutchwithuse- ful information on gingival health for dentists and patients, and a list of all 200 dental practitioners taking part in the massive free screening acrossthecountry. The Société Française de Parodon- tologie et d’Implantologie Orale, the French society of periodontology and oral implantology, organised a multidisciplinary event together with endocrinologists, cardiologists and gynaecologists with the aim of educating and raising awareness about the link between periodontal andsystemichealth. The Ukrainian Society of Periodon- tists organised a day of periodontal check-ups at the Shupyk National Medical Academy of Postgraduate Education in Kiev. Patients had the opportunity to learn about differ- ent periodontal treatment options, as well as strategies to improve their gingival health, including dental hygiene and lifestyle recommenda- tions,particularlyforyoungpatients. “Our association has been encour- aging dentists and medical doctors to play their part in the treatment and diagnosis of periodontitis and to raise public awareness of peri- odontitis and its link to systemic health and general wellbeing,” said Daiva Gelažienė, EFP delegate of the Draugija Periodontologų Lietuvos, the Lithuanian periodontal asso- ciation. Among other activities, the society conducted events related to gingival health at schools in Vil- nius, with about 200 children par- ticipating in a game of comparing their knowledge about and skills in keeping their mouths and bodies healthy. “The EFP’s communication tools have been very helpful,” noted Gelažienė.“Weareveryhappytobea partofthisexcellentinitiative.” Dental Tribune Middle East & Africa Edition | 3/201617 12112122