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Ortho Tribune Middle East & Africa No.3, 2017

PUBLISHED IN DUBAI www.dental-tribune.me May-June 2017 | No. 3, Vol. 7 Orthodontic Extrusion of Traumatically Intruded Upper Central Incisor Treatment Plan The treatment plan should aim to extrude the intruded tooth back into its original physiologic position within the upper arch. Three treat- ment alternatives were available: 1. Giving the tooth its own chance to re-erupt spontaneously. 2. Surgical repositioning for the in- truded tooth 3. Orthodontic extrusion. The authors preferred the third treatment option, so the treatment plan was to orthodontically extrude the traumatically intruded upper left central incisor as soon as possi- ble following the traumatic injury. Additionally, endodontic treatment was also planned in order to extir- pate the necrotic pulp (the tooth had complete root development), thus minimising the chances of external root resorption and tooth loss. Treatment Progress Two days after the traumatic injury, the authors were able to bond the upper teeth with a fixed orthodontic appliance extending from the up- per right 1st permanent molar to the upper left 1st permanent molar. A 0.022-in slot / Roth prescription pre- adjusted brackets (Pinnacle-Ortho Technology) were used with a 0.012 inch NiTi orthodontic wire (Ortho Technology company) as an initial aligning arch wire. (Figure 3) During the first week of treatment, the patient was instructed to follow a soft diet, with the aim of avoiding any traumatic contact with the trau- matised tooth. Three weeks following the start of the alignment phase, the tooth was extruded enough (close to the level of the other central incisor) to allow easy access for necrotic pulp extir- pation (ethyl chloride examination confirmed the necrotic pulp status). ÿPage E2 By Prof. Emad Hussein, Jordan, As- sist. Prof. Mohammed Jaradat, Jor- dan, Assoc. Prof. Alev Aksoy, Jordan, Dr. Fadi Khuffash, Palestine, Prof. Ahmad Hamdan, Jordan Introduction The incidence of traumatic dental in- juries varies with age and has a high prevalence worldwide. [1] In most cases, the front teeth are the most af- fected, with the central incisors being at the highest risk of dental trauma. [2] [3] The maxillary arch is involved in a higher percentage (95.72%) of in- cidents when compared to the man- dibular arch. [4] Intrusion luxation can be defined as the form of traumatic dental in- jury that leads to tooth displacement deep into the alveolar bone. This usually results in severe complica- tions (pulp necrosis, inflammatory root resorption, ankylosis); for this reason it is classified as a severe form of traumatic dental injury. [5] [6] Management of traumatically in- truded anterior teeth is of prime importance, since these teeth are so important both aesthetically and functionally. Management of these traumatised teeth differs according to the root apex maturity and the se- verity of the intrusion luxation itself. Pulp necrosis occurs in one hundred percent of cases involving intrusion luxation of mature permanent teeth with fully-formed apex and in 62.5 % of those involving intruded teeth with open apex. [7] [8] This case re- port aims to emphasise the impor- tance of immediate orthodontic loading of traumatically intruded mature permanent teeth with closed root apex. Diagnosis and Etiology A 15-year-old female was referred to the orthodontic clinic for dental evaluation. Her chief complaint was, ‘’I have a displaced upper front tooth following a sport accident.’’ (Figure 1) During orthodontic evaluation, the patient reported that she had re- ceived a sport injury one day ago. As an emergency treatment, she re- ceived immediate therapy by a gen- eral dentist, consisting of bleeding control, prescription of an antibiotic and an anti-inflammatory analgesic. Clinically, “The patient presented a dolichofacial pattern and normal occlusion, with well-aligned teeth, except for the traumatised upper left central incisor (4 mm intrusion depth) (Figures 1 and 2). Symptoms of temporomandibular disorders were not found. Pulp vitality of the traumatised tooth was tested with ethyl chloride, and a negative result indicated the presence of necrotic pulp tissue.” Treatment Objectives The patient had an intruded upper left central incisor tooth as a result of a traumatic accident, so the fol- lowing treatment objectives were established: 1. Extrude the intruded upper left central incisor into its original physi- ologic position 2. Allow easy access for necrotic pulp extirpation from the intruded inci- sor. Figure 1 Figure 2

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