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Management of an Avulsed Central Incisor. Dr. Stephen Abrams Cliffcrest Dental Office 2995 Kingston Road, Scarborough, Ontario 416-265-1400 E Mail; dr.abrams4cell@sympatico.ca. Background History. 48 year old male fell face first on the floor after getting up from the couch.

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management of an avulsed central incisor

Management of an Avulsed Central Incisor

Dr. Stephen Abrams

Cliffcrest Dental Office

2995 Kingston Road, Scarborough, Ontario

416-265-1400

E Mail; dr.abrams4cell@sympatico.ca

background history
Background History
  • 48 year old male fell face first on the floor after getting up from the couch.
  • No history of heart problems, or alcohol consumption.
  • Sustained bruises to the face, mouth and avulsed tooth # 21.
  • Taken to hospital for treatment.
  • Tooth located 3 hours later and then put in a glass of cold milk.
  • Patient was seen in the office 15 hours later
tooth in place incisal edges repaired march 7 2004
Tooth in Place & Incisal Edges Repaired March 7, 2004

Incisal edges repaired with bonded composite (EPIC TMPT Parkell). Tooth 11 – 22 splinted with composite as well. Pin placed into incisal edge of 11 to retain large composite build up.

bony sequestrum march 22 2004
Bony Sequestrum March 22, 2004

Mirror view bony sequestrum approximately 2 mm. tall and 4 mm. long removed

lingual view of 21 april 27 2004
Lingual view of # 21 April 27, 2004

Good tissue apposition on the lingual of # 21 where sequestrum was removed.

Endodontic access initiated and Calcium Hydroxide placed in Tooth # 21

april 27 2004 splint removed
April 27, 2004 Splint Removed

Note good gingival tissue adaptation around the teeth.

endodontic treatment completed june 8 2004
Endodontic Treatment Completed June 8, 2004

Trial File

Obturation with Thermafil

photographs of june 8 2004
Photographs of June 8, 2004

Periodontal tissue is healthy around teeth 11 – 22. There has been some minor recession on the lingual of tooth 21 following the removal of the bony sequestrum. There is no periodontal pocketing and the probing depth is 3 mm. with a firm soft tissue attachment.

issues concerns
Issues & Concerns
  • Need to monitor the vitality of tooth # 11 and # 22. May need endodontic treatment in the future.
  • No symptoms of pain on hot, cold or percussion on teeth 11 or 22.
  • Need to monitor the teeth for any signs of resorption or ankylosis. If this were to occur then consider extraction and implant placement.