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Avulsion injuries are a severe type of dental trauma that can result in sequelae such as root resorption, ankylosis and tooth loss. We report on an unusual case where a previously avulsed, replanted and root-treated UR1 did not erupt for 3 years, and then spontaneously erupted. Findings from a small volume CBCT scan showed significant internal root resorption extending to the root wall, which supports an explanation of the internal root resorption removing an area of ankylosis and allowing the tooth to erupt. The value of using dental CBCT scanning is highlighted in managing complex dental trauma.
CPD/Clinical Relevance: The use of a small volume CBCT scan can give insight into the clinical presentation of post-traumatic tooth movement.
Article
Dental trauma is common and affects approximately one quarter of schoolchildren worldwide.1 Findings from the Children's Dental Health Survey 2013 reported that, on average, one in 10 children had sustained previous dental trauma of their upper incisors.2 Almost twice as many boys (11.2%) presented with any traumatized incisors compared with girls (6.9%).3
An avulsion injury, where the tooth is completely knocked out of the mouth, accounts for 0.5-3% of all dental trauma to permanent teeth.4 A significant risk for an avulsion injury is healing by ankylosis, whereby a union between tooth and bone occurs due to the absence of the periodontal membrane. The risk of ankylosis can be estimated at 90% in cases of avulsion injuries with greater than 30 minutes’ dry time, or greater than 90 minutes’ total extra-alveolar time. Owing to their complexity, a multidisciplinary setting is often best suited for management of such cases.5 Effective management of dental trauma is important for function, aesthetic and social wellbeing. A negative association between untreated dental trauma and quality of life has previously been reported.6
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