Autogenous bonding of tooth fragment retained in lower lip after trauma
A 10-year-old male patient came to the Trauma Project clinic at the Federal University of Rio of Janeiro with the complaint of a fractured tooth. The patient had been seen initially at the emergency department of a nearby general hospital where anti-inflammatory medication was prescribed. No treatment was given for the fractured tooth or for the laceration of the lower lip. Also, the dental fragment embedded in the lower lip went unnoticed. The mother reported that the child had sustained an orofacial trauma 2 days ago due to a fall during a soccer game on asphalt. The medical history was non-contributory and all the recommended vaccines had been taken.\nDuring the extraoral and intraoral examination, soft-tissue edema and laceration involving the lower lip alerted the possibility of the presence of a tooth fragment in the soft tissue. Palpation of the lower lip revealed a hard mass and the patient complained of pain in the region. Intraoral examination showed an enamel and dentin crown fracture without pulp exposure of the upper left permanent central incisor [] that was sensitive to thermal stimulation.\nA radiographic film was placed between the lower lip and mandibular incisor to verify the presence of an object. The radiographic exposure dose was 25% of that used for standard periapical radiographs. This radiographic exam revealed a large radiopaque foreign body suggestive of the coronal fragment of the fractured incisor []. There was no evidence of root fracture, pathological periapical lesion or periodontal ligament tissue injures of the upper anterior teeth [].\nThe patient remained 1 week under anti-inflammatory and antibiotic medicines to reduce the swelling and risk of infection. After this, he was submitted to a surgical excision of the fragment under local anesthesia []. The fragment was stored in a saline solution.\nAfter 8 days, the lower lip was healed. The fragment and the fractured tooth were etching with phosphoric acid 37% for 20 s, washed with water, and curing adhesive under rubber dam. The fragment was positioned on the tooth with a nano-hybrid resin layer and the excess was removed before photopolymerization []. After, a mouth-guard was made, which was recommended to use during sports practice to protect against any new traumas []. The patient is attending follow-up visits to accompany the tooth both clinically and radiographically.