Management of multiple intrusive luxative injuries: A case report with 7-year follow-up
An 11-year-old girl was referred to the Emergency Ward of Indira Gandhi Medical College, Shimla in the evening, following traumatic injuries to her teeth caused by a fall from the first floor of her house. Her medical history was unremarkable and all her vaccinations were up to date. On examination, there were no signs of neurological or extra oral injuries. Intra-orally, she presented severe intrusive luxation of 11, 21 and 22 (more than 6 mm) and laceration on the lower lip.\nAt the initial appointment, the intra-oral soft-tissues were cleaned with saline and hydrogen peroxide. Patient was prescribed antibiotics and analgesics, chlorhexidine mouthwash, oral hygiene instructions were given and soft diet was advised. Sutures were placed on the lower lip laceration and patient was referred to the Department of Pediatric Dentistry.\nThe intruded teeth showed no mobility. There was no evidence of traumatic injury to any other teeth. The radiographic examination consisted of one panoramic view and two periapical views. Periapical view revealed closed apices of intruded incisors []. The periodontal space surrounding intruded incisors was diminished and no root or bone fracture was detected.\nSince the teeth presented with mature apices, prophylactic endodontic treatment was planned. Hence, gingivectomy was performed to gain access to the root canal. The access opening was carried out neither bleeding nor consistent pulp was found during the root canal preparation; thus, the diagnosis of necrotic pulp of teeth was confirmed. Then, the root canals were filled with calcium hydroxide (Ca(OH)2) mixed with normal saline and it was decided to allow teeth for spontaneous eruption. At 1 week follow-up, there was no evidence of re-eruption. Subsequent weekly examinations revealed no eruption of the intruded teeth.\nTen weeks following dental injury, a decision was made to reposition the intruded teeth orthodontically. A fixed multi-bracketed appliance was bonded to the intruded teeth and adjacent teeth. The extrusion was carried out with elastic traction. Twenty six weeks after the start of treatment by orthodontic extrusion, the location of the intruded 11, 21 and 22 were restored to their original position. Ca(OH)2 dressing was changed initially after 4 weeks and subsequently after 12 weeks. The teeth were obturated with Gutta-percha after 1 year []. The case was monitored for 7 years and no clinical and radiographic pathology was detected [Figures –].