Dental fragment embedded in the lower lip after facial trauma: Brief review literature and report of a case
A white Caucasian 10-year-old boy was admitted to the Dental Clinic at the University of Bari (Policlinico), Italy, complaining of a firm mass in the lower lip, painless and recovered by a squamous-crusty lesion. Both the central incisors appeared fractured. His mother reported that the boy had fallen while playing football the day before the visit and she collected a single tooth fragment stored in a paper tissue. There was no history of other previous injuries and no symptoms of concussion. Lip examination revealed a laceration on the left side of the lower lip. A firm nodule, measuring approximately 1 cm in diameter in the same region was noted. Intra-oral examination revealed an Ellis class II fracture of the permanent right and left maxillary central incisors []. All maxillary incisors teeth responded promptly to the pulp tests. A lateral soft tissue radiograph and a periapical radiograph of the maxillary central incisors were performed. There were no signs of root fractures or other periapical diseases but the presence of a tooth fragment in the lower lip was confirmed []. An antibiotic (clavulanic acid plus amoxicillin 500 mg t.i.d.) and anti-inflammatory therapy (ketoprofen 40 mg) was prescribed and the patient was discharged and readmitted the next day.\nUnder regional block anesthesia, the wound site was cleansed with a chlorhexidine solution 0.2%, and a small horizontal incision was made. The tooth fragment was retrieved and gently removed. The wound was irrigated with saline and a 4-0 black silk suture was placed.\nThe tooth fragment embedded in the lip corresponded to the upper central left incisor [], while the fragment recovered by the patient's mother belonged to the upper central right incisor. Both teeth fragments were stored in saline solution and re-attached in the same session, separately, using for each one, the procedure described by Rappelli et al.[] According to these authors, the operating field was isolated with a rubber dam and the fractured portion of the teeth fragments was etched with a 37% orthophosphoric acid gel for 30 s followed by gentle rinsing. A bonding system was then applied to the etched surfaces without polymerization. The fractured margins of the two central incisors were treated with a ‘total etch technique’: 30 s of etching for enamel and 15 s for dentine. An adhesive system was applied to the etched surfaces. Each fragment was then accurately placed on the original position and a single photo-polymerization was completed in 40 s. A bevel was performed along the fracture line to improve aesthetics according to Andreasen et al.[]\nAfter the adhesive resin was placed, a compound resin of transparent dye was applied to cover the demarcation line between the glued surfaces. Polishing and finishing were performed by using fine grain disks and decreasing grain adamantine pastes applied with dedicated rotating felts. The final result was satisfying on esthetic and functional profile [].\nThe patient was reviewed on a regular basis for over a year: No symptoms, no tenderness to percussion, absence of mobility and a positive reaction to pulp testing were found.