A new approach of permanent tooth avulsion in a growing patient

OBJECTIVES Dental traumas frequently occur in young children and young adults. The maxillary incisors are the most commonly damaged teeth with a greater risk for central maxillary incisors, especially in children with increased overbite and overjet. In avulsions’ treatment of permanent teeth, the reimplantation of the same element is the first choice of treatment in most cases. However, there are contraindications to this therapeutic option, such as: delay of the operation, age, compliance, the patient’s oral health and the condition of the dental element. A recent therapeutic alternative described by Göllner et al. is a temporary rehabilitation using TADS pending a future implant insertion at the end of growth. In the following study the authors report a case of traumatic avulsion of a maxillary central incisor rehabilitated using two orthodon tic mini-screws inserted with a computer-guide technique. MATERIALS AND METHODS A 13-year-old male patient arrives at the dental clinic a week after the traumatic avulsion of the upper right central incisor due to a fall off the bicycle. A clinical and radiographic examination shows a complete avulsion of the upper left central incisor and an uncomplicated fracture of the incisal margin of the upper right central incisor, without soft tissues lesions. The cephalometric examination highlights a normodivergent skeletal Class III (ANB:-2.1°; Wits Appraisal:-3.5 mm) with a reduction of overjet and overbite (OB: 1.2 mm; OV: 1.4 mm). Two mini-screws have been using the Easy Driver technique (Uniontech, Parma, Italy). RESULTS In this study the authors use two orthodontic mini-screws and a temporary resin prosthetic element of the frontal incisor. A CBCT has been prescribed to analyze possible fractures of the alveolar bone and to plan the computer guided insertion. In this way facilitates the precise and safe insertion of the mini-screws in the anterior hard palate area. The two orthodontic mini-screws are placed in a parallel position affecting the two cortical bones to have greater stability. The manufacturing of a temporary resin prosthetic element of the frontal incisor fastened to the two mini-screws awaiting an implant-prosthetic revaluation at the end of growth. The prosthetic rehabilitation of the upper right central incisor is supported by the composite restoration of the incisal edge of the upper left central incisor. CONCLUSIONS Using this technique, even less experienced operators have the opportunity to easily insert the miniscrews and to fasten the device during the same appointment avoiding the riskier manual insertion. The benefits of this temporary treatment in growing young patients are: simplicity and safety of insertion of mini-screws; aesthetic result of the prosthesis; easy maintenance of proper hygiene; stability (absence of risk of decementation or loss of retention in mixed dentition). CLINICAL SIGNIFICANCE This clinical case shows an easy and fast method to manage a dental trauma. This method can be a choice for those patients having low disposable income. Moreover, it is useful in growing patients because it can be adapted to the vertical growth of the jawbone.