PMC5442333_01
(a) Intraoral photograph of the patient at the clinic following trauma to the 4 incisors, with intrusion of the upper left lateral incisor. (b) Intraoral photograph of the patient following two weeks awaiting spontaneous reeruption of 22, showing insufficient reeruption. (c) Periapical radiographic projection of the orthodontic extrusion carried out after the failure of spontaneous reeruption, with complete extrusion of 22 and root development visibly indicated. (d) Radiographic projection 6 years after the trauma, in which arrested root growth and bone tissue growing inside the root canal can be observed on one of the control periapical radiographs taken after orthodontic treatment.
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fig1
The first case involved a 15-year-old female patient with replacement root resorption secondary to an intrusion of the maxillary left lateral incisor (2.2) (Figure 1(a)) after a traumatic injury to the 4 upper incisors when she was eight years old, which included soft-tissue laceration. In accordance with the IADT protocol informed consent was obtained and we waited for two weeks, in order to assess whether there had been any tooth movement, indicating the onset of spontaneous reeruption of 2.2 (Figure 1(b)). This did not happen and orthodontic extrusion of the affected tooth was carried out. (Figure 1(c)). After 6 years, it was observed that the root had stopped growing and that there was bone-like tissue growth in the root canal (Figure 1(d)).
(a) Routine radiographic projection 7 years after the trauma, in which arrested root development can be observed and replacement root resorption in 22 extends from the cervical area down practically the whole of the root. (b) Photograph of the anterior area. Note the clinical aspect of the tooth with suitable aesthetic appearance in harmony with the adjacent teeth. (c) Photograph of 22 during decoronation, after cutting off the crown at the bone margin. (d) Photograph of 22 at the completion of the decoronation procedure, when the full-thickness flap was placed over the alveolus and sutured with interrupted stitches. (e) Radiographic projection of 22 after decoronation, showing the root remaining at the level of the bone crest and the wire for prosthetic rehabilitation. (f) Intraoral photograph of aesthetic rehabilitation achieved via a bridge attached with 0.9 mm wire and a composite pontic, achieving a satisfactory esthetic result.
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After 7 years of clinical and radiological monitoring, it was confirmed that root development had stopped and that resorption had spread from the cervical area to practically the entire root (Figure 2(a)). The clinical appearance of the tooth was completely normal (Figure 2(b)). Then, using a diamond bur, odontosection of the crown was performed above the cementoenamel junction, taking particular care not to leave any enamel residue in the root of the decoronated tooth (Figure 2(c)). Finally primary closure was obtained by coronal repositioning of the flap (Figure 2(d)). We subsequently carried out esthetic rehabilitation using an adhesive bridge with 0.9 mm wire and a composite pontic, taking special care to leave a space of at least 1 mm between the mucous membrane and the pontic to avoid interfering with later alveolar bone remodeling (Figure 2(e)). This gave the patient satisfactory functional and esthetic integrity (Figure 2(f)).
PMC5442333_02
(a) Frontal intraoral photograph of the patient after a trauma to the upper left central incisor, which occurred 2 weeks earlier and caused an avulsion that was immediately reimplanted. Observe infraocclusion with respect to 2.1 and 1.2. (b) Periapical control radiograph performed 2 weeks after reinsertion of 11, in which intrusion and ankylosis are apparent. (c) Intraoral photograph during decoronation as the full-thickness flap is raised around the ankylosed tooth. (d) Intraoral photograph during decoronation, as the pulp tissue is removed from the root canal using an endodontic K-file.
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After the clinical examination, moderate infraocclusion was diagnosed with no discoloration (Figure 3(a)). Radiographs showed arrested root growth and replacement root resorption (Figure 3(b)). The decoronation procedure followed the methodology described for case 1 (Figures 3(c) and 3(d)).
(a) Radiographic projection of 11 showing the root remaining after decoronation and the wire for prosthetic rehabilitation. Note the absence of the periodontal ligament space. (b) Intraoral photograph showing aesthetic rehabilitation using a bridge attached with a 0.9 mm wire and a composite pontic, giving an acceptable aesthetic appearance and leaving a 2 mm space between the mucous membrane and the pontic so as not to interfere with bone remodeling.
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Afterwards, provisional aesthetic rehabilitation was carried out, using an adhesive bridge, which will remain until an implant can be inserted (Figures 4(a) and 4(b)).