PMC10175012_01
Case I: preoperative photographs of 9-year-old female presenting with avulsed tooth #32 attached to gingiva in the oral cavity. (a) Intraoral. (b) IOPA.
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An avulsed tooth was attached to the gingival tissue in the oral cavity (Figure 1(a)). An intraoral radiographic examination ruled out presence of an associated alveolar fracture (Figure 1(b)).
Case I: immediate post-operative photographs of reimplanted and stabilized tooth #32. (a) Intraoral. (b) IOPA.
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The lacerations (Figures 2(a) and 2(b)) were also sutured using non-absorbable sutures.
Case I: follow-up. (a) Frontal view after removal of splint at 2 weeks with adequate healing. (b) Frontal view showing slight inflammatory redness around tooth #32 after 3.5 years. (c) Radiograph showing root resorption till middle one-third of root at 3.5 years. (d) No. 80 Gutta Percha adjusted to 13 mm according to the suspected length of periodontal communication. (e) 20  angulated radiograph showing severe communicating internal and external root-resorption at 3.5 years.
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An intraoral splint was removed after 2 weeks (Figure 3(a)). Clinical examination recorded a tender, grade I mobile tooth with visible gingival inflammation, and deep periodontal pockets (Figure 3(b)). The Intra oral periapical radiograph (IOPA) of the tooth recorded severe inflammatory root resorption until the middle one-third of the root (Figure 3(c)). A 20  horizontally angulated IOPA with a 13 mm gutta-percha point confirmed the presence of severe inflammatory external and internal resorption in the reimplanted tooth (Figures 3(d) and 3(e)).
Procedure checklist and their chronological order of treatment and follow-up of Case I.
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The timeline, chronological order of treatment, and follow-ups are described in Table 2 and Figure 4.
PMC10175012_02
Case II: pre-operative photographs of an 18-year-old woman with avulsion of teeth #31, #32, #41, and #42. (a) Intraoral. (b) Avulsed teeth. (c) IOPA of the teeth #31 and #32. (d) IOPA of the teeth #41 and #42.
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Clinical evaluation has revealed that the teeth were completely dry, sockets were filled with coagulum (Figures 5(a) and 5(b)), and absence of any associated alveolar bone fracture (Figures 5(c) and 5(d)).
Case II: immediate post-operative photographs of reimplanted and stabilized teeth #31, #32, #41, and #42. (a) Frontal view of mandibular anterior teeth. (b) Frontal view with maximum intercuspation. (c) Lingual view of mandibular anterior teeth.
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They were also reinforced with an additional lingual splint from teeth #33 to #43 using 30-G SS wire (Figures 6(a), 6(b), and 6(c)).
Case II: follow-up at 7 months. (a) Frontal view of mandibular anterior teeth showing fractured splint and periodontally compromised teeth #32, #41, and #42. (b) Re-avulsed tooth #31 with root resorption till the middle third of root and calculus deposits below cemeto-enamel junction. (c) IOPA showing inflammatory root and bone resorption of teeth #41 and #42. (d) IOPA showing inflammatory root and bone resorption with reference to tooth #32.
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However, she missed her regular follow-up visits and reported after 7 months with a fractured splint (Figure 7(a)). Clinically, tooth #31 was re-avulsed with severe root resorption (Figure 7(b)). The inflammatory root-resorption with severe alveolar bone loss was also evident on the IOPA's of remaining teeth, suggesting the procedure's failure (Figure 7(c)).
Procedure checklist and their chronological order of treatment and follow-up of Case II.
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The timeline, chronological order of treatment, and follow-up are described in Table 3 and Figure 8.