25 October 2021

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An alternative treatment option in case of permanent tooth avulsion in a growing patient: a case report

Authors: Antonio Gracco, Edoardo Conte, Alessandro Frezza, Sabina Saccomanno, Alberto De Stefani, Giovanni Bruno

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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 we report a case of traumatic avulsion of a maxillary central incisor rehabilitated using two orthodontic mini-screws inserted with a computer-guide technique.

MATERIAL 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: -3.5mm) with a reduction of overjet and overbite (OB: 1.2mm; OV: 1.4mm). We insert two mini-screws using the Easy Driver technique (Uniontech, Parma, Italy). 

RESULTS
In the following study we 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 miniscrews 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 miniscrews 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 miniscrews; 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.