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VOLUME 21 , ISSUE 7 ( July, 2020 ) > List of Articles

CASE REPORT

Combination of Revascularization and Apexification in the Treatment of an Avulsed Tooth: A Case Report

Ayman M Abulhamael, Stefan Zweig, Abrar S Kutbi, Rayan S Alrehili, Ziyad T Alzamzami, Yousef M Alharbi

Citation Information : Abulhamael AM, Zweig S, Kutbi AS, Alrehili RS, Alzamzami ZT, Alharbi YM. Combination of Revascularization and Apexification in the Treatment of an Avulsed Tooth: A Case Report. J Contemp Dent Pract 2020; 21 (7):803-807.

DOI: 10.5005/jp-journals-10024-2830

License: CC BY-NC 4.0

Published Online: 30-10-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Aim: To demonstrate an exceptional result in the treatment of an avulsed tooth that had been stored in a dry environment for over 2 hours before being replanted. Background: Sixteen percent of all traumatic injuries to the permanent dentition are avulsions. Maxillary central and lateral incisors are most commonly affected. Case description: In this report, a 7-year-old girl sustained trauma to the upper right maxillary incisor during a bicycle accident. The tooth was avulsed and remained outside the oral cavity for more than 2 hours in a dry napkin before eventual reimplantation in the emergency room. Upon presentation to the endodontic clinic at the University of Southern California, the case was assessed, and the available treatment options discussed with the patient's parents. Revascularization using BC putty was the chosen mode of treatment. At a 6-month recall appointment, the patient presented with a sinus tract. A decision was then made to perform apexification using the mineral trioxide aggregate (MTA) as an apical filling material. To date, the tooth remains intact and functional. Conclusion: Although both of the described treatment modalities are acceptable and commonly used in modern endodontics, apexification of a tooth following a failed attempt of a regenerative procedure has not been described. In this case, a chronic abscess formed and the ultimate goal of revascularization was not achieved. However, the performance of the revascularization procedure was not without benefit since it allowed the tooth to develop in both length, dentinal volume, and aided in the partial closure of the apical foramen. Additional studies are needed regarding the treatment of avulsed teeth. This case study may provide a viable treatment alternative in a number of clinical situations. Clinical significance: The procedures described in this case report may be of clinical significance in the treatment and retention of teeth, which may otherwise be considered to have a poor prognosis and extracted.


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  1. Moore A, Howley M, O'Connell A. Treatment of open apex teeth using two types of white mineral trioxide aggregate after initial dressing with calcium hydroxide in children. Dental Traumatol 2011;27(3):166–173. DOI: 10.1111/j.1600-9657.2011.00984.x.
  2. Silveira C, Sebrão C, Vilanova L, et al. Apexification of an immature permanent incisor with the use of calcium hydroxide: 16-year follow-up of a case. Case Rep Dent 2015;2015:984590.
  3. Andreasen J, Ravn J. Epidemiology of traumatic dental injuries to primary and permanent teeth in a danish population sample. Int J Oral Surg 1972;1(5):235–239. DOI: 10.1016/S0300-9785(72) 80042-5.
  4. Feiglin B. Textbook and colour atlas of traumatic injuries to the teeth: Jens O. and Frances M. Andreasen. Aust Endod J 2010;20(2):20–20.
  5. Aldrigui J, Abanto J, Carvalho T, et al. Impact of traumatic dental injuries and malocclusions on quality of life of young children. Health Qual Life Outcomes 2011;9(1):78. DOI: 10.1186/1477-7525-9-78.
  6. Janakievski J. Avulsed maxillary central incisors: the case for autotransplantation. Am J Orthod Dentofacial Orthop 2012;142(1):9–17. DOI: 10.1016/j.ajodo.2012.04.010.
  7. Anil Kumar G, Anusha T. Single visit apexification with mineral trioxide aggregate. Annals and Essences OF Dentistry 2010;2(3):106–109. DOI: 10.5368/aedj.2010.2.3.106-109.pdf.
  8. Vijayran M, Chaudhary S, Manuja N, et al. Mineral trioxide aggregate (MTA) apexification: a novel approach for traumatised young immature permanent teeth. BMJ Case Rep 2013;2013:bcr2012008094. DOI: 10.1136/bcr-2012-008094.
  9. Bakland L, Andreasen J. Will mineral trioxide aggregate replace calcium hydroxide in treating pulpal and periodontal healing complications subsequent to dental trauma? A review. Dent Traumatol 2011;28(1):25–32. DOI: 10.1111/j.1600-9657.2011.01049.x.
  10. Prabhakar A, Gulati A, Lnu S, et al. Esthetic management of an anterior avulsed tooth: A case report. Int J Clin Pediatr Dent 2009;2(3):35–38. DOI: 10.5005/jp-journals-10005-1016.
  11. Law A. Considerations for regeneration procedures. J Endod 2013;39(3):S44–S56. DOI: 10.1016/j.joen.2012.11.019.
  12. Hargreaves KM, Law AS. Regenerative endodontics. In: Hargreaves KM, Cohen S. Pathways of the Pulp. 10th edn, ch. 16, St Louis, MO: Mosby Elsevier; 2011. pp. 602–619.
  13. Andreasen J, Borum M, Jacobsen H, et al. Replantation of 400 avulsed permanent incisors. 4. factors related to periodontal ligament healing. Dent Traumatol 1995;11(2):76–89. DOI: 10.1111/j.1600-9657.1995.tb00464.x.
  14. Andreasen J. Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors in monkeys. Int J Oral Surg 1981;10(1):43–53. DOI: 10.1016/S0300-9785(81)80007-5.
  15. Goldstein S, Sedaghat-Zandi A, Greenberg M, et al. Apexification and apexogenesis. N Y State Dent J 1999;65(5):23–25.
  16. American Association of Endodontists. Regenerative Endodontics American Association of Endodontists.
  17. Malmgren B, Cvek M, Lundberg M, et al. Surgical treatment of ankylosed and infrapositioned reimplanted incisors in adolescents. Eur J Oral Sci 1984;92(5):391–399. DOI: 10.1111/j.1600-0722.1984.tb00907.x.
  18. Ham K, Witherspoon D, Gutmann J, et al. Preliminary evaluation of BMP-2 expression and histological characteristics during apexification with calcium hydroxide and mineral trioxide aggregate. J Endod 2005;31(4):275–279. DOI: 10.1097/01.don.0000140584.65320.cc.
  19. El Meligy OA, Avery DR. Comparison of apexification with mineral trioxide aggregate and calcium hydroxide. Pediatr Dent 2006;28(3):248–253.
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