jcda
ca
ESSENTIAL DENTAL KNOWLEDGE
The following is a summary of an article recently published in the Clinical Dentistry
The Canadian Dental Association
section of the JCDA website. For the full version, see jcda.ca.
Published by
jadc
Clinical
Summaries
DES CONNAISSANCES
DENTAIRES INDISPENSABLES
Clinical Reports
Publié par
l’Association dentaire canadienne
Fixed Orthodontic Appliances in the Management of Severe Dental
Trauma in Mixed Dentition: A Case Report
Fouad-Hassan Ebrahim, BSc, DDS; Gajanan Kulkarni, BDS, LLB, MSc, D Ped Dent, PhD, FRCD(C)
Abstract
We describe a case of complex trauma to the early mixed dentition in which
tooth avulsion, intrusion, extrusion and lateral luxation were managed effectively
using a fixed, non-rigid orthodontic splint after treatment with a traditional wirecomposite splint had failed. The use of orthodontic brackets and flexible wires
provided several advantages, such as the ability to splint severely malpositioned
teeth; easy assessment without removing the splint; slow, gentle repositioning
of traumatized teeth; and gradual reestablishment of the arch form allowing for
ease of future prosthodontic rehabilitation.
Failing wire-composite splint used to
treat severe complex dental trauma
sustained by a 7-year-old boy (top).
Orthodontic splint constructed using
buccal tubes on the primary second
molars, edgewise brackets on the
primary canines and traumatized permanent incisors, and a 0.015” coaxial stainless steel wire (bottom).
More online
Complete case report and
additional photos at:
jcda.ca/article/d131
jcda
ca | 2014 | Vol. 80, No. 1 |
ESSENTIAL DENTAL KNOWLEDGE
Published by
The Canadian Dental Association
jcdaf
ca
I
n this case report, we describe the use of a fixed orthodontic appliance to manage
complex dental trauma in a pediatric patient after failure of a conventional wirecomposite splint.
A 7-year-old boy presented to a private dental practice after sustaining severe orofacial trauma 2 weeks earlier. A wire-composite splint that had been constructed by
a pediatric dentist following the injury was failing. At the time of injury, no manual
repositioning had been undertaken. As the wire-composite splint began to debond,
the patient’s mother sought a second opinion from a general dentist, who deemed the
teeth unsalvageable because of their persistent mobility and the failure to facilitate
stabilization and periodontal healing. The dentist recommended that teeth 12, 11 and
22 be extracted and prosthetic treatment be deferred for the future. Dissatisfied with
this treatment plan, the patient’s mother sought treatment from another pediatric
dentist, the corresponding author.
Clinical examination revealed that the patient was in the early mixed dentition stage.
His medical history was non-contributory. The boy had sustained severe trauma as
well as a periodontal degloving injury to the maxillary permanent incisors. The right
maxillary lateral incisor (tooth 12) was severely extruded (about 5 mm) and displaced
lingually; it displayed M3 mobility and was traumatically occluding on the mandibular incisors. The right maxillary central incisor (tooth 11) was intruded approximately 4 mm and luxated laterally with its apex perforating the fractured buccal cortical plate; it also had an ena