This is a case of a 3-year-old male patient, with no medical or dental history of interest, suffered a dental trauma after a domestic accident and went as an emergency to the Pediatric Dentistry Service of the Hospital.
Chief complaint: his mother went to the emergency room with the fragment of her child's tooth root in her hand, explaining that she had found this "loose canine in the child's mouth" after a dental trauma. In the physical examination, the following was found: a bruise, abrasion, and laceration of the maxillary buccal mucosa and gingiva of the primary maxillary central incisors zone. There was mobility in the primary maxillary right central incisor and light mobility without displacement in the primary maxillary left central incisor. The clinical and radiological exploration of the lateral incisors was normal, without any pathology. The patient presented with anterior open bite because of pacifier habit persistence.
Periapical radiographic examination revealed the near complete absence of the primary maxillary right central incisor root. This exploration provided evidence that the patient had suffered a root fracture of the primary maxillary right central incisor (fracture located to cervical part of the root) accompanied by transalveolar and transmuco-gingival avulsion of the tooth root fragment (Figure 1). The dental crypts of the maxillary alveolar process of the developing permanent teeth were found without any radiological alteration (the dental follicle of the permanent maxillary right central incisor was in 5 Nolla stage).
Root avulsion of the primary maxillary right central incisor, subluxation of the primary maxillary left central incisor, and fracture of the alveolar process were diagnosed.
An antibiotic regimen of amoxicillin-clavulanic acid was started as a treatment for one week. Soft diet was recommended and oral hygiene instructions were explained (brush with a soft brush after every meal). It was also recommended to apply chlorhexidine 0.1% topically to the affected area with cotton swabs twice a day for one week and to restrict the use of a pacifier, as well as to avoid putting pressure on the traumatized area.
Several posttrauma follow-up appointments were performed, exactly 15 days, one month, and three months after the trauma.
During the first examination, 15 days after the trauma, the clinical intraoral examination showed that the buccal mucosa of the primary maxillary right central incisor was healing, and the periapical radiography showed absence of the primary maxillary right central incisor root, but without any alteration or pathological image. The crown of the primary right central incisor did not present mobility (it was in its initial position in the dental arch) and there was not any risk of aspiration. In addition to this, the child had already given up the pacifier habit, as it was recommended in the posttrauma instructions.
Another examination was performed one month after the trauma. The clinical intraoral examination showed normal buccal mucosa and the primary maxillary right central incisor crown did not show mobility. A periapical radiography was also performed.
Another examination was performed 3 months after the trauma (Figure 2). The clinical intraoral examination showed a perfectly healed vestibular mucosa with normal appearance and mobility of the primary maxillary right central incisor crown. A periapical radiography was also performed.
After the last examination, the patient went to the emergency room three more times because he suffered different traumas on the primary maxillary right central incisor (playing football, hitting himself with a chair, and running). A lacerated contused wound in the lower lip was observed during the last physical trauma examination, as well as an abrasion injury on the chin (Figure 3).
Four months after the trauma, the primary maxillary right central crown remained in its position in the dental arch.
As there was a lack of occlusal contact with the opposing tooth, which would have caused the crown extrusion, the tooth remained in his mouth. This absence of occlusal contact was due to the anterior open bite caused by the former pacifier habit.
Six months after the trauma, the patient's mother called to tell us that the primary maxillary right central incisor crown had been exfoliated and we appointed another examination to assess the state of the crown and alveolar bone (Figure 4).
After the exfoliation of the primary maxillary right central incisor crown, the growth and development of the patient had to be monitored in order to check the eruption of the permanent maxillary incisors. After an 8-year follow-up, the permanent maxillary central incisor had normally erupted (Figure 5).