Root canal treatment

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Traumatic Avulsion

One Sunday morning, a 13 year old boy came to our studio who, after falling, reported the complete avulsion of the right central incisor, which also had an enamel-dentin crown fracture with pulp exposure (Ellis III category), the dislocation of the left central incisor with enamel-dentin fracture without pulp exposure (Ellis II category) and a fracture on the right side. (Figure 1)
completa avulsione dell’incisivo centrale
The traumatic event occurred the previous evening, when despite having gone to the emergency room and not having received the appropriate care, his parents came across the emergency dental care offered by our practice on the internet.
The avulsed element had been preserved in milk but the time spent since the traumatic event was about 12 hours.
As per protocol, we placed the tooth in a Hank's buffered salt solution and proceeded to perform the clinical examination and to take the anamnesis.
Radiografia dell'aveolo
A clinical and radiographic examination did not show any had socket bone fractures (Figure 2).
Given that the avulsed tooth had a fully formed apex and the time spent outside of the mouth was more than 60 minutes, we decided to perform the root canal treatment outside the oral cavity, paying attention during the canal irrigation with disinfectants not to undermine the periodontal ligament by dipping the tooth every 2 minutes in the buffered saline.
trattamento canalare
Having completed the root canal treatment (Figure 3), and after rebuilding the fractured part of the crown, we immersed the avulsed dental element in saline.
Before reimplanting the avulsed tooth, we performed the composite reconstruction of the other two fractured incisors.
We focused thus on a delicate revision of the socket by gently aspirating the clot that had formed.
The avulsed element was then repositioned in the socket with gradual compression until reaching the dental alignment and was held in position for ten minutes.
splintaggio vestibolare
This position was stabilised with a vestibular splint which was kept for 4 weeks (Figure 4).
The patient was then prescribed systemic antibiotics, chlorhexidine rinses and instructions issued for rigorous oral hygiene which is of fundamental importance for the whole time in which the splint is in position.
visita di controllo
We performed a check-up on the patient after 10 days (Figure 5) and we checked the splint and strengthened it, and also carried out a viability test on the dislocated incisor with a positive result.
After the removal of the splint at 4 weeks, the right incisor was perfectly stable (mobility grade 1) while the left incisor had retained vitality.

Before dismissing the patient, the composite reconstructions were renewed to give a better cosmetic result. (Figure 6)

ricostruzioni in composito
risultato finale dopo il nostro intervento
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