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Home > Images > Skeletal Trauma > Alternative to dental implants in the infant patient: A case report of a fractured tooth

Hector R. Martinez, Manuel de la Rosa, Eduardo Garcia Luna and Gerardo Rivera

An 8-year-old female was admitted to the pediatric dental clinic as an emergency patient for a complicated fractured permanent anterior tooth. The accident occurred ten days prior to her visit to clinic. The clinical examination showed a vertical crown/root fracture with pulp exposure of the right permanent maxillary central incisor (image A). A 2 mm pulp exposure was clearly evident (image B). After local infiltration anesthesia, a retraction cord with haemostatic agent was placed in the sulcus area to control the bleeding, as well as, to help keep a wider gingival sulcus space to aid in later repositioning the mobile piece of tooth (image C). The panoramic radiograph showed the fracture began at the incisor edge and extended to the lateral surface of the root, involving 2 mm of the crestal bone (image E). For apexification, calcium hydroxide (Ca(OH)2) paste was used as a holding medium after shaping the canal to insure apex closure of the young root (image F). The first change of Ca(OH)2 was 3 months after the accident and the second was 6 months after the first replacement (images G & H). After 9 months the complete apexification was determined radiographically and final closure was accomplished using gutta-percha (image I). The final stage was producing a successfully aesthetic crown (image D). The tooth fragment reattachment procedure may offer a conservative, cost-effective, and aesthetically pleasing option when infant patients present with dental trauma and placing an implant is contraindicated.

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