CLINICAL APPROACH IN TRAUMATIC DENTAL INJURIES: 2 CASE REPORT

Aim: Traumatic dental injuries are most commonly observed in children and young adults. Depending on

the effect of the force, fractures may occur only in the teeth or in the soft tissue and alveolar bone together

with the teeth. In permanent teeth, crown fractures and trauma to the upper anterior teeth are most common.

The prevalence of vertical root fractures in root filled teeth is significantly greater than in teeth with

vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre-existing fractures

and biochemical effects of loss of vitality is highly relevant. The aim of this case report is to present the

diagnostic procedures and clinical approach applied to a patient who was applied to our clinic due to trauma

and a patient who had pain for a long time.

Case Reports:

Case 1: A 15-year-old boy admitted to our clinic with complaints of fracture, pain and sensitivity in his

upper anterior teeth. In the clinical and radiographic evaluations of the patient, uncomplicated enamel-dentin

fractures in teeth 12, 11 and 21 and non-displaced alveolar bone fracture in the region of teeth 21-23 were

detected as a result of a fall 1 week ago. Tooth number 12 was treated with TheraCal LC (Bisco Inc, Schaumburg,

IL, USA) with indirect pulp capping and adhesive restoration. Temporary restorations were applied to

teeth 11 and 21 and a 4-week semi-rigid splint was applied to the upper anterior teeth. At the control session

after splint removal, the upper anterior teeth responded positively to vitality tests. After the periodontal treatment

of the patient was completed, adhesive restorations of teeth 12, 11 and 21 were completed and the teeth

were followed up at 1 week, 1 month, 3 months and 6 months.

Case 2: A 45-year-old male patient was admitted to our clinic with a long-standing pain in the right lower

region and severe tenderness on biting. According to the clinical and radiographic examination of the patient,

it was observed that there was percussion tenderness in tooth number 45, the related tooth had root

canal treatment and there was a large J-shaped lesion in the apical part of the tooth. After a positive response

to the bite test applied to the patient, cone beam computed tomography (CBCT) was taken from the related

tooth. After CBCT evaluations, a vertical root fracture was detected in tooth number 45. The related tooth

was extracted and healing was followed.

Results: In the 3 and 6 month follow-up of the first patient, it was observed that the teeth were asymptomatic

and gave positive results to vitality tests, and there was no sensitivity in the teeth to percussion and palpation.

The symptoms of the second patient also disappeared.

Conclusion: Dental traumas are important injuries to the hard and soft tissues of the teeth that require

emergency treatment. Correct diagnosis, use of CBCT during diagnosis, emergency management, treatment

plan and regular follow-up are very important for a successful prognosis and patient comfort.

Keywords: Dental trauma, alveolar bone fracture, crown fracture, vertical root fracture