Management of intrusive luxation of maxillary incisors with dens in dente: a case report

Abstract

Intrusive luxation is one of the most severe types of dental traumatic injuries. The risk of occurrence of pulpal necrosis and inflammatory or replacement resorption is high. In an attempt to prevent or delay the appearance of such lesions, endodontic intervention is required soon after the occurrence of trauma. A 17-year-old boy reported to the Department of Conservative dentistry and Endodontics, KLE VK Institute of Dental Sciences, Belgaum, 2 days after a fall from a bicycle. Clinical and radiographic examination revealed an intrusive luxation of the left maxillary central incisor and lateral incisor. There were complicated crown fracture with the right maxillary central incisor and uncomplicated crown fracture with the left maxillary central incisor. Also, all the incisors showed the presence of Oelhers type II Dens-in-dente. The management was hence challenging. Immediate surgical repositioning was performed and the teeth were stabilized with a composite resin splint. Endodontic therapy was initiated with the right maxillary central incisor, and the canal was sealed with calcium hydroxide dressing. After 3 weeks, pulp sensitivity was repeated with the maxillary left central and lateral incisors. The result was negative. Considering the incidence of pulp necrosis and root resorption in intruded teeth with complete root formation, they also were dealt in a similar manner as the maxillary right central incisor. The splint was removed after 1 month. After 6 months of calcium hydroxide therapy, there was a satisfactory apical and periodontal healing. At this stage, the teeth were obturated and the fractures were restored with composite resin. A 1-year follow up revealed a satisfactory clinical and radiographic outcome.