Dentoalveolar Trauma Research Articles

ROMPIMIENTO APICAL TRANSITORIO Y SU RELACIÓN CON EL TRAUMA CAUSADO POR MOVIMIENTOS DE ORTODONCIA

El rompimiento apical transitorio es una lesión moderada de la pulpa o una lesión combinada entre ligamento periodontal (PDL) y la pulpa en dientes con formación radicular completa; ocurre como resultado de un trauma inducido por fuerzas ortodónticas y/o trauma dentoalveolar en el que los tejidos traumatizados experimentan un proceso espontáneo de reparación de estas estructuras sin causar un daño permanente en la pulpa. Sus manifestaciones clínicas incluyen: alteraciones en la sensibilidad, cambio de color, reabsorción ósea u obliteración del conducto radicular. El propósito de este artículo es presentar los aspectos más importantes relacionados con este tipo de lesión.[Bedoya LF, Gay MM. Rompimiento apical transitorio y su relación con el trauma causado por movimientos de ortodoncia. Ustasalud 2010; 9: 101 - 111]

The Initial Management of Dento-Alveolar Trauma in General Dental Practice

Dento-alveolar trauma presents commonly in general dental practice, but may prove difficult to manage for those unfamiliar with it. Timely and well-informed intervention can significantly improve the clinical outcome for the patient. This article aims to inform the clinician on best current practice for the assessment and initial management of dental traumatic injuries, incorporating current international guidelines and practical arrangements for follow-up care. The dental trauma patient often presents to the general dental practitioner and the appropriate emergency management plays a vital role in relieving pain, protecting the dentino-pulpal complex, reducing displaced teeth and improving prognosis.

A 9-Year Retrospective Study of Dental Trauma in Piracicaba and Neighboring Regions in the State of São Paulo, Brazil

The purpose of this study was to evaluate the occurrence of dentoalveolar trauma during a 9-year period in the Oral and Maxillofacial Surgery Division at Piracicaba Dental School, State University of Campinas in patients from the Piracicaba municipality and neighborhood regions in São Paulo, Brazil. This retrospective epidemiologic study from January 1999 to December 2007 evaluated all patients who presented at the Oral and Maxillofacial Surgery Division at Piracicaba Dental School with sustained oral and maxillofacial traumatic injuries associated with dentoalveolar trauma. Information regarding age, gender, etiology, use of protective devices such seatbelts, crash helmets, and presence of facial fractures and general trauma, oral condition, stage of dentition, date of trauma, drug abuse, type, teeth affected, and classification of the trauma were gathered from the medical files. Descriptive analysis was conducted. In total, 2,785 patients were analyzed and 542 (19.46%) were included in this study. The male to female ratio was 2.81:1. Most patients presented with oral hygiene as regular (51.85%). Friday, Saturday, and Sunday were the most prevalent days. Smoking was the most common harmful habit analyzed (16.05%) followed by alcohol use (15.87%). Bicycle accidents (26.94%) were the most common cause, followed by falls (22.69%). With regard to protective devices, 31.51% of drivers were wearing seatbelts during the accidents and helmets were used by 84.38% of motorcycle drivers at the moment of injury. One hundred thirty-five facial fractures were associated with dental and dentoalveolar traumas, and the mandible was the facial bone most associated with dentoalveolar trauma. Upper and lower limbs were most frequently associated with general trauma, accounting for 140 (38.78%) and 111 (30.75%), respectively. This study shows that dentoalveolar trauma rates and patterns in the Piracicaba municipality and neighborhood regions in São Paulo are similar to other populations. The weekend is the period with the major incidence of dentoalveolar trauma. Alcohol consumption was linked with this type of trauma. Dentoalveolar trauma is involved in and closely related to severe maxillofacial trauma. The use of a helmet is as important as that of a seatbelt. More studies are necessary for a better knowledge and understanding when considering protocols and organization charts in emergency rooms.

Surgical protocols and outcome for the treatment of maxillofacial fractures in children: 9 years' experience

Trauma and facial fractures in a population of children have been analysed in several studies mainly regarding their incidence and much less their treatment modalities. The aim of this study was to retrospectively analyse the treatment methods and outcome of facial fractures in children and young adolescents during the last decade and to discuss findings and propose treatment protocols. Patients of the Paediatric Maxillofacial department, treated for fractures of the facial skeleton were included in the study. Open reduction and osteosynthesis plate fixation (titanium and resorbable material) was the main treatment method with conservative treatment saved for selected cases. Titanium plates were removed after bone healing. Intermaxillary fixation (IMF) was not used regularly in mandibular fractures, with the exception of condylar fractures. 156 children and young adolescents with 208 fracture sites in total were treated. 139 fracture sites (66.8%) were treated with open reduction and 69 conservatively. The mandible was affected in 49.0% of the cases, the maxilla in 21.2% (both with the alveolar process fractures included), the zygomatic complex in 10.1%, the orbital walls in 9.6%. There were 38 alveolar process fractures. The results of the fracture treatment verified the usefulness of open reduction and plate fixation in children. There was no need for wire suspension and only occasional need for IMF. Closed reduction was selectively applied in condylar fractures and dento-alveolar trauma.

Knowledge of 1st-4th-Grade Teachers from Municipal Public Schools of the City of Manaus/AM about Tooth Avulsion

Objective: To evaluate the knowledge of 1st-4th grade teachers form municipal public schools of the city of Manaus/AM about tooth avulsion. Method: Three hundred and eleven professionals from all regions of the city of Manaus/AM were interviewed using a standardized form containing closed, open and multiple-choice questions about tooth avulsion, tooth replantation and the procedures necessary to improve the prognosis in cases of avulsed teeth. After the interview, a folder containing information about the correct urgency procedures to be adopted in case of tooth avulsion was handed to the participants, in an attempt to make elementary public school teachers capable of spreading this knowledge. Results: 57.1% of the teachers had only high school education and 49.8% had 1 to 5 years of professional experience. From the teachers that attended first-aid training (29.9%), only 12.9% had previous information on dentoalveolar trauma. 66.9% could not distinguish primary from permanent teeth, and 61.7% would only give a towel for the student to bite in case of dental trauma, not dispensing the necessary attention to the avulsed tooth. Only 5.5% would replant the avulsed tooth at the site of the accident. Most teachers (55.9%) responded that immediate dental care is necessary, 51.1% considered the dentist as the most qualified professional for these cases, and 58.8% would choose tap water as the ideal storage medium for the avulsed tooth. Conclusion: The interviewed teachers did not have adequate knowledge of the urgency procedures to be adopted in case of tooth avulsion, demonstrating the need of incorporating this subject to the curriculum of these professionals and performing health educational campaigns to improve the frequency and prognosis of replanted teeth.

Undergraduate experience and self-assessed confidence in paediatric dentistry: comparison of three UK dental schools

Previous studies have suggested that dental students may not receive sufficient clinical experience in core paediatric dentistry skills. This study aimed to compare dental undergraduates' self-reported experience and confidence in paediatric dentistry within three UK dental schools (Liverpool, Manchester and Sheffield). In April/May 2009, 147 final year dental students completed an anonymous questionnaire which captured their experience of seven core clinical skills in both hospital and outreach settings. A visual analogue scale was also employed to record perceived levels of confidence for six generic activities including: examination, diagnosis and treatment planning; patient selection for treatment under general anaesthesia; operative dentistry; preventive dentistry; management of dento-alveolar trauma, and provision of routine care for children on qualification. The key finding was that Liverpool, Manchester and Sheffield dental students received comparable clinical experiences in paediatric dentistry, which appeared to satisfy the requirements of the General Dental Council's The first five years. One hundred percent had carried out fissure sealants and restorations, and 87-98% had experience of extractions. Outreach placements were crucial in ensuring students had sufficient opportunity to undertake core skills, notably extractions and pulp therapies. All students reported a lack of confidence in dental trauma management which warrants greater emphasis in the undergraduate curriculum.

Summary of: Initial management of paediatric dento-alveolar trauma in the permanent dentition: a multi-centre evaluation

Objective To investigate the time lapse prior to provision of emergency dental care and appropriateness of earliest treatment provided for children with dental trauma. Design A multi-regional prospective and cross-sectional survey. Setting Paediatric dental departments of Liverpool, Manchester and Sheffield. Subjects One hundred and fifty referred or emergency paediatric patients with trauma to the permanent incisors. Results One hundred and fifty subjects were recruited. Mean age of the subjects was 11.1 years (SD= 2.6; range = 6.2-16.6); 100 were male and 50 were female. The mean time interval from injury until initial presentation to a health care professional was 22.6 hours (SD = 76.1; range = 0-672). Thirty-six percent of children (n = 54) first presented to a general dental practitioner whilst 30% (n = 45) presented to accident and emergency medical staff. Following initial assessment, a further mean time lapse of 8.1 hours (SD = 43.7; range = 0-504) was incurred in 25% of cases prior to dental referral. In 39% of subjects (n = 58/150), treatment was considered inappropriate. The most frequent example of inadequate management was failure to protect exposed dentine, which was found for 71% (n = 24/34) of complicated crown fractures and 40% (n = 25/62) of uncomplicated crown fractures. Conclusion This study identified marked delays in the management of some paediatric dental trauma to permanent incisor teeth which, in itself, could be suboptimal. Greater educational and clinical support would seem to be warranted in this area of service provision.

Initial management of paediatric dento-alveolar trauma in the permanent dentition: a multi-centre evaluation

To investigate the time lapse prior to provision of emergency dental care and appropriateness of earliest treatment provided for children with dental trauma. A multi-regional prospective and cross-sectional survey. Paediatric dental departments of Liverpool, Manchester and Sheffield. One hundred and fifty referred or emergency paediatric patients with trauma to the permanent incisors. One hundred and fifty subjects were recruited. Mean age of the subjects was 11.1 years (SD = 2.6; range = 6.2-16.6); 100 were male and 50 were female. The mean time interval from injury until initial presentation to a health care professional was 22.6 hours (SD = 76.1; range = 0-672). Thirty-six percent of children (n = 54) first presented to a general dental practitioner whilst 30% (n = 45) presented to accident and emergency medical staff. Following initial assessment, a further mean time lapse of 8.1 hours (SD = 43.7; range = 0-504) was incurred in 25% of cases prior to dental referral. In 39% of subjects (n = 58/150), treatment was considered inappropriate. The most frequent example of inadequate management was failure to protect exposed dentine, which was found for 71% (n = 24/34) of complicated crown fractures and 40% (n = 25/62) of uncomplicated crown fractures. This study identified marked delays in the management of some paediatric dental trauma to permanent incisor teeth which, in itself, could be suboptimal. Greater educational and clinical support would seem to be warranted in this area of service provision.

Facial Trauma: How Dangerous Are Skiing and Snowboarding?

The aim of this study was to investigate maxillofacial injuries sustained in both skiing and snowboarding accidents and correlate injury mechanisms and patterns evaluating a large population. Between 1991 and 2003, all patients with maxillofacial injuries due to skiing and snowboarding accidents (1,393 cases) were reviewed and statistically analyzed according to age, gender, type of injury, cause of accident, location of trauma, and associated injuries. Skiing accidents resulted in a total of 1,250 injuries, and snowboarding resulted in 143. In this study 686 skiers presented with 1,452 facial bone fractures and 80 snowboarders sustained 160 fractures of the face. Skiers had dentoalveolar trauma in 810 cases and 1,295 soft tissue injuries, whereas snowboarders had 88 dental injuries and 187 soft tissue lesions. Mechanisms of injury included 542 cases due to skiing and 85 falls due to snowboarding (a 1.79-fold higher risk for snowboarders). The gender distribution showed a male-female ratio of 3:1 in skiers and 5.5:1 in snowboarders. In both groups male patients were more prone to have a facial bone fracture than female patients. Snowboarders aged between 10 and 29 years had a 2.14-fold higher risk of sustaining a maxillofacial injury than skiers. In both groups facial bone fractures occurred more often in male patients, and they were more likely to result from falls and collisions with other persons. Young snowboarders had a higher risk of maxillofacial injuries (especially soft tissue lesions) than skiers, whereas for children and old persons, skiing posed a much higher risk. Wearing a helmet while skiing and snowboarding should be mandatory to prevent serious trauma to the head.

Histological evaluation of experimentally induced subluxation in rat molars and its implications on the management of orthodontic treatment

The purpose of this study was to evaluate the histological alterations occurred in the periradicular region of rat molars after intentional subluxation using an experimental method to induce dentoalveolar trauma. Eighteen adult male Wistar rats (Rattus norvegicus albinus) were selected for the study. The dentoalveolar trauma was experimentally induced by the application of an occlusogingival force on the occlusal surface of the maxillary right first molar using a tensiometer secured on a fully articulated support with adjustable steel shafts. The animals were assigned to six groups (n = 3), according to the intensity of the force applied to induce trauma: Group I (GI, control) - no force application; Groups II-VI (GII-GVI) - the animals were subjected to 600, 700, 800, 900 and 1000 cN force, respectively. After experimental induction of trauma, the animals were sacrificed by anesthetic overdose and the right maxillas were removed and processed for histological analysis under light microscopy. In the animals of GII, GIII and GIV, the histological alterations were similar to those described for GI. GVI (1000 cN) presented the most severe alterations, with the occurrence of buccal bone plate fracture, alveolar fracture and root fracture, which are not present in mild traumatic injuries like subluxation. The 900 cN force (GV) was capable to produce clinical and histological alterations in the gingival and periodontal tissues compatible with those observed in subluxation.

Maxillofacial injuries and dental trauma in patients aged 19-80 years, Recife, Brazil

Aim A retrospective study was undertaken to assess causes of maxillofacial trauma in Recife, Pernambuco, Brazil. Method A review of 186 patients with maxillofacial injuries aged 19 and 83 years old seen and treated at the Hospital da Restauração between January and December 2006 was conducted and were analyzed according to age, sex, etiology, site of fracture, dentoalveolar trauma and alcohol abuse. Analysis was made in Epi Info using the Chi-square and Fisher's Exact Tests. Results It was found that maxillofacial injuries were most frequent in males (89.2%) and in the 19–28 year age group (46.8%). Traffic accidents/motorcycle (23.7%) and physical violence (20.4%) were the most common etiological factor. Facial fractures were detected in 90.9% and a statistically significant difference between sex and facial fracture was found (p = 0.000). The most common facial fracture was maxilla (29.1%), followed by the mandible (27.5%). A positive association between the presence of facial fracture and alcohol consumption was observed (p = 0.002). Dentoalveolar trauma was present in 7.5% of patients. Conclusion The incidence of facial fractures in Brazilian population is similar than previously reported elsewhere. There were most common in male patients, mainly due to traffic accidents/motorcycle and physical violence.

Traumatic displacement of maxillary permanent incisor into the nasal cavity

The purpose of this paper was to describe a case of unviable alveolar repositioning of an intruded tooth into the nasal cavity and to bring the subject of intrusive tooth injury among patients with dentoalveolar fractures to the attention of trauma surgeons. A 26-year-old male was involved in a car accident and crashed his mouth against the dashboard due to sudden deceleration. Intraoral examination revealed an anterior maxillary dentoalveolar fracture and absence of the central maxillary incisors, right lateral maxillary incisor, and left maxillary canine. Computed tomography showed a dislocated tooth in the nasal cavity. The "missing" left maxillary canine was easily recovered from the floor of the left nostril. Because complete dislocation of a tooth can cause a frontal sinus abscess, an airway complication, a respiratory tract obstruction, and a complicated lung abscess or sinusitis, anytime a tooth is not accounted for after a dentoalveolar trauma, the possibility that it has been fully intruded should be considered. Computed tomographic scan should be a routine diagnostic study in all cases with associated missing anatomical structures in the oral and maxillofacial region. The need to involve the dental professional in the initial assessment of dental trauma in emergency rooms in hospitals is important in order to identify how many teeth might be missing after dental trauma and to correctly reposition the avulsed teeth when possible.

Effects of severe dentoalveolar trauma on the quality‐of‐life of children and parents

This investigation assessed the effects of dental trauma on the perception of pain and quality of life (QoL) of patient-parent pairs for a year following severe injuries. A visual analogue scale (VAS) was used to assess the pain of injury and treatment for 27 individuals 8-20 years and their parents. The Child Oral Health Quality of Life (COHQoL) survey was used to assess the effects of dental injuries on the QoL of 23 children aged 8-14 and their parents. Mean VAS scores revealed that all patients and parents perceived the pain of initial injury to be significantly greater than pain of splint removal (P < or = 0.05) and that pain decreased in a stepwise manner from injury through emergency treatment to splint removal. The COHQoL questionnaire demonstrated a profound and continuing effect on children and their parent's QoL following severe dental injury. The initial parental COHQoL score was significantly greater than the 12-month score (P < or = 0.05) in both 8-10 and 11-14- year-olds. The COHQoL results indicated a measurable reduction in the QoL of patients and parents was still present 12-months after the injuries. At the end of one-year children were still affected by the social and well-being aspects of the injury yet parents exclusively reported that one-year effects were limited to their children's oral symptoms and functional limitations. Severe dental injuries produce initial and ongoing pain. Detrimental effects on the QoL of both children and parents are still present at one-year and these long-term effects are different for children and parents.

Traumatic Injury Prevalence in Children Treated at the Pediatric Dentistry Clinic of the Federal University of Piauí, Brazil

Objetivo: Determinar a prevalencia e as caracteristicas clinicas de injurias traumaticas alveolo-dentarias em pacientes assistidos na Clinica Odontologica Infantil da Universidade Federal do Piaui (UFPI). Metodo: Foi realizado um estudo epidemiologico retrospectivo mediante a avaliacao dos prontuarios de pacientes na faixa etaria de 8 a 168 meses, frequentadores da Clinica Odontologica Infantil atendidos no periodo de marco de 1996 a maio de 2006. Foram examinados um total de 2.447 prontuarios, dos quais foram selecionados 260 (10,6%) que continham relatos sobre a ocorrencia de traumatismo alveolo-dentario. As variaveis analisadas compreenderam a idade, genero, tipos de lesao, dentes mais afetados e estagio de desenvolvimento dentario (tipo de denticao). Os pacientes foram distribuidos de acordo com a faixa etaria e com o genero. Para a analise estatistica foi utilizado o teste do Qui-quadrado, com valor de p<0,05. Resultados: Nao houve diferenca quanto ao numero e o tipo de traumatismo alveolo-dentario em relacao a faixa etaria e ao genero (p = 0,848). Dentre as lesoes traumaticas, 54 (21%) foram do tipo luxativas, 111 (42%) foram fraturas coronarias, 44 (17%) nao foram especificadas e 51 (20%) relatavam historia de trauma associado a descoloracoes dentarias. Quanto as lesoes luxativas, as avulsoes dentarias foram as mais prevalentes (42,6%), seguidas por intrusao (24%), deslocamentos laterais (20%) e extrusao (9%). Aproximadamente 64% dos traumatismos ocorreram em pacientes com denticao decidua (64,4%), sendo os incisivos centrais superiores afetados em 78% dos casos. Conclusao: A prevalencia de traumatismos alveolos-dentarios foi de 10,6%. As fraturas coronarias foram as lesoes predominantes em ambas as denticoes, sendo os incisivos centrais superiores os elementos mais envolvidos. Nao foi observada influencia da faixa etaria e do genero em relacao aos traumatismos alveolo-dentarios.

Simple replantation protocol to avoid ankylosis in teeth intended for orthodontic treatment

Background : Dento-alveolar trauma resulted from accidents involving the oral regions mostly affect the upper central incisors. Overjet that is beyond 5 mm and incompetent lip also contribute to increase the risk. Several literatures had already discussed different methods of replantation of avulsed teeth. However, it was not meant for further orthodontic treatment. Purpose : The objective of this review is to propose a simple replantation protocol of avulsed teeth which also prevent from ankylosis. Reviews : Protruded teeth usually need orthodontic treatment; therefore, an appropriate management should be done to avoid the development of ankylosis. Ankylosis of the periodontal ligament (PDL) becomes a problem in orthodontic tooth movement in repositioned or replanted teeth. In addition, ankylosed teeth also more susceptible to root resorption. Actually, it was caused by the endodontic treatment. In particular, severely protruded or unoccluded teeth are hypofunctional, therefore have narrow PDL, thus it may facilitate to ankylosis development. Ideal management protocol such as the use of root canal sealer i.e. mineral trioxide aggregate (MTA); the using of Emdogain, and resilient wiring or semi-rigid fixation with brackets has become a solution in avulsed teeth arranged for orthodontic treatment. Nevertheless, the presence of oral surgeon, endodontist and orthodontist in the same time, and also ideal preparations after an accident was difficult to achieve. Conclusion : Considering that reducing the ongoing PDL inflammation with intracanal medicaments and maintaining the functional force during mastication is possible; it is concluded that this simple replantation protocol is likely.

Bone replacement following dental trauma prior to implant surgery – present status

Dento-alveolar trauma often leads to a need for reconstruction of the alveolar crest before an implant can be placed. Although autogenous bone grafts is considered the 'gold standard', this may be associated with patient morbidity and graft resorption. Consequently, the use of bone substitutes has increased. Today, a substantial number of biomaterials are available on the market, but only a few are well documented. The user should be aware that these biomaterials have different properties: resorbable or non-resorbable, time of resorption and resorption mechanism. The purpose of this review is to describe the function of various bone substitutes and indications for their use in reconstructive implant surgery and to give an overview of the current situation.

Surgical repositioning of a traumatically intruded permanent incisor in a patient with rheumatic fever: case report

Intrusive luxation of permanent teeth is a relatively uncommon type of injury to the periodontal ligament. However, it is one of the most severe types of dentoalveolar trauma. By definition, intrusive luxation consists of the axial displacement of the tooth into the alveolar bone, accompanied by comminution or fracture of the alveolar bone. Here we report the treatment management of a traumatically intruded immature permanent central incisor by surgical repositioning undertaken in a 10-year-old child with rheumatic fever 10 days after sustaining a severe dentoalveolar trauma. The intraoral examination showed the complete intrusion of the permanent maxillary right central incisor and the radiographic examination revealed incomplete root formation. Prophylactic antibiotic therapy was prescribed and the intruded tooth was surgically repositioned and endodontically treated thereafter. The postoperative course was uneventful, with both clinically and radiographically sound conditions of the repositioned tooth up to 3 years and 2 months of follow-up. These outcomes suggest that surgical repositioning combined with proper antibiotic prophylaxis and adequate root canal therapy may be an effective treatment option in cases of severe intrusive luxations of permanent teeth with systemic involvement.

Knowledge of firefighters with special paramedic training of the emergency management of avulsed teeth

Immediate replantation into the socket is the ideal procedure in cases of accidental avulsion of permanent teeth. In Brazil, firefighters with special paramedic training are in charge of providing first-aid care to victims of road accidents and might have to deal with tooth avulsions. This study assessed the knowledge of firefighters regarding the emergency management of avulsed teeth. Information was collected from a questionnaire submitted to 110 volunteer firefighters in seven cities in the São Paulo State (Brazil). The results revealed that 70.9% of the respondents did not know what tooth avulsion was; 53.6% did not know what tooth replantation was or defined it incorrectly; 60% would not act properly in tooth avulsion cases; 20.9% did not consider replantation of the avulsed tooth into the socket as a treatment option; the ideal time interval for tooth replantation was unknown to 40% of the interviewees; 90% of the participants answered that they would not be able to perform tooth replantation. Among those who considered themselves unable to perform tooth replantation, 47.3% chose saline as the best storage medium for an avulsed tooth, 21.8% chose milk, 3.6% chose the patient's mouth and 20% reported not knowing where to store the tooth; 81.8% of the firefighters reported not to have ever received any specific directions on tooth replantation and 100% of them considered this knowledge a requirement for first-aid care to accident victims. In conclusion, the knowledge of the surveyed firefighters regarding emergency management after tooth avulsion was unsatisfactory in several aspects that are important for the success of replantation procedures. Firefighters with special paramedic training should be educated on how to proceed in cases of dentoalveolar traumas and tooth avulsions in order to improve treatment prognosis and increase the survival rate of replanted teeth.

Severe Fracture of the Maxillary Alveolar Process Associated with Extrusive Luxation and Tooth Avulsion: A Case Report

The aim of this report is to present a case of severe fracture of the maxillary anterior alveolar process with substantial bone dislodgement associated with extrusive tooth luxation and avulsion. Dentoalveolar trauma is a challenge to dentistry, especially in young patients, for it can lead to early tooth loss which compromises oral function, esthetics, self-esteem, and alter the long-term plan of care for the victim. A 12-year-old girl with severe dentoalveolar trauma to the maxillary anterior region presented for emergency care for her injury. Treatment consisted of fracture reduction of the alveolar process, repositioning of the teeth that had suffered extrusive luxation, placement of a semi-rigid splint, and suturing of soft tissue lacerations. The traumatized teeth presented with pulpal necrosis and were treated endodontically. After 24 months of follow up, the fracture of the alveolar process was completely healed and the displaced teeth presented no signs of ankylosis or root resorption. First-aid care contributed remarkably to this case allowing the re-establishment of esthetics, function, and patient's self-esteem. In spite of trauma extension the treatment outcomes were favorable. Cases of dentoalveolar trauma should be evaluated on an individual basis. However, early emergency management and adequate follow-up can prevent further complications and contribute to treatment success.

The esthetic rehabilitation of misplaced dental arch after fracture of anterior maxillae: a case report

IntroductionIn cases where the patient experiences trauma, the teeth may be fractured or a bone segment could be fractured causing misplaced teeth. Ceramic veneer restorations may be a solution for re-establishing the ideal position. The treatment of misplaced dental arch segment is presented and treatment options are discussed.Case presentationA 30-years-old female Turkish patient had a history of a dentoalveolar trauma and a surgical operation. Her main complaints were about the unpleasant appearance of her anterior teeth. The maxillary anterior teeth were positioned labially and had irregularities in vertical position inharmonious with each other and the horizontal plane. The misplaced sector treated with minimally invasive dentin bonded porcelain laminate veneers.ConclusionCeramic veneers can be a solution for patients with malpositioned anterior teeth even the situation is severe and excessive tooth reduction is needed.