Munoz-Sanchez Marie-Laure, Decerle Nicolas, Devoize Laurent, Nicolas Emmanuel, Cousson Pierre-Yves, Veyrune Jean-Luc
Faculty of Dentistry, University of Clermont Auvergne, 63000 Clermont-Ferrand, France.
CHU Clermont-Ferrand, Service d'Odontologie, 63003 Clermont-Ferrand, France.
Healthcare (Basel). 2021 May 6;9(5):542. doi: 10.3390/healthcare9050542.
Endodontic treatment is often the first-line procedure to manage the immediate or long-term aftermath of dental trauma, particularly in cases of luxation or avulsion. Failure to manage trauma in the short or medium term leads to significant functional or aesthetic consequences, especially in the adolescence period. Under this specific conditions, endodontic treatment could provide a temporary solution by keeping teeth with poor prognosis on the arch while waiting for better anatomical conditions for implantology. This clinical case aimed to describe the management of a maxilla-facial dental trauma and the following consequences in a 10-year-old male patient. Clinical and radiological examination showed complete extrusive luxation of 11 and 21 and intrusive luxation of 12 and 22. Endodontic treatment of 11 and 21 was performed six months after the trauma. Two years later, the patient was referred to the endodontic department because pink spot lesions appeared on 12 and 22 due to cervical invasive resorptions (class III for 12 and class II for 22). Endodontic treatment of 12 and filling with resin composite of 22 were performed. During the following two years, complication management finally led to placement of four OBI (Euroteknika, Sallanches, France)-type mini-implants after avulsion of all four maxillary incisors. Palliative endodontic treatment helped maintain the prosthetic space and the volume of supporting tissue needed for future implant placement. The interest of using delaying procedures (palliative endodontic treatments and mini-implants) was to allow the patient to complete growth. Managing early treatment failure of trauma in adolescents has to be pluridisciplinary and should take into account the evaluation of the treatment's difficulty, the prognosis of the endodontic treatment, the available bone volume and the pubertal growth stage.
牙髓治疗通常是处理牙外伤近期或远期后果的一线治疗方法，尤其是在牙齿松动或脱位的情况下。在短期或中期未能妥善处理外伤会导致严重的功能或美观问题，尤其是在青春期。在这种特定情况下，牙髓治疗可以提供一个临时解决方案，即在等待种植牙更有利的解剖条件时，将预后不良的牙齿保留在牙弓上。本临床病例旨在描述一名10岁男性患者上颌面部牙外伤的处理及后续后果。临床和影像学检查显示11和21牙完全脱出性松动，12和22牙嵌入性松动。外伤后6个月对11和21牙进行了牙髓治疗。两年后，患者因12和22牙出现因颈部侵袭性吸收导致的粉红色斑点病变（12牙为III类，22牙为II类）被转诊至牙髓科。对12牙进行了牙髓治疗，对22牙进行了树脂复合材料充填。在接下来的两年里，并发症的处理最终导致在四颗上颌切牙全部脱位后植入了四颗OBI（法国萨朗什的Euroteknika公司生产）型微型种植体。姑息性牙髓治疗有助于维持修复空间和未来种植体植入所需的支持组织体积。采用延迟治疗程序（姑息性牙髓治疗和微型种植体）的好处是让患者完成生长发育。青少年牙外伤早期治疗失败的处理必须是多学科的，应考虑治疗难度评估、牙髓治疗预后、可用骨量和青春期生长阶段。
