History:
ABOUT THE ACCIDENT
1. How did the accident occur?
2. When and where?
3. What are the specifics of injury: Type of object contacted; Direction; Identify abuse/violence
ABOUT THE PATIENT
1. Where is the Injury?
2. Any bleeding at time of accident?
3. What has been done?
4. Loss of consciousness, amnesia, headache, vomit, blur vision, confuse, seizure?
5. What symptoms pt is having?
7. Where is the tooth? How was it brought to the clinic from time of accident?
6. Has the child swallow the tooth?
MEDICAL HISTORY
1. Medication
2. Allergies
3. Bleeding disorder
4. Tetanus status
MANAGEMENT
Treatment option
1. Tooth replantation.
2. Partial denture
3. Cantilever bridge
4. Implant when patient has reach adulthood.
Best option may be tooth replantation. After rinsing the tooth root with saline, place the tooth back into the socket. Stabilize the tooth by placing flexible splint for 2 weeks. Root canal treatment is indicated after 7-10 days or when tooth shows signs and symptoms of necrosis.
Great question. An osseointegrated implant would behave much like an ankylosed primary tooth, with the same lack of alveolar growth and dental eruption.
Found from the 1 article stating implants placed after age 15 for girls and age 18 for boys have the most predictable prognosis. Implants placed before these ages may not be permanent and may have to be re-implanted [1].
Another study mentioned the appropriate age for osseointegrated dental implant placement is very unique, since the end of facial growth is widely variable and has to be determined by means of cephalometric radiograph superimposition for each patient [2]
i. Horizontally impacted 48. Class 3. Position B
ii. Pederson difficulty index: 7
Difficulty score: difficult
iii. Horizontally impacted 48 with two roots. Both apical third of the roots are in close relation to inferior alveolar nerve canal.
iv. Local anesthesia is given. Incision is made and mucoperiosteal triangular flap is raised. Bone guttering is done to expose the crown of 48 til CEJ. Crown is sectioned from its roots and removed. Roots are separated and removed individually. Sharp bony edges are smoothened with bone file. Socket is irrigated and then sutured.
