09/10/2010 Complete intrusion of a maxillary right primary central incisor

Resident: J. Hencler
Date: 09/10/2010

Article title: Complete intrusion of a maxillary right primary central incisor
Author(s): Arthur Merkle, DMD

Journal: Pediatric Dentistry-22:2, 2000
Major topic: Trauma
Type of Article: Case Study

Main Purpose:
Present a rare case of complete intrusion of a maxillary right primary central incisor.

Findings:
A 29-month old female fell off a swing sustaining oro-facial injuries and was treated at the ED. Dentists on the hospital staff were not involved in the emergency care of this child. A plastic surgeon repaired oral and facial lacerations. A maxillary primary central incisor was assumed avulsed. Later, a routine dental exam of the child reveals an intrusion injury where the primary central incisor was displaced through the floor of the nasal cavity. IOE revealed a palpable mass in the maxillary labial vestibule near the anterior nasal spine. A mass was visible on the floor of the nasal cavity through the right naris. An occlusal radiograph confirmed the presence of the primary incisor and a lateral film revealed an intrusion injury in which the displacement was nearly one whole incisor length. Patient was referred to OS for EXT under GA. The intruded tooth was EXT through the right naris and had normal post –op recovery with uncomplicated healing.

Key points in the article discussion:
Luxation trauma is very common in the primary dentition. B/c alveolar bone in the young child in pliable, primary teeth are more likely to be luxated than fractured. Of luxation injuries, intrusive and extrusive traumas are the most common. If intruded sufficiently, the clinical presentation may suggest avulsion rather than intrusion. The apex of a completely intruded primary incisor will usually perforate the thin alveolar bone on the labial vestibule. This case is unusual b/c a maxillary right primary central incisor was intruded enough for the apex of the tooth to perforate the nasal cavity, so that avulsion was assumed.

Summary of conclusions:
This article emphasizes the importance of careful clinical and radiographic evaluation of dental trauma. Appropriate radiographs should be taken to verify clinical findings. In this case, earlier dx and tx would have placed the child and her developing dentition at less risk for possible complications associated w/ the intrusive injury.

Assessment of article:
Very interesting case. Take home message is this; “if you can’t see it, that doesn’t mean it’s not there.” Take a radiograph.