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Management of Anterior Crossbite due to Splinting for Dental Trauma: A Case Report with 4-year Follow-up Camila Corral Nuñez Andrea Veliz Ramirez Sigrid Schade Cristian Navarrete Hans von Mühlenbrock Braulio Catalan Gamonal Aws Alani Dental Update 2024 48:1, 707-709.
Authors
Camila CorralNuñez
BDS, MClinDent, PhD, Child and Adult Dental Traumatology Clinic, Department of Restorative Dentistry, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.
DS, Paediatric Dentistry Specialist, Child and Adult Dental Traumatology Clinic, Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.
BDS, Paediatric Dentistry Specialist, Child and Adult Dental Traumatology Clinic, Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.
BDS, Child and Adult Dental Traumatology Clinic, Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.
This report describes the sequelae and subsequent management of a 7-year-old boy who failed to attend follow-up visits after a dental trauma and was initially managed with an active splint. The splint was maintained for 9 months, resulting in an anterior cross-bite, caused by retroclination of the upper incisors. The splint was removed and occlusal build-ups were placed on the molars. Nine months later, the form and shape of the upper dental arch were re-established and the cross-bite was corrected. Four years after the dental trauma, the injured teeth were asymptomatic and had continued root development.
CPD/Clinical Relevance: Splints for dental trauma management should be passive and removed at the requisite time, to avoid the risk of the splint generating a malocclusion.
Article
Splint management for luxated, avulsed, or fractured teeth is a cornerstone of dental trauma management.1,2 Periodontal healing, once a tooth has been repositioned, provides the clinician with a predictable and efficient way to maintain the teeth, thus avoiding the need for complicated and invasive tooth replacement options. In the growing patient, this becomes even more crucial as the patient has yet to fully develop and timely management reduces the burden of treatment throughout the patient's life. Hence, splint therapy is needed, but requires adherence to guidelines and protocols to prevent complications as a result of the splint provision.
In the developing dentition, a concerted effort should be made to maintain pulp vitality and ensure continued root development. This is key as the immature tooth has an immense capacity to heal and continue root development.2 In situations where the pulp loses vitality, the repercussions are severe as the tooth's prognosis diminishes with thin dentine walls and is further compounded and compromised in situations where the root is fractured. In situations where roots are fractured, the remaining tissues have the capacity to heal. The modes through which healing can occur depend on a variety of factors.3,4 Indeed, fractures may present concurrently with other injuries, such as concussion, subluxation, or, in more severe cases, extrusion or lateral luxation of the coronal fragment. Once stabilized, healing can take the form of two broad categories: healing with hard tissue union; or healing with the ingrowth of connective tissue or bone. The former is obviously the more favourable category.5 Something that has changed significantly in the past 20 years is the length of splinting time.1,6 This is relevant as prolonged splinting, which may potentially be caused by failure to follow up, may compromise dentoalveolar development and require further treatment down the line.
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