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Neuroradiology Case of the Week
Case 276
Ashwani K. Sharma, MD, and P-L Westesson, MD, PhD, DDS
Clinical
Presentation: A
20-year-old baseball player ran into fence.
Imaging Findings: Absence of tooth from the socket, fracture of the tooth are the imaging features along with a fracture of the alveolar ridge.
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| Figure 1B |
Figures 1A&B show absence of right upper canine from its socket (avulsed) with fracture of the upper second right incisor along with fracture of the right alveolar ridge.
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Diagnosis: Canine tooth avulsion
Discussion: Tooth avulsions occur when a tooth is displaced from its socket.
Avulsion is a complex injury affecting the pulp, periodontal ligament and the alveolar bone. Avulsed permanent teeth can survive following replantation. However, post-traumatic external root resorption eventually resulting in loss of the traumatized tooth is a frequent finding [1]. As avulsions mostly occur in children and adolescents, ankylosis following replantation of avulsed permanent incisors may also affect the growth of the alveolar ridge, and the eruption and position of the adjacent teeth [2].
Basically, three tissues are involved in healing after replantation of an avulsed tooth: pulp tissue, periodontal ligament, and alveolar bone of the tooth socket [3]. Following trauma, the pulp can show three healing modalities: pulp survival, pulp obliteration, or pulp necrosis. The latter plays an important role in the development of post-traumatic external root resorption, and therefore, the term 'pulpal infection root resorption' has been suggested [4].
References:
- Andersson L, Bodin I, Sörensen S. Progression of root resorption following replantation of human teeth after extended extraoral storage. Endod Dent Traumatol. 1989 Feb;5(1):38-47. [Medline]
- Ebeleseder KA, Friehs S, Ruda C, Pertl C, Glockner K, Hulla H. A study of replanted permanent teeth in different age groups. Endod Dent Traumatol. 1998 Dec;14(6):274-8. [Medline]
- Chappuis V, von Arx T. Replantation of 45 avulsed permanent teeth: a 1-year follow-up study. Dent Traumatol. 2005 Oct;21(5):289-96. [Medline]
- Fuss Z, Tsesis I, Lin S. Root resorption--diagnosis, classification and treatment choices based on stimulation factors. Dent Traumatol. 2003 Aug;19(4):175-82. [Medline]
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