Planning esthetic treatment after avulsion of maxillary incisors

When a young patient accidentally loses two neighboring maxillary incisors, the choice of treatment plan is difficult. Although implant restorations are a popular option, they cannot be placed until skeletal growth is finished. Furthermore, the use of two neighboring implant crowns represents a considerable challenge from an esthetic point of view. This case report describes an innovative solution that combined autotransplantation of a developing premolar and orthodontic space closure.

An 11-year-old girl sought treatment for avulsion of both her maxillary right lateral incisor and her central incisor, which occurred as a result of a horseback-riding accident. Replantation by her general dentist was unsuccessful. An oral surgeon transplanted the mandibular right second premolar to the injury site, and the author moved the maxillary right quadrant mesially to close all spaces. The first premolar was intruded, and the canine extruded, to provide normal marginal gingival contours. A prosthodontist, working with his dental technician, restored the "abnormal" crowns with three porcelain veneers. The outcome was almost indistinguishable from a natural dentition.

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When faced with treating severe traumatic injuries in growing patients, even after avulsion of incisors, clinicians working in cooperation can optimize the outcome. A combination of transplantation and space closure may represent the best treatment option, particularly when coupled with elements of esthetic dentistry. The advantage of this approach is that a concomitant malocclusion can be treated simultaneously, and that the treatment result is permanent. Interdisciplinary cooperation between orthodontists and other dentists, such as oral surgeons, prosthodontists and general practitioners, appears to be of increasing importance in achieving high-quality treatment results in such cases.