Clinical Management of Orofacial Trauma Including Multiple Avulsions, Lateral Luxation, and Alveolar Fracture: A Case...

The occurrence of different types of trauma concomitantly can complicate the establishment of the most appropriate treatment. This report describes the clinical management of orofacial trauma including multiple avulsions, lateral luxation, alveolar fracture, and their sequelae after 7 years of follow-up. A 19-year-old woman presented to emergency care 4 hours after an accidental fall that resulted in the avulsion of teeth #8, #9, and #25; a complicated crown fracture and lateral luxation of tooth #7; an uncomplicated crown fracture of tooth #10; and a fracture of the maxillary alveolar bone. Only teeth #8 and #9 were located by the patient. The immediate treatment included surgical reduction and extrusion of the lateral luxation, delayed replantation of the avulsed central incisors, nonrigid splint stabilization, and suturing of gingival lacerations. Subsequent visits involved removal of the splint, root canal treatment of the maxillary incisors, implant placement to replace the avulsed mandibular incisor, and esthetic rehabilitation with composite resin. At the 5-year follow-up, cone beam computed tomography revealed advanced surface root resorption in the replanted incisors. At the 7-year follow-up, an aggravation of inflammatory resorption in the replanted incisors was observed. This report demonstrates that adequate knowledge of trauma management by clinicians is essential for the effective management of more complex cases. It also highlights the importance of long-term follow-up in cases of avulsion and replantation due to potential long-term sequelae.