title: Comprehensive management of a complex traumatic dental injury.
abstract: A 24-year-old female patient presented with complaint of palatal swelling and a sinus tract facial to tooth #22. She reported an injury to the tooth 15 years earlier and no recollection of treatment, although there was evidence of an endodontic access into the crown. Radiographically the root appeared to have stopped developing, and it was associated with a large periapical lesion. After 3 unsuccessful attempts at apexification using calcium hydroxide (CH), further examination including use of cone-beam computed tomography (CBCT) was carried out. The latter allowed for better evaluating the situation and for better planning a more comprehensive treatment plan to include surgical removal of the apical lesion. The large radiolucent area extended from tooth #21 to #23. Using a dedicated software tool developed to be used in conjunction with CBCT, volumetric assessment of the lesion was carried out for healing follow up. The root end was filled from the apical direction with newly developed accelerated silicate cement 4-5 mm into the apical part of the canal. Subsequently, the rest of the canal was filled with the same type of cement. At the 1-year postsurgical follow up, the tooth remained asymptomatic, and using the CBCT volumetric program, bony healing could be demonstrated.
authors.affiliation: Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cotti
authors.affiliation: Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Esposito
authors.affiliation: Department Oral health Scienced, Head Oral Imaging center, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Reinhilde
authors.initials: R
authors.lastname: Jacobs
authors.affiliation: Medical Image Computing, ESAT/PSI, Department of Electrical Engineering, University of Leuven, Leuven, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Slagmolen
authors.affiliation: Department of Endodontics, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Leif K
authors.initials: LK
authors.lastname: Bakland
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D018677:Tooth Injuries / Q000628:therapy*; D055815:Young Adult
keywords: dental trauma; permanent tooth; treatment