Odd sequelae of severely traumatized teeth following an accident

ODD

SEQUELAE

FOLLOWING Report

M

OF SEVERELY

TRAUMATIZED

TEETH

AN ACCIDENT

of a Case

AIVY bizarre seyuelae involving thv teeth arc swn following automobile accidrnts. (‘lassifications of injuries and suggested trcatnient plans for the accident patient arc plentiful in the dental literatuw.‘-” The severity of the trauma in these cases generally determines the extent of injury to the pulp and periodontium and thus proportionately affects the prognosis of the teeth. Irrespective of the irritant, inflammation always takes place within the conncctivc tissu(~.4 When the hard structures of the teeth arc severely traumatized, causing coronal fracture or incipient pnlpitis without Ifraet,ure, inflammation usually occurs within the mcscnchymal connective tissue of the pull). Necrosis of the pulp predisposes the pcriradicular m(‘scnchvmal struct,urcs IO inflammation. In casts 01 radicular fracture. luxation, or avulsion, the illflammation usually takes place within the conncctivc tissue of the pcriotlontiunl, namely, the alveolar bone, t,he periodontal connective tissue, and the wmcntum. Perhaps inflammation newr occurs in t,hc boric, pt’r se, but within the connwtivc tissue of t,he pwiosteum and the connective tissue of the n~cdullal+~ SJKWCS. IIowever, t raluna eiln initiate combinations of pulpal and periodontal inflammation concomitantly. The case to be reported demonstrates t,he bizarre sequelwe that Cilll result from scvcre traumatic injury.

Wiu.

Fig. fractured Fix.

l.-Clinical mandibular 2.-Complrte~I

The maxillary xplmt was followed of the teeth during six weeks after the lateral root aspects The roentgenograms

appearance of accident segment anc( extent of enrcr~vn<‘y twatnwnt.

I

patient luxation July

on July 6. 1959. of maxillary right 6. 1959.

to remain ill pla~r splint \~a;; a Ilonc~l by srlectivtgrintliug of the anierior swallowing and mastirxtory (x(sursionR acxidcnt show~l largca L ( (xppcd-out ’’ of th(, maxillary right lntc~rxl and both of the mandibular teeth exhibited no

for lour tcseth to ( Fig. 6 i,Wf,S of central cvidencc

Note ~lisglacement latrral incisor.

of

weeks. K~m~val of the: prcsvclnt c>srcassivr cdontact ) Roc~ntgcnograms taken rorntgPnolueenc~$ 011 tilt incisors (Figs. 7 and 8). of pathosi%

Fig.

3.-Postowrative

Fig.

4.

clinical

appearancr

on

July

Fig.

37,

1959

5.

Fig.

1 I.--Clinical

appearance

of

of patient attached

on 31a.y ginqira

29, 1961. is clearly

Teeth ileflnml.

are

normal

in

color.

ark11 zonr

A\lthough reports of scverclg displaced teeth in a segment with hontr arc sparse, Hare” reported a cast of severely traumatized mandibular teeth similal to the present case. The sequelac were at variance, hut an excellent, result was ol~tainctl 1,~ endodontic procedures. A review of the literature regarding peripheral resorption reveals that tht> (:ottlich and Orhan’” rrportcd that resorption of cause is somewhat obscurr. the root occurs when the metabolism of the cemcntum is impaired l-j>- tearing away thn fibers of the suspension mechanism ot’ th(b periodontal mctmhranc~. Nygaard-osthy” stated that rupture of the vessels 01’ the I)eriodontium and bleeding within the confined spaces between the hone and eementum lcad to the formation of granulation tissue, which precipitat cs ostcoclasis. BourncL2 also stated that resorption of hone may accompany intense hypcrcmia and granulation Cssue. Thoma and Goldman’” affirmed that peripheral resorption is lxought about hy vascular granulation tissue and inferred that it ma\- 1~ induced by the prolonged effects of a local inflammation. Simons has c:on,jecturrd that possibly esut hc mechanism can be cxplaincd on the hasis of the pII of the inflammatory date which hecomes progressively acid in chronic inflammation. resulting in a local acidosis. Henry and Weinnlann14 cited trauma as the most common cause of resorption of the ccmentum. These investigators alsc noted tllilt compression. cash-