牙髓治疗通常是管理牙齿创伤的直接或长期后果的一线程序。特别是在脱位或撕脱的情况下。未能在短期或中期内处理创伤会导致重大的功能或美学后果,尤其是在青春期。在这种特定条件下,牙髓治疗可以通过将预后不良的牙齿保留在牙弓上,同时等待更好的解剖学条件进行种植,从而提供临时解决方案。此临床病例旨在描述一名10岁男性患者的上颌骨-面部牙齿创伤的处理以及以下后果。临床和放射学检查显示11和21完全突出脱位,12和22侵入脱位。创伤后六个月进行了11和21的牙髓治疗。两年后,患者被转诊至牙髓科,因为宫颈侵入性吸收导致12日和22日出现粉斑病变(12例出现III级,22例出现II级).进行了12的牙髓治疗和22的复合树脂填充。在接下来的两年里,并发症管理最终导致放置了四个OBI®(Euroteknika,Sallanches,法国)所有四个上颌切牙撕脱后的微型植入物。姑息性牙髓治疗有助于维持假体空间和未来植入物放置所需的支撑组织体积。使用延迟程序(姑息性牙髓治疗和微型植入物)的兴趣是允许患者完成生长。青少年创伤早期治疗失败的管理必须是多学科的,应该考虑到治疗难度的评估,牙髓治疗的预后,可用骨量和青春期生长阶段。
Endodontic treatment is often the first-line procedure to manage the immediate or long-term aftermath of dental trauma, particularly in cases of luxation or avulsion. Failure to manage trauma in the short or medium term leads to significant functional or aesthetic consequences, especially in the adolescence period. Under this specific conditions, endodontic treatment could provide a temporary solution by keeping teeth with poor prognosis on the arch while waiting for better anatomical conditions for implantology. This clinical
case aimed to describe the management of a maxilla-facial dental trauma and the following consequences in a 10-year-old male patient. Clinical and radiological examination showed complete extrusive luxation of 11 and 21 and intrusive luxation of 12 and 22. Endodontic treatment of 11 and 21 was performed six months after the trauma. Two years later, the patient was referred to the endodontic department because pink spot lesions appeared on 12 and 22 due to cervical invasive resorptions (class III for 12 and class II for 22). Endodontic treatment of 12 and filling with resin composite of 22 were performed. During the following two years, complication management finally led to placement of four OBI® (Euroteknika, Sallanches, France)-type mini-implants after avulsion of all four maxillary incisors. Palliative endodontic treatment helped maintain the prosthetic space and the volume of supporting tissue needed for future implant placement. The interest of using delaying procedures (palliative endodontic treatments and mini-implants) was to allow the patient to complete growth. Managing early treatment failure of trauma in adolescents has to be pluridisciplinary and should take into account the evaluation of the treatment\'s difficulty, the prognosis of the endodontic treatment, the available bone volume and the pubertal growth stage.