Interdisciplinary treatment of a patient with a completely avulsed central incisor and an unerupted mesiodens – case report

Introduction
Injuries to permanent teeth involving the periodontal tissues in paediatric patients are a clinical challenge requiring multidisciplinary treatment.

Aim
The aim of this paper is to present treatment of a patient after complete avulsion of a permanent maxillary incisor, with the restoration of the lost bone of the alveolar process by introducing a supernumerary tooth into the arch.

Material and methods
The role of an orthodontist in traumatic dental and periodontal injuries involves not only controlling or modifying the teeth position but also requires preserving the original dimensions and shape of the alveolar process. In addition to standard X-ray diagnostic methods, cone-beam computed tomography can be an essential aid in the diagnostic and therapeutic process.

Case report
An eight-year-old boy sustained an injury to the maxillary right central incisor, along with a fracture of the alveolar vestibular plate. Due to the extent of this injury and inadequate management in the first hours after the injury, progressive periodontal inflammation was observed. A dental radiograph revealed the presence of a mesiodens near the apex of tooth 11. The structure and position of the supernumerary tooth were analysed using CBCT scans. The decision was made to extract tooth 11, and the process of mesiodens eruption was observed, allowing for orthodontically-assisted space maintenance in the dental arch. After eruption and restoration, the tooth showed no pathological mobility, and a clinical examination and follow-up CBCT showed bone regeneration at the site of injury.

Summary
Multidisciplinary management supported by diagnostic data from CBCT scans increased the chance of a proper assessment of the prognosis and of making clinically difficult decisions that were beneficial for the patient in the long term. Any permanent tooth with uncompleted root development, regardless of its anatomy, is critical in producing and preserving the shape of the surrounding bone, as it widens the range of therapeutic methods that can be used.