Document Type : Case Report
Authors
- Ahmad Nouroloyouni 1
- Avissasadat Meraji 2
- Rouzbeh Javanshir Heidari 3
- Omid Dianat 4
- Sara Noorolouny 5
- Sepehr Nouroloyouni 6
1 Dept. of Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, Boston, MA, USA.
2 Dentist, Dept. of Periodontics, School of Dentistry, Ardabil University of Medical Science, Ardabil, Iran.
3 Postgraduate Student, Dept. of Prosthodontics, Nova Southeastern University, Fort Lauderdale, FL, USA.
4 Division of Endodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA.
5 Dept. of Pediatric Dentistry, School of Dentistry, Ardabil University of Medical Science, Ardabil, Iran.
6 Dentist, Dept. of Orthodontics, School of Dentistry, Islamic Azad University, Tehran, Iran.
Abstract
Guidelines emphasize immediate management of traumatic dental injuries (TDIs), yet evidence for delayed presentations involving combined root fracture, luxation, endodontic infection, and soft-tissue defects remains limited. This case report describes multidisciplinary tooth preservation and oral rehabilitation in a 39-year-old female who presented 3 months after a motor vehicle accident. Clinical and radiographic examination revealed a cervical-third horizontal root fracture of tooth #9 with grade III mobility and negative pulp sensibility tests, and laterally luxated teeth #24 and #25 with pulp necrosis and periradicular radiolucencies; tooth #24 additionally exhibited external root resorption and hard- and soft-tissue fenestration. Management included staged endodontic disinfection, long-term calcium hydroxide medication, mineral trioxide aggregate apical barrier placement, extended semi-rigid splinting, periradicular surgery, and guided tissue regeneration using freeze-dried bone allograft and a resorbable collagen membrane. At 12 months after treatment initiation, all treated teeth remained in situ and functional. The patient reported no pain or functional limitation; no swelling, sinus tract, recurrent fenestration, or other adverse event was detected. Moreover, the radiographs demonstrated healing of the lesions associated with teeth #24 and #25 and radiographic findings consistent with healing at the fracture site of tooth #9. This case illustrates that selected delayed TDI presentations may still be managed conservatively by adapting acute-trauma principles to the clinical findings, defect morphology, and patient preference.
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