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Case Study
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Dental Treatment Following a Sports Injury

A Case Report

Case Presentation  

A 20-year-old female collegiate basketball player presented with an injury to one of her maxillary incisors, brought on as a result of being struck by the elbow of another player. The patient was not wearing a mouthguard during the incident, and the incisor had been knocked out of position. The injury was initially cleaned and examined by the patient’s trainer; the patient presented to the office for complete treatment two days following trauma.

Upon examination, tooth #9(21) was found to be laterally displaced, lingually and incisally. The patient reported the tooth was making contact with her mandibular dentition and exhibiting temperature sensitivity (Figures 1 and 2). This tooth had been previously injured and was improperly positioned prior to presentation. Approximately 1.5 mm to 2 mm of mobility was evident, and the tooth responded positively to palpation and percussing (ie, a high ping sound). It was also confirmed to have a hyperocclusion with the opposing arch. Radiographically, the tooth appeared within normal limits, with a slight widening of the periodontal ligament. The diagnosis was a lateral luxation of tooth #9, which, according to the American Academy of Endodontists and International Association of Dental Traumatology, is classified as a subluxation injury.2-4 An intraoral and extraoral exam was still performed to assess any other areas of concern. The patient’s remaining teeth appeared to be within normal limits and asymptomatic.


Treatment Planning and the Role of the Dental Professional  

The dental professional approached treatment planning by applying the American Academy of Endodontists and International Association of Dental Traumatology’s general guidelines for treatment of permanent teeth with dental injuries.2-8 The treatment plan was to reposition tooth #9 and place a traditional, non-rigid splint for the next two to three weeks. While alternative techniques may have been employed (eg, malleable mesh for the arch bar), the traditional approach was favored.9 The patient was recommended not to play or practice for the next day. Follow-up appointments with both the clinician and hygienist present were planned as well.

The dental professional must provide instructions and guidance to the traumatized patient on how to take care of the injured teeth during the recovery period. As follow-up treatment in this case, the dentist recommended the patient to employ a soft-food diet or to cut her food into small pieces. The patient was further instructed to chew using the posterior teeth, and to avoid any biting with the anterior dentition. The dentist also instructed the patient to brush her teeth with a soft toothbrush after every meal and to carefully floss each day. A prescription of chlorhexidine was given to the patient with instructions to rinse twice a day for the next two weeks.


Clinical Treatment Modality  

One cc of 2% Lidocaine with 1:100,000 epinephrine was administered locally in the area of tooth #9. Once anesthesia was established, tooth #9 was repositioned by applying pressure on the region of the apical third of the root by pushing lingually, and on the clinical crown by pulling facially (Figures 3 and 4). The patient reported the tooth position felt improved and was no longer making contact with her mandibular dentition. Although the tooth was not fully in arch alignment with the adjacent dentition, the patient confirmed that the positioning was correct (Figure 5). The patient reported that tooth #9 was never in the proper position from her history of having this tooth injured. A non-rigid wire was fitted from teeth #8(11) to #10(22).

Using teeth #8 and #10 as abutment anchors for the splint, a small circular amount of bonding agent was placed on the lingual surfaces of these teeth and light cured for 10 seconds. Composite buttons were placed in these areas. No acid etching was necessary, as the composite would be removed once treatment was completed. The non-rigid wire was positioned onto the composite and light cured for 40 seconds (Figure 6). Centric occlusion with lateral excursive movements was checked with articulating paper, and any interference was removed.

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