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Dentistry www.dentistry.co.uk
6 February 2014
clinical
Patient details
History
Presenting complaint
The patients chief complaint was her
fractured front teeth that she did not like
the appearance of.
History of presenting complaint
History of presenting complaint revealed
that she had suffered trauma in November
2011, when she had fallen in the school
playground and knocked her front teeth on
metal railings. Both upper central incisors
had fractured, but there was no obvious
displacement at the time of injury.
No loss of consciousness or head injuries
had been noted, but there was a laceration
to the upper lip.
She initially attended Heartlands
Hospital, from which she was referred to
Birmingham Childrens Hospital for a chest
X-ray, as the tooth fragments had not been
accounted for. The chest X-ray reported no
abnormalities.
The patient then saw her GDP one day
after the injury, and had adhesive composite
restorations placed on the UR1 and UL1.
However, these were subsequently lost after
six weeks, and were not replaced.
Medical history
The patient suffers from asthma and uses
Ventolin and Becotide inhalers as and when
required. She has not had any previous
hospitalisations due to her asthma.
Dental history
There is no history of any other previous
trauma. Cooperation appeared to be
reduced as the patient had not had any
previous extensive dental treatment, and
Examination
Extraoral
Scarring was noted in the midline of the
patients upper lip; she had sustained a
Figure 1: Preoperative periapical
laceration to this area at the time of injury. radiographs
Intraoral
Soft tissues: oral hygiene was fair, but some
gingival inflammation was present. Hard
tissues: teeth present were upper right, lower
right, upper left, lower left 1, 2, c, d, e, 6.
Unrestored, enamel-dentine fractures
were evident on the UR1 and UL1, with the
UL1 fracture being fairly extensive. Caries
was noted on the LLd.
and UL1
2. Likely non-vital UR1; chronic apical
periodontitis secondary to trauma
3. Caries LLd
4. Anxious patient.
Treatment options
Treatment plan
Radiographic examination
Periapical radiographs
Long cone periapical radiographs UR2
and UR1, UL1 and UL2 (Figures 1 and
2) revealed open apices on all maxillary
incisors, and periodontal ligament (PDL)
widening around the apex of the UR1. It
also showed the unrestored enamel-dentine
fractures on both maxillary central incisors.
Figure 3 shows a radiograph confirmed
PDL widening around the UR1, with
associated periapical pathology. It also
shows the open apices of all four upper
incisors, as well as the presence of maxillary
canines.
Soft tissue X-ray
The soft tissue radiograph of the upper lip
revealed no abnormalities, and no evidence
of any tooth fragments in the lip.
Diagnoses
Dr Rupal Shah BDS (Hons) MJDF RCS (Eng). Rupal qualified from Kings
College London Dental Institute. After graduating with honours, she
successfully obtained a DFY1 (dental foundation year) position in London.
Thereafter, she commenced a DFY2 post in oral surgery and paediatric
dentistry at Birmingham Dental Hospital, and is currently working as a dental
core trainee in restorative dentistry. She has a keen interest in orthodontics,
endodontics and periodontology.
In her final year of dental school, she was also awarded the A.M. Clover prize,
and was vice-president for KCL Dental Society.
She has travelled to Vietnam with a charity called East Meets West, and was involved in
providing dental care to disadvantaged children in rural Vietnam.
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32
Dentistry www.dentistry.co.uk
6 February 2014
clinical
Figure 8: Postoperative
radiograph
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Review
Discussion
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