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Case ReportTraumatic Displacement of Maxillary Permanent Canine intothe Vestibule of the Mouth

Masayasu Iwase,1 Michiko Ito,2 Hanon Katayama,3 Hiroaki Nishijima,4

Hirokazu Shimotori,1Airi Fukuoka,2 and Yoko Tanaka1

Department of Dentistry and Oral Surgery, Hakujikai Memorial General Hospital,-- Shikahama, Adachi-ku, okyo -, Japan

Department of Oral and Maxillofacial Surgery, School of Dental Medicine, surumi University,

-- surumi, surumi-ku, Yokohama, Kanagawa -, JapanDivision of Community Based Comprehensive Dentistry, Department of Special Needs Dentistry, School of Dentistry,Showa University, -- Kitasenzoku, Ota-ku, okyo -, Japan

Department of Dentistry and Oral Surgery, Jinkokai Hospital, -- Nakamachi, Atsugi, Kanagawa -, Japan

Correspondence should be addressed to Masayasu Iwase; iwase@dent.showa-u.ac.jp

Received January ; Accepted April

Academic Editor: Hamdi Cem Gungor

Copyright Masayasu Iwase et al. Tis is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dentoalveolar injuries are common and are caused by many actors. Dental trauma requires special consideration when a missing

tooth or tooth racture accompanies sof tissue laceration. A tooth or its ragment occasionally penetrates into sof tissue and maycause severecomplications. Tisreport presents a case o delayed diagnosis andmanagement o a displacedtoothin the vestibule othe mouth ollowing dentoalveolar injury. Tis report suggests that radiography can lead to an early diagnosis andsurgical removalo an embedded tooth in the sof tissue.

1. Introduction

Dental trauma can result in a number o different injurytypes involving teeth and their supporting structures. Sixtypes o luxation and seven types o tooth racture have beendescribed []. Te requency o lateral luxation and avulsiono teeth leading to a traumatic dental injury increases with

age, while intrusion decreases with age []. A tooth or itsragment may displace anteriorly, posteriorly, or verticallyaccording to the impact energy and direction o the causalagent, as well as the location o the injury and the supportstructure o the involved tooth. Most dentoalveolar racturesare in ront o the maxilla []. Tere have been many reportso tooth ragments embedded in sof tissue accompanyinga tooth racture [], but this case did not involve a toothracture. Furthermore, displacement o teeth most ofeninvolves the central and lateral incisors, while the caninesare rarely involved []. Cases involving displacement o atooth or itsragment into softissue resulting in dentoalveolarinjury have been reported in the tongue [, ], lips [,],

and nasal cavity [,] but are extremely rare in the vestibuleo the mouth. When dental physicians encounter a toothor its ragment accompanying sof tissue swelling and lac-eration subsequent to a dentoalveolar injury, they shouldpay attention to possible displacement o the tooth or itsragment into the sof tissue. Tereore, previous studies haveemphasized that dental physicians should perorm a clinical

examination o the laceration with proper radiography incases o dentoalveolar injury [,,].

Tis paper reports a case o dentoalveolar injury in whicha canine was embedded in the vestibule o the mouth andsurgically removed rom the sof tissue.

2. Case Presentation

A -year-old emale was reerred to the Department oDentistry and Oral Surgery o Hakujikai Memorial GeneralHospital or clinical examination o the lef maxilla withspontaneous pain. Te patient had sustained an injuryto the lower ace days earlier. She promptly consulted

Hindawi Publishing CorporationCase Reports in DentistryVolume 2015, Article ID 360160, 3 pageshttp://dx.doi.org/10.1155/2015/360160

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F : Extraoral view at rst medical examination o lacerative

scar in the lower lip and swelling in the nasolabial sulcus.

F : Intraoral view at rst medical examination o lacerativescar o the gingiva in the lef maxilla.

a neighboring emergency hospital because o laceration othe lower lip and gingiva o the maxilla. Tereafer, she wastreated with suture o the lower lip under local anesthesiaby a general surgeon and was instructed to put pressure onthe bleeding gingiva with gauze. In addition, she lost the lefmaxillary lateral incisor and canine due to trauma. She couldconrm the existence o one o the teeth, but the existence o

theother tooth wasunclear. No treatmentor examination wasprovided or the missing teeth. She received prescriptions orantibiotics and analgesics and returned home. Te bleedingeasily stopped aferwards. However, because o swelling andpain o the lef maxilla, the patient consulted our hospital.

Her chie complaint at the time o the rst medicalexamination was swelling and oppressive pain o the lefmaxilla (Figure ). Intraoral view conrmed swelling o theoral vestibule mucosa in the rst premolar region (Figure ).Panoramic radiography showed a horizontal embeddedcanine (Figure ). C scan showed racture o the alveolarbone in parts o the lateral incisor and canine (Figure ).Based on these ndings, replantation o the canine was not

F : Panoramic radiograph showing horizontally embeddedcanine o the lef maxilla.

F : Axial C showing racture o alveolar bone in the lateralincisor and canine.

an option. Furthermore, C scan showed that the canine

was embedded in the vestibule sof tissue (Figure ). Wedecided to perorm surgical excision o the embedded canineunder local anesthesia (. cc lidocaine in % solution with : , adrenaline) together with intravenous sedationwith midazolam ( mg/body). An incision was then madein the lacerated gingiva, and the embedded canine wasremoved surgically. Fibrous tissue and ragments o alveolarbone surrounding the embedded canine were also curetted(Figures and ). Te incision wassuturedwith . silk suturethreads. Systemic antibiotic ( g omoxe sodium, twice aday or three days) was intravenously administered to thepatient. Analgesic (tramadol hydrochloride/acetaminophen, tablets or pain) was also prescribed to the patient. Te

wound healed avorably and sutures were removed on theseventh postoperative day, and the patient was dischargedrom the hospital.

3. Discussion

Te recognition and identication o an embedded tooth orits ragment are important because continuous movementand contraction o the muscles may dislocate the oreignbodies. Moreover, oral bacteria ora can inect the woundand deep tissues. Failure to remove an embedded tooth or itsragment in the sof tissue may result in persistent chronicinection, pus discharge, or disguring brosis []. Previous

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F : Coronal and axial C showing embedded canine into sof tissue o the vestibule o the mouth.

F : Intraoral view during operation showing exposure oembedded canine into sof tissue o the vestibule o the mouth.

F : Identied and removed permanent canine.

reports have emphasized that radiography, including C,should be a routine diagnostic procedure in all cases withassociated missing anatomical structures in the oral andmaxilloacial region [,]. Involving dental proessionals inthe initial assessment o dentoalveolar injury in emergencyrooms in hospitals is important in orderto identiy how manyteeth might be missing afer dentoalveolar injury.

Tis case report demonstrates the importance o an accu-rate patient history, physical examination, and radiographicevaluation o such a patient. When dentoalveolar injury

occurs,both hard andsof tissue structures must be examinedcareully or evidence o an embedded tooth.

Conflict of Interests

Te authors declare that there is no conict o interestsregarding the publication o the paper.

References

[] E. Lauridsen, N. V. Hermann, . A. Gerds, S. Kreiborg, andJ. O. Andreasen, Pattern o traumatic dental injuries in thepermanent dentition among children, adolescents, and adults,Dental raumatology, vol. , no. , pp. , .

[] B. R. Chrcanovic, S. C. Bueno, D. . da Silveira, and A. L.N. Custodio, raumatic displacement o maxillary permanent

incisor intothe nasalcavity, Oraland Maxillofacial Surgery,vol., no. , pp. , .

[] F. J. Hill and J. F. Picton, Fractured incisor ragment in thetongue: a case report,Pediatric Dentistry, vol. , no. , pp. , .

[] D. G. McDonnell and E. X. McKiernan, Broken tooth rag-ments embedded in the tongue: a case report,British Journalof Oral and Maxillofacial Surgery, vol. , no. , pp. ,.

[] A. C. da Silva, M. De Moraes, E. G. Bastos, R. W. F. Moreira, andL. A. Passeri, ooth ragment embedded in the lower lip aferdental trauma: case reports, Dental raumatology, vol. , no., pp. , .

[] A. A. Antunes, . S. Santos, A. U. Carvalho De Melo, C. F.

Ribeiro, S. R. J. Goncalves, and S. De Mello Rode, oothembedded in lower lip ollowing dentoalveolar trauma: casereport and literature review,General Dentistry, vol. , no. ,pp. , .

[] A. H. B. Luna, R. W. F. Moreira, and M. de Moraes, raumaticintrusion o maxillary permanent incisors into the nasal cavity:report o a case,Dental raumatology, vol. , no. , pp. , .

[] .-C. ung, Y.-R. Chen, C.-. Chen, and C.-J. Lin, Fullintrusion o a tooth afer acial trauma,Te Journal of rauma,vol. , no. , pp. , .

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