A Case Of Root Fracture With Avulsion And Delayed Replantation

Avulsion and root fracture represent the two most severe forms of traumatic dental injuries. One of the crucial goals in the treatment of traumatized is to maintain the space and site until the child reaches adulthood. A 7-year-old child experienced a root fracture of the right maxillary permanent incisor, with the crown segment being avulsed and preserved in saline for 12 hours. No pulp tissue was observed within the pulp cavity of the avulsed segment. The residual fractured root was in the alveolar bone. The root development is at Nolla stage 7. No radiographic evidence showed alveolar ridge or mandibular fractures. We performed a gingival flap surgery to expose the fractured surface of the tooth, replanted the avulsed coronal segment, and stabilized it. Subsequently, we accessed the pulp chamber, induced bleeding from the apical region below the enamel-cementum junction, and applied a filling. Nearly two years postoperatively, the tooth root continued to develop, and the replanted segment remained stable without any mobility. Replacement resorption is a common complication following delayed replantation. However, in this particular case, the avulsed root fragment is situated near the cervical region of the tooth due to the root fracture, and the periodontal ligament (PDL) of the remaining root is healthy. Additionally, successful revascularization was achieved in the pulp cavity of the coronal segment. No replacement resorption has been observed to date. In delayed replantation, the use of revascularization may reduce ankylosis/replacement resorption and promote the establishment of a functional healing response.