Clinical Management For Immature Dilacerated Mandibular Incisor With Apical Periodontitis

Dilaceration combined with enamel dysplasia could be found following severe trauma of the primary predecessor. Apical periodontitis of immature dilacerated mandibular incisors usually happens, and multiple challenges in clinical management exist. A 6-year-old female child reported the chief complaint of pain in the left lower anterior teeth for 7 days, aggravated for 1 day accompanied by swelling of the lower lip. The patient complained of masticatory pain, nocturnal pain, and spontaneous pain. The parents reported that the primary predecessor had intrusion trauma 4 years ago, and the traumatized tooth fell off spontaneously 1 year ago, followed by the eruption of the permanent tooth with curved crown. Clinical and radiograph examination revealed a dilacerated and immature tooth #31 with an acute exacerbation of chronic periapical periodontitis. Initially, apexification was performed, and follow-up was done for 3 years. Subsequently, as the root failed to develop maturely, an apical barrier treatment was carried out. Later, a transverse crown fracture happened, and a strip crown of the primary maxillary lateral incisor was used for composite resin restoration. The dilaceration was probably a consequence of the previous trauma, and the periapical inflammation might be attributed to the tooth structure defects. Treatment strategies were tailored according to the evolving condition of the tooth. For pediatric cases involving dilacerated teeth and associated complications, customized and comprehensive treatment plans and extended follow-up are essential to balance optimal tooth development and favorable prognosis, further improving the life quality of patients.