Delayed presentation of a closed apex tooth intrusion and missing tooth fragment located in the lip

Introduction<br/>Intrusive luxation (IL) injuries are rare, representing 0.3-2% of all dental injuries to permanent teeth. Prompt treatment reduces unfavourable outcomes with root resorption common in IL injuries. However, evidence for delayed IL management is limited due to the injury rarity and predominance of evidence provided from early management of cases.<br/><br/>Clinical Case<br/>A 70-year-old female attended the Oral and Maxillofacial Surgery Department (OMFS) on the day of a traumatic fall. Her lip laceration was sutured, but no management of dental trauma provided. Her General Dental Practitioner referred her back to OMFS three days later but was told that they do not manage dental trauma.<br/><br/>The patient had no further management until presentation to the Restorative Dentistry Department one month later. Diagnoses made: Intrusive luxation (5mm) UL2, lateral luxation with pink intrinsic crown discolouration UR1, UL1, and enamel fractures of all three teeth. Soft tissue radiographs showed a missed tooth fragment within the upper lip.<br/><br/>Treatment: Oral Surgery colleagues removed the tooth fragment from the lip. UL2 was surgically repositioned and splinted for 4 weeks. UR1, UL1, UL2 were root canal treated, followed by internal and external bleaching. Clinically and radiographic follow-up was as per International Association of Dental Traumatology (IADT) guidelines. At 1-year radiographic follow-up periapical healing was apparent UR1, UL1. Potential early signs of root resorption on the UR1 and UL1 which will be closely monitored.<br/><br/>Conclusion<br/>IADT guidelines facilitate efficient management of dental trauma, however, there remains potential for delays and mismanagement which may lead to increased patient anxiety, number of appointments and unfavourable outcomes. Little is published on the impact of delayed presentation on outcomes. Further training and educational resources are required to facilitate translation of IADT guidelines into clinical practice. These are being developed and piloted within NHS Tayside in Scotland.