Emergency Endodontic and Prosthetic Management of Complex Dental Trauma at sea: A Case-based Insight

INTRODUCTION Traumatic dental injuries account for 5% of the total physical injuries requiring medical intervention.[1] Dental trauma in remote maritime environments poses unique challenges due to the absence of immediate shore-based care.[2] This short communication highlights the successful emergency management of a traumatic dental injury at sea. The trauma caused a complicated crown fracture and tooth avulsion in a seafarer. This short communication showcases successful management of the case in the maritime setting using available materials by a trained dental professional, mitigating functional and esthetic consequences at sea. CASE SUMMARY A 22-year-old male sailor presented with severe pain and esthetic concerns following dental trauma sustained during onboard activity. Clinical and radiographic assessment revealed a complicated crown fracture in tooth #11 (maxillary right central incisor) and complete avulsion of tooth #21 (maxillary left central incisor). The avulsed tooth was lost overboard, precluding reimplantation [Figure 1].Figure 1: Preoperative frontal viewManagement approach Endodontic treatment A single-visit root canal therapy was carried out onboard on tooth #11. A hybrid instrumentation protocol with hand and rotary files was used. Copious irrigation, intracanal medicament, and cold lateral obturation with gutta-percha were done. An AH Plus sealer was used to complete the obturation under strict infection control [Figure 2].Figure 2: Obturation of fractured 11Temporary esthetic rehabilitation A prefabricated polycarbonate crown was customized and bonded as a fixed partial denture (Maryland bridge type) to replace tooth #21. The fractured tooth #11 was restored with light-cure composite resin. The Maryland bridge was stabilized using flowable composite and a stainless-steel wire splint bonded to adjacent teeth. The treatment done in the constraints of a ship-based dental center provided both esthetic and functional rehabilitation [Figure 3].Figure 3: Pre- and postoperative frontal viewClinical significance This case demonstrates: The feasibility of performing complex dental procedures at sea using limited resources The functional and psychological benefit of immediate esthetic rehabilitation The value of having a dental officer onboard, trained in managing dental trauma beyond basic emergency measures. DISCUSSION Traumatic dental injuries, particularly in anterior teeth, can significantly impair function and morale in seafaring personnel.[3,4] While reimplantation is the preferred mode of treatment for avulsed teeth, this may not be possible in situations where it is not possible to recover the tooth.[5] In remote locations like the maritime setting, when reimplantation is not possible, temporary solutions like a bonded Maryland bridge can serve as an effective interim prosthesis.[6] The fabrication of these interim replacements may need to be modified using materials such as composite resins or polycarbonate crowns based on availability.[7] Root canal treatment at sea requires careful aseptic technique, highlighting the need for appropriate equipment, infection control protocols, and training.[8] This type of interim prosthesis has the disadvantage of frequent debonding and food lodgment, leading to caries initiation.[9] Hence, they need to be replaced with a more permanent prosthesis over time. Since not all naval vessels are staffed with dental surgeons, basic training for medical professionals on dental trauma will enhance management at sea. Inclusion of dental trauma management protocols as a part of onboard first aid could augment readiness and reduce long-term complications. CONCLUSION Timely, resourceful, and technically sound dental care can be delivered even in constrained maritime environments. The combined endodontic and prosthetic management in this case ensured pain relief, restored function, and maintained the seafarer’s morale, reinforcing the importance of specialized dental expertise in the maritime scenario. The incorporation of basic dental trauma management for paramedical staff and medical professionals on board will enhance overall patient outcomes. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.