|Year : 2013 | Volume
| Issue : 1 | Page : 52-55
Tooth fragment embedded in the upper lip after dental trauma: A case report presenting an immediate diagnostic approach and complete rehabilitation
A Agarwal1, U Rehani2, V Rana1, N Gambhir3
1 Reader, Subharti Dental college, Meerut, Uttar Pradesh, India
2 Head Of the Department, Pedodontics, Subharti Dental college, Meerut, Uttar Pradesh, India
3 Postgraduate Student, Department of Pedodontics, Subharti Dental college, Meerut, Uttar Pradesh, India
|Date of Web Publication||27-May-2013|
A-1/6, Ram Kishor Road, Civil Lines, New Delhi
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Dental traumas are reasonably common, especially in children and adolescents. They are caused by many factors with fall accounting for the most frequent one. Dental trauma requires a special consideration when dental fractures accompany soft tissue lacerations. Dental fragments occasionally penetrate into soft tissue and may cause severe complications. Early diagnosis and surgical removal of these fragments could prevent undesirable foreign body reaction and scarring. This report presents immediate diagnosis and management of a case in which dental fragment was embedded in the lip soft tissue.
Keywords: Dental trauma, tooth fragments, upper lip
|How to cite this article:|
Agarwal A, Rehani U, Rana V, Gambhir N. Tooth fragment embedded in the upper lip after dental trauma: A case report presenting an immediate diagnostic approach and complete rehabilitation. J Indian Soc Pedod Prev Dent 2013;31:52-5
|How to cite this URL:|
Agarwal A, Rehani U, Rana V, Gambhir N. Tooth fragment embedded in the upper lip after dental trauma: A case report presenting an immediate diagnostic approach and complete rehabilitation. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2019 Jul 20];31:52-5. Available from: http://www.jisppd.com/text.asp?2013/31/1/52/112415
| Introduction|| |
Dentoalveolar complex injuries are common and are caused by many factors including falls, assaults, vehicle accidents, sports- and work-related injuries. Among these incidents, fall, traffic accidents and sports activities account for the most common etiologic factor. ,,, The pattern and the frequency of dentoalveolar injuries are variable and are highly dependent on the age and gender of the patient at the time of trauma, type of etiologic mechanism, location of the incidence, direction and the energy of impact, and the periodontal health of involved teeth. The type of dentofacial injury is also related to the age and gender. Children and teenagers are mostly affected, with boys considered as being at a higher risk than girls.  The exarticulations and luxations are more common in deciduous dentition while the incidence of crown-root fractures are higher in permanent dentition. 
Many studies have suggested the higher prevalence of the incisors' trauma during childhood and adolescence, which can range from 10 to 20%, according to sex and age of patients.  The reason for the increased vulnerability of the maxillary incisors is because of the projection of anterior teeth and is also due to the short upper lip that does not protect these teeth adequately. 
The incisors, particularly when fractured, are quite often the cause of laceration of soft tissue at the time of trauma. When soft tissue is lacerated, attention should be paid to the fractured or missing teeth. If laceration and bleeding make the clinical examination difficult, a simple soft tissue radiograph helps in the detection of included tooth fragment.
An accurate diagnosis and efficient management is of importance in dental injuries and is particularly true in cases where maxillary anterior teeth are involved in the pediatric patient population because of the physical and psychological trauma that is associated with the injury.
This article describes an immediate diagnostic approach in a patient presenting with a fractured incisor and an upper lip laceration following orofacial injury.
| Case Report|| |
A 12-year-old female reported to the department of Pedodontics and preventive dentistry at Subharti Dental College, Meerut, with the chief complaint of injury to the lip and teeth after she fell on the ground while playing. An extraoral evaluation showed lacerations on the right side of the upper lip. Also, there was swelling present on the same side [Figure 1].
A thorough intraoral examination revealed a fracture of the permanent right maxillary central incisor involving enamel, dentine and pulp. Also, fracture of right maxillary lateral incisor involving the enamel was seen. There was neither any evidence of root fracture nor a pathological periapical alteration, determined by a periapical radiograph [Figure 2]. The patient did not experience a loss of consciousness but she was unaware of the fractured tooth fragments.
Considering the soft tissue edema and the fractured crown with the patient history, an intraoral periapical radiograph of the upper lip was conducted. Radiopaque tooth fragments embedded in the upper lip were observed [Figure 3]. The patient was submitted to a surgical excision of the fragment under local anesthesia. After administration of 2% solution of 1:100000 epinephrine, an incision was made in the upper lip. The dental fragment was identified and removed gently [Figure 4] and [Figure 5]. A radiograph was obtained to confirm the complete removal of the fragments [Figure 6]. Sutures were placed and antibiotics prescribed [Figure 7]. Tetanus prophylaxis was provided. The patient was seen 1 week postoperatively and sutures were removed [Figure 8]. Two weeks postoperatively, root canal treatment was conducted for the same tooth, a glass fiber post was given and the crown was restored with acrylic crown [Figure 9] and [Figure 10].
|Figure 2: Intraoral periapical radiograph of maxillary anterior region showing fractured right central and lateral incisors|
Click here to view
|Figure 3: Intraoral periapical radiograph of lip showing embedded tooth fragment|
Click here to view
|Figure 6: Intraoral periapical radiograph of lip showing complete removal of tooth fragment|
Click here to view
| Discussion|| |
Trauma is described as an injury resulting from an external force. It is the leading health problem the children are facing today. It has no significant predictable pattern of intensity and may not only leave physical scars but also has a psychological impact on the victim. 
The damage to the teeth and their supporting structures correspond to one of the most frequent traumas to the maxillofacial region. The tooth most commonly affected by trauma is the maxillary central incisor, with a quoted of 70-80% of all traumatic injuries. Uncomplicated crown fractures have been confined to enamel or involve both enamel and dentine.  The more or less complete labial cover which shields the dentition is the reason for the large number of dental traumas being associated with injuries to the lip, gingiva and oral mucosa.
The presence of foreign bodies into the maxillofacial tissues is a relatively common situation in the emergency surgical practice.  A soft tissue laceration associated with a dental injury should always alert the dentist about the presence of dental fragment inclusion in the peripheral tissues. A thorough clinical examination should be carried out for an accurate diagnosis. If laceration and bleeding make the clinical examination difficult, a simple soft tissue radiograph would help in the detection of included tooth fragments in the oral region.
Tooth fragments that are embedded in the soft tissue act as foreign bodies, significantly increasing the risk of infection and may result in persistent chronic infection, and eventually retard healing, even in wounds initially free of infection. 
The bacterial flora of the mouth contains many virulent organisms. Failure to remove totally the portion of teeth embedded in the soft tissue may lead to breakdown of the suture line, persistent chronic infection and discharge.
The treatment of choice in such cases remains the surgical excision of the fragments. Depending upon their size and the time they have been embedded in the tissue, these fragments can be used to restore the remaining fractured tooth.
In our patient, complete removal of the tooth fragment was undertaken and antibiotic coverage was provided to prevent any sign of infection. The tooth was subjected to root canal treatment; a glass fiber post was given and restored with an acrylic crown. We emphasize the need for adequate clinical and radiographic examination of any dentofacial injury and the role of a dental surgeon in providing immediate consultation.
| References|| |
|1.||Pektas ZO, Kircelli BH, Uslu H. Displacement of tooth fragments to the lower lip: a report of a case presenting an immediate diagnostic approach. Dent Traumatol 2007;23:376-9. |
|2.||da Silva AC, de Moraes M, Bastos EG, Moreira RW, Passeri LA. Tooth fragment embedded in the lower lip after dental trauma: case reports. Dent Traumatol 2005;21:115-20. |
|3.||Andreasen JO, Andreasen FM. Textbook and Colour Atlas of Traumatic Injuries to the Teeth. 3rd ed. Saint Louis: C. V. Mosby; 1997. p. 170-88. |
|4.||Naudi AB, Fung DE. Tooth fragment reattachment after retrieval from the lower lip: a case report. Dent Traumatol 2007;23:177-80. |
|5.||Andreasen JO. Etiology and pathogensis of traumatic dental injuries: A clinical study of 1298 cases. Scand J Dent Res 1970;78:329-42. |
|6.||Das UM, Viswanath D, Subramanian V, Agarwal M. Management of dentoalveolar injuries in children: A case report. J Indian Soc Pedod Prev Dent 2007;25:183-6. |
|7.||Martins WD, Fávaro DM, Westphalen FH. Emergency maxillofacial radiology: Foreign body localization: Report of cases. Dentomaxillofac Radiol 2005;34:189-92. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]