Dental trauma associated with high impact sport

Marcelo Coelho Goiato; Liliane da Rocha Bonatto; Emily Vivianne Freitas da Silva; Aljomar José Vechiato-Filho; Rodrigo Antônio de Medeiros; Daniela Micheline dos Santos

doi:10.4103/0975-8844.157404

CASE REPORT

Year : 2015 | Volume : 7 | Issue : 1 | Page : 63-65

Dental trauma associated with high impact sport

Marcelo Coelho Goiato, Liliane da Rocha Bonatto, Emily Vivianne Freitas da Silva, Aljomar José Vechiato-Filho, Rodrigo Antônio de Medeiros, Daniela Micheline dos Santos
Department of Dental Materials and Prosthodontics, Aracatuba Dental School, Universidade Estadual Paulista, Aracatuba, Sao Paulo, Brazil

Date of Web Publication

20-May-2015

Correspondence Address:
Prof. Marcelo Coelho Goiato
Department of Dental Materials and Prosthodontics, Aracatuba Dental School, Universidade Estadual Paulista, Jose Bonifacio Street, #1193, 16015-050 Aracatuba, Sao Paulo
Brazil

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0975-8844.157404

Abstract

The objective of this study was to report a case of tooth fracture during the sport practice and the treatment performed for the patient. A 17-year-old male patient was subjected to an endontic treatment followed by the reattachment of the fractured teeth. Teeth were endodontically treated by conventional method. After, the acid etching with 37% phosphoric acid gel was performed and a bonding agent was applied on the dental surface. The fragments were reattachment and bonded with minimum amount of composite resin since the teeth/fragment interface was small. The occlusal contacts were adjusted in the finish line of restorations with a diamond bur and the polishing was performed with aluminum oxide discs. Positive esthetical and periodontal outcomes with no complications in the endodontic treatment were observed on radiographic examinations after twelve months of follow up. The endodontic treatment associated with the reattachment of the fractured teeth by a bonding procedure was a conservative treatment for the patient. The use of mouthguards is important to prevent such dramatic events.

Keywords: Injuries, Sports Medicine, Athletic Injuries, Dental Bonding

How to cite this article:
Goiato MC, da Rocha Bonatto L, da Silva EF, Vechiato-Filho AJ, de Medeiros RA, dos Santos DM. Dental trauma associated with high impact sport. J Orofac Sci 2015;7:63-5

How to cite this URL:
Goiato MC, da Rocha Bonatto L, da Silva EF, Vechiato-Filho AJ, de Medeiros RA, dos Santos DM. Dental trauma associated with high impact sport. J Orofac Sci [serial online] 2015 [cited 2023 Mar 28];7:63-5. Available from: https://www.jofs.in/text.asp?2015/7/1/63/157404

Introduction

Sport is among the most common causes of traumatic dental injuries, which occur frequently in athletes of various modalities. ^[1],[2] This is a challenging situation in a dental emergency, requiring a correct diagnosis and treatment for minimal complications, and for a favorable prognosis of the fractured teeth. ^[3]

The teeth which are more susceptible for dental trauma are the central incisors, followed by lateral incisors, because of their anatomy and position in the dental arch. ^[4],[5],[6] Some factors which influence the location and type of fracture are the age of the patient, and direction and intensity of the impact. ^[7]

The most common dental sports trauma is crown fracture, with higher incidence in males. ^[5],[6],[8] When this happens, it is important that the crown fracture is stored in milk, saline, or saliva. However, the storage under such conditions is limited to short periods of time. ^[9]

Dental injuries can be minimized using mouthguards during participation because of their effectiveness in absorbing impacts. ^{[5],[9],[10],[11]} Most athletes do not have the habit of using them, claiming discomfort and difficulty while breathing and speaking. This fact corroborates with a lack of information about mouthguards and their incorrect use. Once they are properly used, the difficulties are easy to overcome. Their use is extremely important for athletes that train in contact with hard surfaces, with risk of being hit by direct blows, or falling. ^[5],[10]

Therefore, the aim of this study was to report a case of tooth fracture during sport participation and the treatment performed.

Case Report

A 17-year-old male patient was admitted at the Aracatuba Dental School, Sao Paulo State University, Brazil, after 12 h of trauma. The patient preserved the two fragments of the #11 and #12 incisors in a glass with mineral water [Figure 1] and reported he had been training Muay Thai when he was hit by a blow. The patient complained about pain after impact and mainly the esthetic loss because of the fractured teeth. Dental fractures with pulpal exposure were observed on clinical examination [Figure 2].

Figure 1: Fragments of the incisors #11 and #12

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Figure 2: Maxillary view showing the extension of the fracture and the pulp exposure of the injured teeth

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Endodontic treatment was indicated for incisors #11 and #12 because of the long-term pulpal exposure with a high risk of contamination. Then, the treatment options were discussed with the patient (tooth fragment reattachment, composite resin restoration, porcelain laminate veneer, and postcrown restorations). The patient chose the endodontic treatment for the fractured teeth, followed by reattachment. The driving forces toward the decision of the patient were the advantages and disadvantages, the prognosis, and the cost/benefits of each proposed treatment.

Therefore, the teeth were endodontically treated by conventional method [Figure 3]. The fragments were removed from the glass of water, dried, and after acid-etching with 37% phosphoric acid (FGM ^® ), dual cure bonding agent (Adper Single Bond 2; 3M-ESPE ^® ) was applied on the surface and light cured with a light emitting diode (Bluephase - Ivoclar - Vivadent ^® ), according to the instructions of the manufacturer. This etching was performed on the dental surface, and the fragments were repositioned and bonded with a minimum amount of Composite Resin (EA2 Filtek^™ Z350 XT; 3M-ESPE ^® ) since the tooth/fragment interface was small [Figure 4]. The occlusal contacts were adjusted with a diamond bur (3195KG ^® , extra fine), and the polishing was performed with aluminum oxide discs (Sof-lex Pop-on - 3M-ESPE ^®).

Figure 3: Radiographic examinations during the root exploration of incisors #11 and #12

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Figure 4: Final aspect after the reattachment of incisors #11 and #12

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Positive esthetical and periodontal outcomes with no complications in the endodontic treatment were observed during radiographic examinations after 12 months of follow-up. The patient considered the treatment both esthetically and functionally satisfactory [Figure 5].

Figure 5: Appearance after 12 months of follow-up

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Discussion

Sports is a common cause of traumatic dental injuries ^[1],[2] and a challenge requiring a correct diagnosis and treatment for minimal complications, and for a favorable prognosis of the fractured teeth. ^[3]

Dental fractures are a common situation among athletes of several modalities, with crown fractures being the most common type of these injuries. ^[4],[5],[6] The maxillary incisors are the most affected teeth because of their anatomy and position in the dental arch.

Bücher et al. ^[3] and Díaz et al. ^[6] show that the majority of patients received treatment within 24 h. Our case agrees with these studies, since the patient requested dental treatment after 12 h of trauma, having stored the fractured teeth in mineral water. The fact that our patient did not store the fragments in milk, saline solution or saliva ^[9] shows that athletes may not have adequate information about dental trauma and proper fragment storage.

In addition, the patient reported infrequent use of a mouthguard. Hersberger et al., ^[5] and Maxén et al. ^[9] showed that athletes affirmed no need of wearing mouthguards, despite their well-known advantages, because they report difficulty in breathing and speaking.

The case presented corroborates the results of Rajput et al. ^[13] , in which endodontic treatment associated with fragment reattachment is a safe and predictable alternative. Zuhal et al. ^[14] reported a success of 92% in treatments with a bonding procedure associated with the reattachment of fragments, or only with the restoration of the fractured teeth with composites.

Furthermore, this procedure is the most conservative among all available treatments because it involves only a bonding procedure, preserving the maximum amount of tooth structure. In addition, it also maintains the incisal translucency and color, and the original contour of the tooth. This technique has the advantage of low costs without multiple procedures. ^[13],[15]

Other options for dental trauma treatment reported in literature, such as the restoration of tooth fracture with composite resin ^{[16],[17],[18],[19]} , which according to Bassett ^[19] , is a conservative treatment with satisfactory esthetic properties, good resistance, and a durable polish. Rehabilitation with porcelain laminate veneer is a highly esthetic alternative. However, it has a superior cost when comparing it to composite resins, and it requires a prosthetic laboratory (ceramist). ^[18],[20] On the other hand, the confection of postcrown restorations has an excellent prognosis, and it may be a successful treatment. ^[16] Though, it is considered the most invasive option. ^[15]

Conclusion

Endodontic treatment associated with the reattachment of fractured teeth by a bonding procedure was a conservative treatment for the patient. It also was easy to execute and had low cost allowing the restoration of the function and the esthetics of the patient.

References

1.	Tuli T, Haechl O, Berger N, Laimer K, Jank S, Kloss F, et al. Facial trauma: How dangerous are skiing and snowboarding? J Oral Maxillofac Surg 2010;68:293-9.
2.	Shirani G, Kalantar Motamedi MH, Ashuri A, Eshkevari PS. Prevalence and patterns of combat sport related maxillofacial injuries. J Emerg Trauma Shock 2010;3:314-7. [PUBMED]
3.	Bücher K, Neumann C, Hickel R, Kühnisch J. Traumatic dental injuries at a German university clinic 2004-2008. Dent Traumatol 2013;29:127-33.
4.	Cetinbas T, Yildirim G, Sönmez H. The relationship between sports activities and permanent incisor crown fractures in a group of school children aged 7-9 and 11-13 in Ankara, Turkey. Dent Traumatol 2008;24:532-6.
5.	Hersberger S, Krastl G, Kühl S, Filippi A. Dental injuries in water polo, a survey of players in Switzerland. Dent Traumatol 2012;28:287-90.
6.	Díaz JA, Bustos L, Brandt AC, Fernández BE. Dental injuries among children and adolescents aged 1-15 years attending to public hospital in Temuco, Chile. Dent Traumatol 2010;26:254-61.
7.	Fakhruddin KS, Lawrence HP, Kenny DJ, Locker D. Etiology and environment of dental injuries in 12- to 14-year-old Ontario schoolchildren. Dent Traumatol 2008;24:305-8.
8.	Elias H, Baur DA. Management of trauma to supporting dental structures. Dent Clin North Am 2009;53:675-89, vi.
9.	Maxén M, Kühl S, Krastl G, Filippi A. Eye injuries and orofacial traumas in floorball - a survey in Switzerland and Sweden. Dent Traumatol 2011;27:95-101.
10.	Takeda T, Ishigami K, Ogawa T, Nakajima K, Shibusawa M, Shimada A, et al. Are all mouthguards the same and safe to use? The influence of occlusal supporting mouthguards in decreasing bone distortion and fractures. Dent Traumatol 2004;20:150-6.
11.	Goiato MC, dos Santos DM, Moreno A, Haddad MF, Pesqueira AA, Turcio KH, et al. Use of facial protection to prevent reinjury during sports practice. J Craniofac Surg 2012;23:1201-2.
12.	Takeda T, Ishigami K, Hoshina S, Ogawa T, Handa J, Nakajima K, et al. Can mouthguards prevent mandibular bone fractures and concussions? A laboratory study with an artificial skull model. Dent Traumatol 2005;21:134-40.
13.	Rajput A, Talwar S, Ataide I, Verma M, Wadhawan N. Complicated crown-root fracture treated using reattachment procedure: A single visit technique. Case Rep Dent 2011;2011:401678.
14.	Zuhal K, Semra OE, Hüseyin K. Traumatic injuries of the permanent incisors in children in southern Turkey: A retrospective study. Dent Traumatol 2005;21:20-5.
15.	Rajput A, Ataide I, Fernandes M. Uncomplicated crown fracture, complicated crown-root fracture, and horizontal root fracture simultaneously treated in a patient during emergency visit: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e48-52.
16.	Smidt A, Sharon E, Adler ML. Reinforced composite restoration following trauma to a mandibular tooth: Technique and follow-up treatment. Quintessence Int 2012;43:753-8.
17.	Atabek D, Alaçam A, Aydintuğ I, Konakoğlu G. A retrospective study of traumatic dental injuries. Dent Traumatol 2014;30:154-61.
18.	Anchieta RB, Rocha EP, Watanabe MU, de Almeida EO, Freitas-Junior AC, Martini AP, et al. Recovering the function and esthetics of fractured teeth using several restorative cosmetic approaches. Three clinical cases. Dent Traumatol 2012;28: 166-72.
19.	Bassett J. Conservative restoration of a traumatically involved central incisor. Compend Contin Educ Dent 2012;33:264-7.
20.	Giachetti L, Bertini F, Bambi C. An 8-year follow-up of a fractured endodontically treated incisor restored with a modified laminate veneer. Dent Traumatol 2008;24:104-7.