Various statistics have shown that avulsion (total displacement of tooth out of its socket) following traumatic injuries is relatively infrequent, ranging from 0.5 to 16% of traumatic injuries in the permanent dentition.
The maxillary central incisors are the most frequently avulsed teeth. Avulsion of teeth occurs most often in children from 7 to 9 years of age, when the permanent incisors are erupting. Most frequently, avulsion involves a single tooth; but multiple avulsion are occasionally encountered. Fractures of the alveolar socket wall are often associated with avulsion. After the tooth is lost, an almost certain sequelae is the rapid resorption of alveolar bone. In many cases, only a very thin crestal bony lamella remains after healing of the alveolus, with clinically obvious horizontal and vertical depressions.
In a young patient missing an anterior tooth, the operator may find implant insertion, in the proper anatomical position, difficult or impossible, because of inadequate bone volume. This situation aggravates with time because of continuous resorption and relative growth of the adjacent alveolar bone around the teeth. New and predictable bone augmentation techniques allow compensation for bone reduction while waiting for completion of growth.
In cases of localized ridge augmentation, the amount of initial bone volume and its shape dictate whether implant insertion and bone augmentation will be performed simultaneously. The indications for this approach are: sufficient bone volume to achieve initial implant stability and a predictably high success rate for the augmentation. When bone volume and shape do not allow for initial stability, there is indication for a staged approach, in which the bone is initially augmented, the results are evaluated and the implant is then inserted.
The first stage, the bone regeneration phase, may last between 8-10 months. The second, the implant integration period, may take an additional 6-8 months. The effect of growth on the augmented bone is not quite clear and there is only a paucity of information concerning the use of bone regeneration procedures in growing patients. Clinical decision when to start implant treatment after avulsion is dependent not only on the timing of implant insertion, but also on bone regeneration procedures.
To be continued…
Dr. Ayman Nassef
Hurghada, Sheraton Road, in front of Sea Gull Hotel, above Costa Coffee – 2nd floor
Mobile: 0122 322 69 13
Member of Alexandria Organization for Implantation