This little guy caught a fly ball… in the mouth. The lateral was laterally luxated. The central was avulsed and replanted with a dry time of 15 minutes. The lateral was repositioned and splinted. I saw them the day after the injury. We made sure he was on an antibiotic and anti-inflammatory and saw him back in a week to start endodontic therapy as the apex of these teeth were completely deveoloped and the risk of resorption high. After what we thought was a sufficient time in both CaOH and splint therapy, we completed the endodontic therapy and placed fiber posts.

Over the next few years we saw resorption develop. According to the Resorption Classification for Clinicians, this resorption would be considered External Crestal Resorption, moderate scooping. We removed the invasive tissue and restored the root using composite. A custom resin matrix was used for isolation.

Over time, we could see that the central was subject to resorption as well; External Ankylotic Resorption. This was evident by the ankylotic tone when percussed. Radiographically, this was evident my the marked lack of periodontal ligament and lack of tooth root definition. Clinically, this was evident by the infraposition of the clinical crown relative to the other central.

In treatment planning the case, the orthodontist thought some initial leveling and aligning using the ankylosed tooth would be helpful before decoronation. After this was accomplished, the fiber post and root filling was removed and the crown was decoronated using the flapless decoronation approach as outlined by Jared Buck in Best Practices: A Desk Reference

A pontic was added to the orthodontic therapy.

We can see over time that bone developed over the tooth root and the the root is turned over in osseous regeneration. The alveolar ridge is preserved for future restorative replacement.

Here’s the 5 year followup.