Surgical Intervention on an upper Side Incisive Affected by Transmigration and Dilaceration: Case Report

Abstract

The term “transmigration” is attributed to the fact that dental elements cross the midline of the bone base (maxilla or mandible), positioning themselves on the contralateral side. The incidence of this dental anomaly in permanent central incisors impacted on the maxilla is an unusual phenomenon and its etiology has not yet been elucidated. This pathology can be associated with root tearing. Given the context, this study describes a case report of a surgical intervention of an upper lateral incisor affected by transmigration and laceration. Patient P.M.R, 37, was seen at the surgery clinic. He used a removable prosthesis with only tooth 8 and complained that “a tooth was missing in the mouth”. Tooth 7 was fractured in the crown and endodontic treatment was performed. The clinical examination showed an increase in volume close to the anterior nasal spine. A CT scan was requested which revealed that the right central incisor was included. In the coronal section, it was possible to observe only the inverted tooth crown. In the sagittal section, it was also possible to see the root, which had a large curvature in a V-shaped fold. After the diagnosis, he opted for the removal of the included element, since it was impossible to perform a traction due to its anomalous shape. Anesthesia of the anterior superior alveolar nerve and nasopalatine was performed using mepivacaine 2% 1: 100,000, syndesmotomy and a relaxing incision was made in the distal of tooth 9 going to the base of the nose. After exposing the crown, an odonto-section was performed with an HL 702 drill at the crown / root limit and the crown was removed. A small channel was made in the mesial of the crown to find a support point and to remove the root with the molt detacher nº 9. Afterwards, the place was washed with 0.9% saline solution to remove bone bruises and done the suture returning the flap to its original place. Made the prescription drug with amoxiline 500mg 8/8 hours for 5 days, ibuprofen 600mg 12/12 hours for 3 days.Patient returned with 8 days for suture removal and asymptomatic. It is possible to conclude with this study that surgical intervention in cases where the dental element is affected by transmigration and root laceration is effective.