Travma Öyküsü Bulunan İmmatür Bir Üst Santral Kesici Dişte Kronik Apikal Enfeksiyon ve Bukkal Kemik Dehisensinin Multidisipliner Yönetimi: Bir Olgu Sunumu

Abstract

Travmatik dental yaralanmalar, immatür daimî dişlerde pulpa nekrozu ve kronik apikal enfeksiyonun başlıca nedenlerinden biridir. Bu dişlerde açık apeks, ince kök dentin duvarları ve eşlik eden destek doku kaybı tedaviyi güçleştirebilir. Bu olgu sunumunda, yaklaşık altı yıl önce dental travma geçirmiş 14 yaşındaki bir kız hastanın 21 numaralı dişinde kronik apikal enfeksiyon, labial vestibüle drene olan intraoral sinüs traktı ve konik ışınlı bilgisayarlı tomografi ile doğrulanan ileri bukkal ve proksimal kemik kaybı sunulmaktadır. Enfeksiyon kontrolü amacıyla kök kanal tedavisine başlanmış ve seanslar arasında kalsiyum hidroksit medikasyonu uygulanmıştır. Aktif drenajın sona ermesinin ardından mineral trioksit agregat (MTA) ile apikal bariyer oluşturulmuş ve kalan kanal boşluğu MTA ile doldurulmuştur. Mobilitenin azaltılması amacıyla esnek splint uygulanmış ve diş oklüzyondan çıkarılmıştır. Endodontik ve periodontal tedaviye rağmen yumuşak doku defektinin devam etmesi üzerine destekleyici antiseptik yaklaşım olarak kısa süreli seyreltilmiş Lügol solüsyonu irrigasyonu uygulanmıştır. Defektte gerileme sağlanmasının ardından, defekt bölgesinin debridmanı ve kök yüzeyinin tetrasiklinle koşullandırılması sonrasında kasıtlı replantasyon gerçekleştirilmiştir. Erken dönemde olumlu yumuşak doku iyileşmesi gözlenmiş ve diş mevcut takip süresince ağızda tutulmuştur. Bu olgu, ileri destek doku kaybı bulunan travmatize immatür dişlerin korunmasındaki güçlükleri göstermekte ve multidisipliner tedavinin, dikkatli prognoz değerlendirmesinin ve uzun dönem takibin önemini vurgulamaktadır.

Keywords

• Apeksifikasyon
• Dental travma
• Kasıtlı replantasyon
• Mineral trioksit agregat
• Sinüs traktı

Multidisciplinary Management of Chronic Apical Infection and Buccal Bone Dehiscence in a Traumatised Immature Maxillary Central Incisor: A Case Report

Abstract

Traumatic dental injuries are a leading cause of pulp necrosis and chronic apical infection in immature permanent teeth, in which an open apex, thin radicular dentine and associated loss of supporting tissues may complicate treatment. This report describes a 14-year-old girl who presented with chronic apical infection of the maxillary left central incisor (tooth 21), an intraoral sinus tract draining into the labial vestibule, and advanced buccal and proximal bone loss confirmed by cone-beam computed tomography approximately six years after dental trauma. Root canal treatment was undertaken for infection control, with inter-appointment calcium hydroxide medication. After active drainage had ceased, an apical barrier was created with mineral trioxide aggregate (MTA), and the remaining canal space was obturated with MTA. A flexible splint was placed to reduce mobility, and the tooth was relieved from occlusion. Because the soft-tissue defect persisted despite endodontic and periodontal management, short-term irrigation with diluted Lugol's solution was used as an adjunctive antiseptic measure. Following reduction of the defect, intentional replantation was performed after debridement of the defect and conditioning of the root surface with tetracycline. Early soft-tissue healing was favourable, and the tooth was retained during the available follow-up period. This case demonstrates the complexity of preserving traumatised immature teeth with severe supporting-tissue loss and highlights the importance of multidisciplinary treatment, cautious prognostic assessment and long-term follow-up.

Keywords

• Apexification
• Dental trauma
• Intentional replantation
• Mineral trioxide aggregate
• Sinus tract

Ethical Statement

Not applicable.

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