Nilüfer Tülin POLAT, Mustafa Hayati ATALA, Fuat AHMETOĞLU, Serkan POLAT

Travma Geçirmiş Hastada Tüm Ağız Tedavisi: Olgu Sunumu

Bu olguda, ağır bir kaza sonrası dental tedavisi gecikmiş ve yoğun girişimsel tedavilerden kaçınan bir hastanın, daha basit tedavilerle tümağız restorasyonu amaçlanmıştır. Alınan anamnezde, hastanın 16 yaşındayken balkondan düştüğü, mandibula da dahil bir çok kemiğininkırıldığı öğrenildi. Çeşitli nedenlerle mandibula kırığı dışındaki, diş ve çevre doku tedavileri 4 yıl ertelenmiş olan hastanın, 11, 13, 14, 15,16, 25,26, 43, 45 nolu dişlerinin kaybedilmiş olduğu görüldü. 17, 18, 24, 33, 34, 35 ve 42 nolu dişlerde değişik boyutlarda kron kırıklarvardı. 23, 44 ve 46 nolu dişlerinin kökleri kemik içinde gömülü kalmıştı. Kapanışta sağda alt ve üst dişsiz kretler birbirlerine, solda ise altyan grup dişler üst dişsiz krete değiyordu. İstirahat ve oklüzal vertikal boyutları arasında 1 mm fark vardı. Hastanın görünümünden dolayıpsikolojisi bozulmuş, yoğun girişimsel tedavilere istek ve tahammülü yoktu. Bu nedenle, ağır travmatik tedavilerden kaçınıldı. Bunun içinalt anterior bölgedeki kemik desteği kaybedilmiş 31, 32 ve 41 nolu dişler çekildi. Sağ üst ve alt, sol üst kretlerden kemik kaldırıldı. 23, 44ve 46 nolu dişlerin kökleri açığa çıkarıldı. Bu köklere ve 24, 36 ve 47 nolu dişlere kanal tedavisi yapıldı. Sağ tarafta sinüs yükseltme ve 3adet implant yerleştirilmesi sonrası alt üst metal destekli seramik restorasyonlarla tedavi tamamlandı. Karmaşık bir vakada, çok azgirişimsel uygulamayla hasta memnun edildi

Anahtar Kelimeler:

Dental travma, kron kırığı, kron-kök kırığı

Oral Rehabilitation of a Severe Trauma Patient: Case Report

It’s been aimed to do the oral rehabilitation of a patient with a delayed dental treatment after a severe accident, by using limited invasivemethods. It is learned from the anamnesis that the patient had been fallen down from the fourth floor at the age of 16. The patient’s oraland dental treatments, except the broken mandibula, had been postponed 4 years for various reasons. She had lost her teeth numbered 11,25 and 43. Her fourteen teeth had different sized crown fractures and 7 of these were embedded in the alveolar bone and mucosa. In thebite occlusion, upper and lower alveolar ridges were in contact on the right side and lower posterior teeth were in contact with the upperalveolar ridge on the left. There was only 1 mm freeway space. Because of the patient’s depression; she had no demand or tolerance toinvasive treatments. The lower anterior 3 teeth which had lost the alveolar support and 3 embedded roots in the right maxilla had beenextracted. Partial bone adjustments -upper and lower right side and upper left alveolar ridges- had been performed. The roots 23, 44, 45,and 46 had been exposed to the oral cavity. Endodontic treatments were done to these roots and 8 other teeth. On the upper right side, 3implants had been placed after the sinus lifting. The treatment had been completed with the porcelain-fused-to-metal restorations.Thepatient had been satisfied by minimum invasive treatment in a complicated case

Keywords:

Dental trauma, crown fracture, crown-root fracture,

PDF

___

1. Holan G, Shmueli Y. Knowledge of physicians in hospital emergency rooms in Israel on their role in cases of avulsion of permanent incisors. Int J Paediatr Dent 2003;13:13–9
2. Al-Nazhan S, Andreasen JO, Al Bavardi S Al Roug S. Evaluation of the effect of delayed management of traumatized permanent teeth. J Endodon 1995; 21: 391-3.
3. Glendor U, Marcenes W and Andreasen JO (2007). Classification, epidemiology and etiology. In: Andreasen JO, Andreasen FM and Andersson L (eds.), Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4th ed. Copenhagen, Denmark: Blackwell-Munksgaard, pp. 217-244.
4. Andreasen FM, Andreasen JO. C In: Textbook and color atlas of traumatic injuires to the teeth. Andreasen FM, Andreasen JO. Mosby Co. Denamark, p:151-79,1994.
5. Keçeci AD. Sporcularda dental travma. Egzersiz 2007,1:6-15.
6. Villat C, Machtou P, Naulin-Ifi C. Multidisciplinary approach to the immediate esthetic repair and longterm treatment of an oblique crown-root fracture. Dent Traumatol 2004;20:56–60.
7. Koparal E, Ilgenli T. Reattachment of a subgingivally fractured central incisor tooth fragment: report of a case.J Clin Pediatr Dent 1999;23:113–6.
8. Leroy RLRG, Asp JKM, Raes FM, Martens LC, De Boever JA. A multidisciplinary treatment approach to a complicated
9. Meiers JC, Freilich MA. Chairside prefabricated fiberreinforced resin composite fixed partial dentures. Quintessence Int 2001;32:99–104.
10. Olsburgh S, Jacoby T, Krejci I. Crown fracture in the permanent dentition: pulpal and restorative considerations. Dent Traumatol 2002;18:103–15.
11. Application of the International Classification of Diseases to Dentistry and Stomatology IDC-DA, 3rd edn. Geneva: WHO, 1995.
12. Andreasen JO, Andreasen FM. Classification, etiology and epidemiology of traumatic dental injuries. In: Andreasen JO, Andreasen FM, eds. Textbook and Color Atlas of Traumatic Injuries to the Teeth, 3rd edn. Copenhagen: Munksgaard, 1993: 151–177.
13. Andreasen FM, Nore´n JG, Andreasen JO, Engelhardtsen S, Lindh-Stro¨mberg U. Long-term survival of crown fragment bonding in the treatment of crown fractures. A multicenter clinical study of fragment retention. Quintessence Int 1995: 26: 669- 681.
14. Cvek M. Endodontic management of traumatized teeth. In: Andreasen JO, Andreasen FM, eds. Textbook and Color Atlas of Traumatic Injuries to the Teeth, 3rd edn. Copenhagen: Munksgaard, 1993: 517–585.
15. Kahnberg K-E. Surgical extrusion of root fractured teeth – a follow-up study of two surgical methods. Endod Dent Traumatol 1988: 45–89.
16. Warfvinge J, Kahnberg K-E. Intraalveolar transplantation of teeth. IV. Endodontic considerations. Swed Dent J 1989: 13: 229–233.
17. Poi WR, Cardoso LC, Castro JCM, Cintra LTA, Gulinelli JL, Lazari JAB. Multidisciplinary treatment approach for crown fracture and crown-root fracture a case report. Dental Traumatology 2007; 23:51-55.
18. Clark JC, Jones JE. Tooth fragments embedded in soft tissue: a diagnostic consideration. Quintessence International 1987; 18: 653-654.
19. Kahnberg KE. Surgical extrusion of rootfractured teeth a follow-up study of two surgical methods. Endod Dent Traumatol 1988;4:85–89.
20. Alaçam T, Nalbant L, Alaçam A. İleri restorasyon teknikleri. Ankara: Polat Yayınları; 1998. s. 66.