Journal of Oral Implantology December 2012 - (Page 757)

CASE REPORT Oral Rehabilitation of Severe Dentoalveolar Trauma: A Clinical Report Fonda G. Robinson, DMD1* Larry L. Cunningham, DDS, MD2 This clinical report describes the oral rehabilitation of an adult male who suffered severe dentoalveolar trauma as a result of a motor vehicle accident. The specific objectives of this treatment were to restore esthetics and masticatory function. Treatment included removal of fractured roots, placement of multiple endosseous implants, and placement of anterior and posterior metal-ceramic crowns and fixed partial dentures. Three year clinical examination revealed no pathology associated with the rehabilitation. The patient’s esthetic and functional expectations were successfully achieved. Key Words: oral rehabiliation, oral and maxillofacial trauma, implant dentistry CLINICAL REPORT 30-year-old white man reported to the emergency department after a trailer hitch fell from a vehicle in front of him, entering his windshield while traveling on the highway and striking him in the face (Figure 1). The patient’s past medical history was unremarkable. He was evaluated and stabilized via Advanced Trauma Life Support protocol. Oral and Maxillofacial Surgery was consulted for facial injuries and the following exam was noted. The patient was alert and oriented, responding to command. No internal organ, orthopedic, or spinal injuries were found. Gross examination of the head and neck region was significant for a full thickness lip and chin laceration to the oral cavity from the lower lip slightly off midline to the chin region where it became stellate (Figure 2a and b). Maxillary and mandibular right anterior dentoalveolar fractures involving the molars, premolars, canines, and incisors crossing the midlines were noted. There was significant communication of the segments with tooth mobility. There were no other 1 A Office of Clinical Administration, The Ohio State University, College of Dentistry, Columbus, Ohio. 2 Division of Oral and Maxillofacial Surgery, University of Kentucky, College of Dentistry, Lexington, Ky. * Corresponding author, e-mail: robinson.1493@osu.edu DOI: 10.1563/AAID-JOI-D-10-00121 indications of facial fractures noted; ocular and auricular exam were normal. These skeletal injuries were confirmed via computerized tomography. The patient was subsequently taken to the operating room for debridement of multiple fragments of teeth and comminuted alveolar bone, open reduction, and internal fixation of the maxillary right and dentoalveolar fracture segment, extraction of teeth numbers 4, 5, 6, 7, 8, 9, 10, 21, 22, 23, 24, 25, 26, 27, 28, 29, and 30, and closure of facial lacerations. Three months after the accident the patient was referred for a prosthodontic evaluation. The patient’s primary concern included the need for replacement of the missing masticatory system. Of equal importance to his primary concern was to have highly esthetic replacement restorations. A detailed medical, dental, and social history did not reveal any contraindications to dental therapy. The patient indicated previous orthodontic therapy approximately 10 years prior to the accident. The patient requested and received clinical photographs from the previous orthodontist to be utilized by the prosthodontist and laboratory technician during the rehabilitation phase of therapy. Clinical and radiographic examination revealed missing teeth numbers 4, 5, 6, 7, 8, 9, 10, 21, 22, 23, 24, 25, 26, 27, 28, 29, and 30 (Figures 3 and 4). No caries existed on remaining teeth. Tooth number 15 had small amalgam restorations. Moderate plaque Journal of Oral Implantology 757

Table of Contents for the Digital Edition of Journal of Oral Implantology December 2012

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Lateral Augmentation of the Maxilla and Mandible Using Framework Technique With Allogeneic Bone Grafts
Accuracy of Cone Beam Computerized Tomography and a Three-Dimensional Stereolithographic Model in Identifying the Anterior Loop of the Mental Nerve: A Study on Cadavers
Evaluation of Microgap Size and Microbial Leakage in the Connection Area of 4 Abutments With Straumann (ITI) Implant
Buccal Bone Plate Remodeling After Immediate Implant Placement With and Without Synthetic Bone Grafting and Flapless Surgery: Radiographic Study in Dogs
Evaluation of Soft Tissues Around Single Tooth Implants in the Anterior Maxilla Restored With Cemented and Screw-Retained Crowns
Accuracy of a Newly Developed Cone-Beam Computerized Tomography-Aided Surgical Guidance System for Dental Implant Placement: An Ex Vivo Study
Nasopalatine Canal Position Relative to the Maxillary Central Incisors: A Cone Beam Computed Tomography Assessment
Esthetics in Implant-Supported Prostheses: A Literature Review
Reliability of Implant Surgical Guides Based on Soft-Tissue Models
Clinical Evaluation of Short and Wide-Diameter Implants Immediately Placed Into Extraction Sockets of Posterior Areas: A 2-Year Retrospective Study
Single Stage Immediate Implant Placements in the Esthetic Zone
Removal of Fractured Dental Implant Screw Using a New Technique: A Case Report
Restoration of Failing Maxillary Implant-Supported Fixed Prosthesis With Cross Arch Splinted Unilateral Zygomatic Implant: A Clinical Report
Oral Rehabilitation of Severe Dentoalveolar Trauma: A Clinical Report
Implant Installation With Bone Augmentation and Transmucosal Healing With Demineralized Human Cortical Bone in the Maxillary Anterior Region: Report of 3 Cases
Bone Morphogenic Protein: An Elixir for Bone Grafting—A Review
Orthodontic Considerations in Restorative Management of Hypodontia Patients With Endosseous Implants
Squamous Cell Carcinoma in Association With Dental Implants: An Assessment of Previously Hypothesized Carcinogenic Mechanisms and a Case Report
Indirect Osteotome Maxillary Sinus Floor Elevation: An Update
Reliability of Implant Surgical Guides Based on Soft-Tissue Models: A Methodological Mistake

Journal of Oral Implantology December 2012