Manejo clínico de trauma dentário em criança com extrusão e deslocamento lateral: relato de caso

Abstract

Dental extrusion is a traumatic condition characterized by the partial displacement of the tooth out of the alveolus. Meanwhile, lateral luxation is a non-axial displacement, which can occur in the lingual/palatal or vestibular directions. These injuries affect three main structures: the tooth, the alveolar portion, and the adjacent soft tissues, potentially leading to bone mobility and tooth luxation. This study aims to report the clinical management of a case of dental extrusion, from the initial approach to the therapeutic intervention. A 9-year-old male patient was referred to the Pediatric Dentistry Clinic at the Federal University of Ceará, Sobral campus, after suffering an accident on a trampoline. During anamnesis, he reported pain and difficulty in occlusion. The clinical examination revealed extrusion of tooth 21 and gingival hematomas in the surrounding area. Radiographic examinations confirmed the extrusion of tooth 21 and the lateral luxation of tooth 22. After diagnosis, the affected teeth were repositioned under infiltrative anesthesia. Due to delayed initial care, the repositioning of tooth 21 was hindered by the presence of a blood clot at the apical region, compromising proper seating. Stabilization was achieved through a semi-rigid splint extending from canine to canine, which remained in place for three weeks before removal. Six months post-treatment, the patient returned for follow-up and radiographic reassessment. A periapical radiolucency was observed in the region of tooth 21, along with a negative response to cold sensitivity testing and pain upon vertical percussion in teeth 21 and 22. Endodontic treatment was per;formed in two clinical sessions. The first session involved endodontic access, initial instrumentation with files, and intracanal medication with calcium hydroxide. The second session included odontometry, instrumentation with memory files, and root canal obturation with gutta-percha and zinc oxide-eugenol-based endodontic sealer. Therefore, this case highlights the importance of effective communication in trauma cases and the need for prompt intervention to improve prognosis and prevent complications. The deficiency in dental care within the public health system is evident, often characterized by a lack of essential supplies and inadequate professional training. These limitations contribute to the underestimation of trauma sequelae, which can significantly impact an individual's quality of life over time.