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60 rev port estomatol med dent cir maxilofac. 2021;62(1):56-62

of the apical third, bone formation between the fragments, tory results. 16,29,32 That paste is used as a filling material in
and absence of periapical lesion or root resorption were not- root fractures due to inducing the formation of a mineralized
ed radiographically (Figure 6). Moreover, the obturation paste barrier, 28,31 which was observed during this case’s radio-
of calcium hydroxide associated with 2% chlorhexidine gel graphic follow -up with roundness of the fracture edges and
and zinc oxide was still filling the root canal of teeth 21 after bone formation between the fragments. These findings are
ten years. similar to those obtained by other authors 33,34 who filled the
root canal of fractured roots with MTA. However, unlike in
33
Yildrim and Gençoğlu’s study, no coronary darkening was
Discussion and conclusions observed in this case report. In addition, like in another
34
case, the obturation paste used in this study was still filling
Sports practice is commonly described as one of the main eti- the root canal after 10 years.
ological factors of traumatic injuries in children and adoles- Pulp necrosis prevalence in permanent teeth after lateral
35
4,5
cents. In this case report, the patient reported suffering luxation can reach 91.3%. Moreover, the longer the time be-
dental trauma during a basketball game in her school while tween pulp necrosis and endodontic treatment, the worse the
not wearing a mouthguard. According to a previous epidemi- prognosis. IADT recommends monitoring tooth luxation to
4
ological study, basketball is among the sports with the high- avoid false -negative results from vitality tests. Likewise, root
est prevalence of dental trauma (70.6%), only after combat canal treatment should only be performed if there are clinical
sports such as wrestling (83.3%) and boxing (73.7%). This prev- signs of pulp necrosis or radiographic evidence of periapical
12
alence shows the importance of wearing mouthguards during involvement. However, in this report, endodontic treatment
sports practice, especially in modalities that require physical was carried out 9 days after trauma, when the patient came to
18
contact. Accordingly, in their recent systematic review, the the clinic reporting spontaneous pain and having no response
authors found a significant reduction in dental trauma preva- to the thermal, electrical, and cavity tests.
lence among athletes who wore mouthguards (7.5%) com- The use of chlorhexidine gel as a chemical substance
pared to those who did not (59.5%). for root canal system disinfection in our treatment protocol
Immediate management of severe dental trauma, pref- is of particular interest. Chlorhexidine is already widely
erably within three hours, is crucial for a better prognosis. used in dentistry because of its characteristics, including
13
In cases of lateral luxation and root fractures, IADT recom- substantivity and a broad spectrum of antibacterial activi-
mends immediate dental element repositioning followed ty, and it is proven to have efficacy against bacteria present
12
by splinting for four weeks. In this case report, the patient in the root canal of necrotic teeth. 15,16 A recent systematic
36
came to the clinic 30 minutes after having suffered the review showed that both chlorhexidine and sodium hypo-
trauma. So, her dental elements were immediately reposi- chlorite effectively promote bacterial decontamination in
tioned, and a semi -rigid splint was placed and left immo- the root canal. In our research center, we adopted chlorhex-
bilized for four weeks. The use of the splint in this study is idine as a standard chemical substance in all endodontic
justified by the lack of flexible material and the need to treatment cases, regardless of the etiology (caries, trauma,
stabilize dental elements at that time. Although the IADT or prosthetic reasons). Over the years, we have obtained a
recommends the flexible splint to minimize the chances of great success rate from the cases treated with this proto-
12
dental ankylosis, scientific evidence is still inconclusive col. 37-39 However, there is still no randomized clinical trial
on the prognosis of luxated or fractured teeth with different comparing the clinical and radiographic outcomes of trau-
types of splints. 19-23 Furthermore, case success seems to be matized and necrotic teeth treated with hypochlorite ver-
more related to the kind of traumatic injury than the splint sus chlorhexidine.
characteristics. 24,25 In this case report, there were no radio- Aside from emergency care and correct diagnosis, long-
graphic signs of ankylosis or root resorption during the en- -term clinical and radiographic monitoring of traumatized
12
tire follow -up period. teeth is imperative. This study presents a long evaluation
IADT recommends endodontic treatment for traumatized period where the case’s positive evolution was observed, in-
12
teeth to avoid root resorption if pulp necrosis is detected. cluding total remission of signs and symptoms and no radio-
In this study, the patient’s tooth 21 was diagnosed with pulp graphic signs of periapical lesion or root resorption. In addi-
necrosis 14 days after the trauma due to not responding to tion, after 10 years of follow -up, teeth 11, 12, and 23 still
sensitivity tests. The patient also presented painful symp- responded positively to sensitivity tests.
toms. The preponderance of pulp necrosis in the coronary This study is not free of limitations. Firstly, its scientif-
fragment after root fractures is about 20%, while the apical ic evidence level is low because it is a single case report.
25
fragment remains vital in most cases. Thus, tooth 21 was Secondly, the case has no computed tomography images,
treated endodontically up to the root fracture line and filled which prevents a more detailed analysis of root fracture
12
only with an obturation paste composed of calcium hydrox- repair.
16
ide P.A., 2% chlorhexidine, and zinc oxide. This paste has In conclusion, it was possible to observe the long -term
26
27
antibacterial properties; is biocompatible, and acts as a clinical and radiographic success of multiple sports -related
physical barrier, helping seal root canals. It was originally dental injuries. This paper reinforces the importance of imme-
28
proposed as a treatment for avulsed teeth but currently is diate care for the success of severe cases of dental trauma and
equally used in the apexification of teeth with open apex 28,30,31 the importance of using mouthguards as a preventive measure
and the treatment of horizontal root fractures, with satisfac- during sports practice.