2013 年 4 巻 2 号 p. 74-83
Here, we report the clinical management of two cases with traumatic injury of immature permanent maxillary anterior teeth. In the first case, a 7.3-year-old girl fell down while riding a bicycle and hit her face. Dental radiographs revealed a coronal fracture of #21 involving the pulp. The need for endodontic treatment of the injured teeth was assessed. In the second case, a 7.5-year-old girl hit her face on a high bar and #21 and #22 were avulsed. After the injury, #21 and #22 were reimplanted and fixed. One month later, a sinus tract was observed, which was diagnosed as chronic apical periodontitis. In both cases, we waited for apex closure by apexification using calcium hydroxide. We replaced the calcium hydroxide regularly. It is difficult for clinicians to determine the timing for root canal filling in conventional endodontic treatment without a microscope as the condition of the apex can not be seen directly. Therefore, we evaluated the condition of the apex using a microscope to decide the timing for root canal filling in these cases. In the first case, 2.1 years after the injury and in the second case, 11 months after the injury, we confirmed that both root canal apices were strongly calcified by microscopic examination. Consequently, we obturated the root canal of #21 by thermoplasticized injection molded technique. Closure of the apex of the root canal and favorable healing were confirmed in both clinical cases using the microscope.
