2019 Volume 40 Issue 1 Pages 52-58
We encountered a patient with maxillary left central incisor root fracture in whom a bridge was mounted after extraction but it became detached after about one month and we had difficulty in resolving the issue.
The patient was a 46-year-old male with autism spectrum disorder, and he visited our clinic with the chief complaint of maxillary left central incisor mobility. Although the resin veneer metal crown bridge was mounted from the maxillary right central incisor to the left lateral incisor after premedication with diazepam and extraction of the maxillary left central incisor under nitrous oxide inhalation sedation, the bridge became detached in one month. It was found that the patient had a habit of biting and pulling a handkerchief. Pulpectomy of the abutment and attachment of a retainer were performed, but detachment, fracture, and loss frequently occurred thereafter, and finally we abandoned prosthetic treatment. Self-injurious behavior, such as hitting his jaw with his fist, was noted and crown fracture of other teeth occurred.
The patient lives with his elderly mother and the detailed past medical history and state of the patient could not be obtained from her. Although the habit and self-injurious behavior were suspected before treatment, these could not be confirmed. This case highlights the difficulty of performing prosthetic treatment in disabled persons and the necessity of sufficient surveillance of the patient’s living situation and behavior in order to deal with such patients.
