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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 4  |  Issue : 3  |  Page : 129-131

Retrieval of a fractured tooth fragment embedded in the lower lip


Department of Pedodontics, SRM Dental College, SRM University, Chennai, Tamil Nadu, India

Date of Web Publication20-Nov-2013

Correspondence Address:
Vijayakumar Rajendran
A33, Madura Gardens, No. 15, Poonamallee High Road, Maduravoyal, Chennai - 600 095, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-433X.121640

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  Abstract 

Traumatic injuries to the maxillary anterior teeth due to domestic accidents and contact sports leading to tooth fracture are a common finding in a pedodontic practice. Sometimes the fractured tooth fragment can penetrate into the surrounding soft-tissue and may be often missed in a routine clinical examination. This case report presents a 10-year-old boy who reported to the Department of Pedodontics, SRM Dental College with fractured maxillary right central incisors along with lower lip laceration due to trauma. Patient was subsequently diagnosed with a fragment of a fractured permanent central incisor in the lower lip after routine clinical examination and radiographic examination. Patient was initially seen at a private dental hospital, where the embedded dental fragment in the lower lip went unnoticed. The fragment was removed surgically and composite filing was done in the fractured central incisor at a later stage. This report highlights the importance of thorough clinical examination followed by radiographic examination in patients reporting with dental fractures due to trauma.

Keywords: Embedded tooth fragment, lower lip laceration, tooth fracture


How to cite this article:
Rajendran V, Haridoss S, Rajendran G, Ramkumar H. Retrieval of a fractured tooth fragment embedded in the lower lip. SRM J Res Dent Sci 2013;4:129-31

How to cite this URL:
Rajendran V, Haridoss S, Rajendran G, Ramkumar H. Retrieval of a fractured tooth fragment embedded in the lower lip. SRM J Res Dent Sci [serial online] 2013 [cited 2022 Sep 25];4:129-31. Available from: https://www.srmjrds.in/text.asp?2013/4/3/129/121640


  Introduction Top


Dental trauma represents one of the major oral health problems especially in children and adolescents. The most common etiological factor being fall, assaults, vehicle accidents, sports ground injuries, accidents at school etc. [1],[2] The incidence rate is highly variable and is related to the age and gender of the patients. The boys are usually affected more than the girls. [1],[2],[3] The fracture of maxillary central incisors accounts high because of its projection due to the normal over jet and the fractured incisors are often accompanied by laceration of surrounding soft-tissue especially the lower lip. [1],[4],[5]

The soft-tissue injuries are either due to the direct contact with responsible object or due to the soft-tissue being driven into the teeth particularly the maxillary central incisors due to the impact. It is not uncommon in these patients to find a fractured tooth fragment in the surrounding soft-tissue. [6],[7] Various authors have reported such tooth fragments being embedded in the lower lip, upper lip and tongue, which were diagnosed and retrieved immediately after the trauma or after some time period as long as 1 year. [5],[8] Attention should be paid to the fractured or missing teeth and a thorough clinical and radiographic inspection should be done to detect or rule out a tooth fragment embedded in the surrounding soft-tissue. [4],[8]

This article reports an immediate diagnosis and management of dental fragment hidden in the lower lip laceration following an orofacial injury.


  Case Report Top


A 10-year-old male patient reported to Department of Pedodontics and Preventive Dentistry, SRM Dental College, Ramapuram, Chennai with a chief complaint of sensitivity from the fractured upper front teeth and pain from the lacerated lower lip due to a fall while playing at home. He reported to our department 48 h after sustaining the oral injury. Patient was conscious after trauma and was taken to a private dental clinic in their locality where he was prescribed antibiotics and anti-inflammatory drugs following a wound debridement.

Extra oral examination showed swelling and laceration on the middle of the lower lip [Figure 1]. Intraoral examination revealed an Ellis class II fracture in the incisal 1/3 rd fracture of the permanent right maxillary central incisor involving enamel and dentin without any evidence of mobility [Figure 2]. The intraoral periapical radiograph of the fractured teeth did not show any periapical alteration or root fracture. Patient and parent could not account for the fractured tooth fragment and the therefore considering the laceration and edema of the lower lip a soft- tissue radiograph of the lower lip was recommended [Figure 3]. Radiograph confirmed the presence two small radiopaque mass suggestive of tooth fragments embedded in the lower lip.
Figure 1: Extra oral photograph showing laceration and swelling in the lower lip

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Figure 2: Intraoral photograph showing fracture of the permanent right maxillary central incisor involving enamel and dentin

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The mass was surgically exposed under Local anesthesia with infiltration of 2% lignocaine solution with 1:100,000 epinephrine. The two radiopaque mass were retrieved and confirmed to be the tooth fragments[Figure 4]. The soft-tissue radiograph of the lower lip was repeated to confirm the complete removal of fragment and sutures were placed [Figure 5] and [Figure 6]. Antibiotics were prescribed and tetanus prophylaxis was provided. At 1 week post-surgical follow-up the sutures were removed and the fractured maxillary right central incisor was restored with a glass-ionomer cement lining and composite resin restoration.
Figure 3: Radiograph of lower lip taken using intraoral periapical radiograph showing the embedded tooth fragments as two small radio opaque mass in the laceration

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Figure 4: Removed tooth fragments

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Figure 5: Extra oral photograph of the lip after removal of the fragments

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Figure 6: Post-surgical radiograph of the lower lip confirming complete removal of the tooth fragments

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  Discussion Top


Trauma to the anterior teeth is a frequent orofacial injury in children and it is mostly associated with fracture of the maxillary anterior teeth and laceration of soft-tissue. The tooth most commonly affected is maxillary central incisors and boys are affected more than girls and the incidence is greater in the first decade of life. [1],[2] The fall during play accounts the common etiological factor along with domestic accidents, sports ground injuries, assaults and road traffic accidents. Factors like increased over jet (>6 mm), lip incompetence and proclined upper anteriors increase the probability of maxillary anterior tooth fracture during such incidents. [1],[2]

In rare instances the children or the parent may not be able to account for the missing teeth or teeth fragments. In such case, the associated soft tissue injury should be subjected to thorough clinical examination and radiographic examination. Literature evidences show that fractured tooth fragments can be commonly found embedded in the upper lip, lower lip, tongue or alveolar mucosa. [3],[4],[6],[7],[9],[10],[11] Incidence is more common in the lower lip as opposed to other sites of the oral cavity. The embedded fragments if went unnoticed may cause infection, swelling and pain of the associated soft-tissue eventually leading to retarded healing and scar formation. [6],[12],[13] Rarely, such fragments will spontaneously erupt from the mucosa or may shift into different locations due to muscle contractions. The usual recommendation is to retrieve the fragment to prevent any undesirable immediate or delayed complications. [6],[7],[8],[9],[10],[11],[12] Hence special attention should be given in diagnosis to identify the unaccounted missing tooth or fracture fragment and the associated soft-tissue wound should be explored and debrided thoroughly before suturing.

In the present case report, the persistence of swelling and edema 48 h after the wound debridement evoked the suspicion of a probable tooth fragment embedded in the soft-tissue laceration. An intraoral periapical film was used to take a soft-tissue radiograph of the lip, which confirmed the presence of tooth fragments.


  Conclusion Top


This case reports the importance of meticulous clinical and radiographic assessment of the soft-tissue injury in association with missing teeth or tooth fragment before placement of suture.

 
  References Top

1.Andreasen JO. Etiology and pathogenesis of traumatic dental injuries. A clinical study of 1,298 cases. Scand J Dent Res 1970;78:329-42.  Back to cited text no. 1
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2.O'Neil DW, Clark MV, Lowe JW, Harrington MS. Oral trauma in children: A hospital survey. Oral Surg Oral Med Oral Pathol 1989;68:691-6.  Back to cited text no. 2
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3.Pasini S, Bardellini E, Keller E, Conti G, Flocchini P, Majorana A. Surgical removal and immediate reattachment of coronal fragment embedded in lip. Dent Traumatol 2006;22:165-8.  Back to cited text no. 3
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4.Pektas ZO, Kircelli BH, Uslu H. Displacement of tooth fragments to the lower lip: A report of a case presenting an immediate diagnostic approach. Dent Traumatol 2007;23:376-9.  Back to cited text no. 4
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5.Al-Jundi SH. The importance of soft tissue examination in traumatic dental injuries: A case report. Dent Traumatol 2010;26:509-11.  Back to cited text no. 5
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6.da Silva AC, de Moraes M, Bastos EG, Moreira RW, Passeri LA. Tooth fragment embedded in the lower lip after dental trauma: Case reports. Dent Traumatol 2005;21:115-20.  Back to cited text no. 6
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7.Munerato MC, da Cunha FS, Tolotti A, Paiva RL. Tooth fragments lodged in the lower lip after traumatic dental injury: A case report. Dent Traumatol 2008;24:487-9.  Back to cited text no. 7
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8.Sangwan S, Mathur S, Dutta S. Retrieval and reattachment of an elusive tooth fragment. J Indian Soc Pedod Prev Dent 2011;29:171-5.  Back to cited text no. 8
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9.Antunes AA, Santos TS, Carvalho de Melo AU, Ribiero CF, Goncalves SR, de Mello Rode S. Tooth embedded in lower lip following dentoalveolar trauma: Case report and literature review. Gen Dent 2012;60:544-7.  Back to cited text no. 9
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10.Hill FJ, Picton JF. Fractured incisor fragment in the tongue: A case report. Pediatr Dent 1981;3:337-8.  Back to cited text no. 10
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11.Muthukumar RS, Alagappan M, Parthiban SV, Reddy V. A tooth fragment embedded in the upper lip after a traumatic dental injury: A case report. StreamDent 2011:2:269-71.  Back to cited text no. 11
    
12.Agarwal A, Rehani U, Rana V, Gambhir N. Tooth fragment embedded in the upper lip after dental trauma: A case report presenting an immediate diagnostic approach and complete rehabilitation. J Indian Soc Pedod Prev Dent 2013;31:52-5.  Back to cited text no. 12
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13.Roth JS, Walczyk JS. Occult tooth fragments spontaneously extruded after six months. Cutis 1994;54:253-4.  Back to cited text no. 13
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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