Full text of DOI:10.1038/sj.bdj.4800483a

PRACTICE
case report
Interesting presentation of a retained
upper deciduous incisor with apical
fenestration
1
M. B. Edney,
On examination, it was noted that the
A case is described where intrusion of a primary incisor resulting
in apical fenestration may have occurred secondary to occlusal
forces. The effects on the permanent dentition and possible
aetiological factors are discussed.
patient presented with a Class I molar rela-
tionship on a Skeletal I base. Oral hygiene
was good and no caries was evident.
Although URA (51) had been lost and UR1
(11) was in an acceptable position, ULA (61)
was still present; the apex of its root clearly
fenestrating through the labial mucosa. As a
result of its retention, UL1 (21) had erupted
rauma to the primary incisors is com- Case report
T
mon and is well documented in the lit- A healthy 7-year-old male was referred to into crossbite with LL1 (31).
erature. The reported incidence ranges the local specialist orthodontic practice by Radiographic examination revealed no
from between 4–30% and is dependent on his GDP regarding a retained ULA (61). abnormal pathology, with the root forma-
1
the sex and age of the child. The most fre- (upper left first deciduous incisor). This tion of UR1 (11) appearing to progress satis-
quently encountered of these traumatic tooth was asymtomatic and there was no factorily.
injuries are subluxation, intrusion and history of trauma. Both the dentist and the
avulsion. Crown and root fractures are patient were concerned with its appearance Treatment
2
rare. Occasionally trauma can result in and also the resultant malocclusion: a con- Treatment consisted of extraction of ULA
apical fenestration, a condition in which sequence of its retention.
the apex of a primary tooth root is found to
perforate both the labial alveolus and its
overlying gingiva thereby exposing it to the
oral environment.
(61), followed by a simple removable
Intrusion with apical fenestration as a
result of occlusal forces appears to be less
well documented, especially in the primary
dentition. A case is reported here, where
this appears to have happened. Its presen-
tation and subsequent management are
discussed below.
Fig.1 Retained
deciduous incisor
showing apical
fenestration
In brief
ꢀ Although trauma to deciduous
incisors is common, apical
fenestration as a consequence is
rare.
ꢀ Extraction of the offending tooth is
the treatment of choice.
ꢀ Any resultant malocclusion can then
be managed accordingly.
1*
General Dental Practitioner, The Dental Centre,
6 The Clockhouse, Brize Norton Road, Carterton,
Oxon OX18 3HN
*Correspondence to: M Ednay
Fig. 2 Lateral view
REFEREED PAPER
retained deciduous
Received 17.09.99; accepted 13.12.99
© British Dental Journal 2000; 188: 369–370
incisor
BRITISH DENTAL JOURNAL, VOLUME 188, NO. 7, APRIL 8 2000
369

PRACTICE
case report
1
Fried I, Erickson P. Anterior tooth trauma in the
primary dentition: incidence, classification,
treatment methods to sequaelae: a review of
literature. ASDC J Dent Child 1995; 62: 256-261.
Ravn J J. Sequelae of acute mechanical
traumata in the primary dentition. J Dent Child
1968; 35: 281-289.
Ravn J J. Development disturbances in
permanent teeth after intrusion of their
primary predecessors. Scand J Dent Res 1976:
84: 131-134.
Menendez O R. Bone fenestration by roots of
deciduous teeth. Oral Surg, Oral Med, Oral
Path 1967; 24: 654-658.
Serrano J. Gingivo-osseous pathological
fenestration. Oral Surg, Oral Med, Oral Path
1971; 32: 697-700.
appliance to correct the crossbite. At a
review 6 months later, UL1 (21) was still in tion associated with ULA (61) does not
good position.
In this case however, the apical fenestra-
appear to be traumatic, but secondary to
the occlusal forces exerted on it by LL1 (31).
As a result of these forces intrusion of ULA
2
3
Discussion
A traumatically intruded primary incisor (61) has occurred with its apex eventually
usually requires no immediate treatment fenestrating through the thin cortical plate
as it normally re-erupts within a few weeks and its overlying mucosa. Subsequently its
and attains its original position within root has not been resorbed by its perma-
4
5
6
3
6 months.
nent successor, and so UL1 (21) has erupted
Apical fenestration however appears to into a palatal position.
require the presence of a non-vital pri-
mary tooth which has been affected by Conclusion
4,5
caries, trauma or attrition. This loss of Intrusion of primary incisors secondary to
Kelly J R, Keeton J M, Barr E S. Apical
fenestration. ASDC J Dent Child 1976; 43:
96-98.
vitality, in addition to disrupting its occlusal forces appears to be a rare phenom-
resorption and the consequent eruption enon. In addition in this case a lack of apical
of its permanent successor, also creates alveolar bone has resulted in fenestration.
a periapical infection, which can destroy
The author gratefully acknowledges the help of
Mr H. A. Patel of Angle House Orthodontic Practice,
Edgware, Middlesex in the writing of this paper.
the labial bone and so extrude the primary
6
root.
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