AUTHORS: DR NEELIMA ANAND, DR RAJEEV ANAND, DR SHWETA SINGH,

CHETAN MEDICAL COMPLEX, MEERUT (U.P.).

ABSTRACT :

An unusual case of injury to the incisors is reported here in a 21yr old patient .The patient tried to shorten the length of central incisors with nail cutter,resulting into nonvital central incisor on left side.,along with this, there were enamel cracks in both the central incisors.

INTRODUCTION:

There are various causes of injuries to the permanent teeth leading to their non-vitality especially anterior teeth.Trauma is one of the main causes of making front teeth non-vital. Prevention of trauma is one of the major factor to avoid this irreversible loss. This case presents an unusual etiology of trauma to the Maxillary Central Incisors.

CASE –REPORT:

A 21 yrs old boy presented to the clinic with the chief complaint of protrusion of teeth. On examination left Maxillary Central Incisor was found to be discolored. ^{(Fig 1 & 2 )}. Patient was asymptomatic and there was no complaint of pain .Patient did not give any history of trauma. On detailed questioning, parents recalled that he used a nail cutter to reduce the size of his two front teeth approximately 6 years back.⁽¹⁾
IOPA x-ray revealed periapical pathology on left maxillary central incisor,correlating the x-ray finally it was evident that the cause of periapical pathology is because of trauma caused by nailcutter.⁽²⁾

Fig(1) pretreatment IOPA x-ray	Fig(2) IOPA x-ray after RCT	Fig(3) IOPA x-ray after 3 months

Fig(4) IOPA x-ray after 6months	Fig(5) IOPA x-ray after 1year

Root Canal Treatment of left maxillary central incisor was carried out.⁽³⁾ Fixed orthodontic treatment was planned for maxillary and mandibular arches .IOPA x-ray taken after 3 months, revealed reduction insize of the radiolucency periapically and healing in the form of increased radiopacity. IOPA x-ray was taken after 1 year and no radiolucency was observed.

Fig (6) Front view	Fig (7) Intraoral view	Fig (8)Front view with brackets

DISCUSSION:

Trauma in any form to the front teeth may lead to the non-vitality of the teeth. It remains unobserved for quite a few years, as patient avoids mild pain.⁽⁴⁾ The condition is noticed either on routine checkup or if patient reports to seek treatment for some other problem.
Root canal treatment or apicosectomy is usually the choice of treatment according to the lesion involved.

CONCLUSION:

Proper case history and radiographic examination is mandatory if a discolored tooth is observed even in an an otherwise asymptomatic patient. Many a times unusual causes of trauma could be found as observed in the above case.

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