Presentations 2020: Ortho&Paeds

444 - A case of unusual bone loss and necrosis following dental trauma

N ARIKAT M Ezzeldin S Bhatia M Collard
Presented by: Nadia Arikat
Cardiff Dental Hospital

Introduction: This case describes the diagnosis and treatment of a 15-year old male who presented with mobility and severe localised bone loss of his mandibular anterior dentition. He was referred to the paediatric department by his dentist for possible acute necrotising ulcerative periodontitis (ANUP). History and examination: The patient stated in his initial consultation that 5 months earlier, he had knocked his mouth by walking into a metal post and noticed his mandibular anterior dentition had become a little mobile and the surrounding gingivae slightly sore. On examination, gingival recession and grade 1 mobility of the mandibular left lateral incisor (LL2) and canine (LL3) were noted. Unusual interproximal hard tissue between these teeth was also visible which could not be dislodged with an ultrasonic or hand scaler. Investigations: Intra-oral periapical (IOPA) radiographs of the lower anterior dentition as well as cone beam computed tomography (CBCT) revealed a radiolucency at the apex of LL2 consistent with infection and vertical bone loss mesial to LL2. Several differential diagnoses were considered including a perio-endo lesion, ANUP and even lymphoma. Treatment: Having obtained consent from the patient and his adopted mother, he underwent surgical curettage of the affected area and removal of the interproximal hard tissue under general anaesthetic. When the tissue sample was sent for histopathological examination, it was found to be bony sequestrum, likely due to his history of trauma. After removing the necrotic bone, the LL2 had become significantly mobile so was extracted and used to fabricate a temporary auto-bridge. Following discussions with restorative specialists, long-term gap replacement options are being considered. Conclusions: This case poses several reflective points, such as that of Gillick competence, treatment of a needle-phobic teenager and managing patient and parents’ conflicting wishes to provide best interest treatment.
Consent Statement: Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian. A copy of the consent form is available for review by the the meeting organisers..

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