Hindawi Publishing Corporation
Case Reports in Dentistry
Volume 2015, Article ID 360160, 3 pages
http://dx.doi.org/10.1155/2015/360160
Case Report
Traumatic Displacement of Maxillary Permanent Canine into
the Vestibule of the Mouth
Masayasu Iwase,1 Michiko Ito,2 Hanon Katayama,3 Hiroaki Nishijima,4
Hirokazu Shimotori,1 Airi Fukuoka,2 and Yoko Tanaka1
1
Department of Dentistry and Oral Surgery, Hakujikai Memorial General Hospital,
5-11-1 Shikahama, Adachi-ku, Tokyo 123-0864, Japan
2
Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University,
2-1-3 Tsurumi, Tsurumi-ku, Yokohama, Kanagawa 230-8501, Japan
3
Division of Community Based Comprehensive Dentistry, Department of Special Needs Dentistry, School of Dentistry,
Showa University, 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan
4
Department of Dentistry and Oral Surgery, Jinkokai Hospital, 3-8-11 Nakamachi, Atsugi, Kanagawa 243-0018, Japan
Correspondence should be addressed to Masayasu Iwase; iwase@dent.showa-u.ac.jp
Received 30 January 2015; Accepted 10 April 2015
Academic Editor: Hamdi Cem Gungor
Copyright 2015 Masayasu Iwase et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Dentoalveolar injuries are common and are caused by many factors. Dental trauma requires special consideration when a missing
tooth or tooth fracture accompanies soft tissue laceration. A tooth or its fragment occasionally penetrates into soft tissue and may
cause severe complications. This report presents a case of delayed diagnosis and management of a displaced tooth in the vestibule of
the mouth following dentoalveolar injury. This report suggests that radiography can lead to an early diagnosis and surgical removal
of an embedded tooth in the soft tissue.
1. Introduction
Dental trauma can result in a number of different injury
types involving teeth and their supporting structures. Six
types of luxation and seven types of tooth fracture have been
described [1]. The frequency of lateral luxation and avulsion
of teeth leading to a traumatic dental injury increases with
age, while intrusion decreases with age [1]. A tooth or its
fragment may displace anteriorly, posteriorly, or vertically
according to the impact energy and direction of the causal
agent, as well as the location of the injury and the support
structure of the involved tooth. Most dentoalveolar fractures
are in front of the maxilla [2]. There have been many reports
of tooth fragments embedded in soft tissue accompanying
a tooth fracture [35], but this case did not involve a tooth
fracture. Furthermore, displacement of teeth most often
involves the central and lateral incisors, while the canines
are rarely involved [2]. Cases involving displacement of a
tooth or its fragment into soft tissue resulting in dentoalveolar
injury have been reported in the tongue [3, 4], lips [5, 6],
and nasal cavity [2, 7] but are extremely rare in the vestibule
of the mouth. When dental physicians encounter a tooth
or its fragment accompanying soft tissue swelling and laceration subsequent to a dentoalveolar injury, they should
pay attention to possible displacement of the tooth or its
fragment into the soft tissue. Therefore, previous studies have
emphasized that dental physicians should perform a clinical
examination of the laceration with proper radiography in
cases of dentoalveolar injury [2, 5, 6].
This paper reports a case of dentoalveolar injury in which
a canine was embedded in the vestibule of the mouth and
surgically removed from the soft tissue.
2. Case Presentation
A 46-year-old female was referred to the Department of
Dentistry and Oral Surgery of Hakujikai Memorial General
Hospital for clinical examination of the left maxilla with
spontaneous pain. The patient had sustained an injury
to the lower face 12 days earlier. She promptly consulted
Case Reports in Dentistry
Figure 3: Panoramic radiograph showing horizontally embedded
canine of the left maxilla.
Figure 1: Extraoral view at first medical examination of lacerative
scar in the lower lip and swelling in the nasolabial sulcus.
Figure 4: Axial CT showing fracture of alveolar bone in the lateral
incisor and canine.
Figure 2: Intraoral view at first medical examination of lacerative
scar of the gingiva in the left maxilla.
a neighboring emergency hospital because of laceration of
the lower lip and gingiva of the maxilla. Thereafter, she was
treated with suture of the lower lip under local anesthesia
by a general surgeon and was instructed to put pressure on
the bleeding gingiva with gauze. In addition, she lost the left
maxillary lateral incisor and canine due to trauma. She could
confirm the existence of one of the teeth, but the existence of
the other tooth was unclear. No treatment or examination was
provided for the missing teeth. She received prescriptions for
antibiotics and analgesics and returned home. The bleeding
easily stopped afterwards. However, because of swelling and
pain of the left maxilla, the patient consulted our hospital.
Her chief complaint at the time of the first medical
examination was swelling and oppressive pain of the left
maxilla (Figure 1). Intraoral view confirmed swelling of the
oral vestibule mucosa in the first premolar region (Figure 2).
Panoramic radiography showed a horizontal embedded
canine (Figure 3). CT scan showed fracture of the alveolar
bone in parts of the lateral incisor and canine (Figure 4).
Based on these findings, replantation of the canine was not
an option. Furthermore, CT scan showed that the canine
was embedded in the vestibule soft tissue (Figure 5). We
decided to perform surgical excision of the embedded canine
under local anesthesia (3.6 cc lidocaine in 2% solution with
1 : 80,000 adrenaline) together with intravenous sedation
with midazolam (3 mg/body). An incision was then made
in the lacerated gingiva, and the embedded canine was
removed surgically. Fibrous tissue and fragments of alveolar
bone surrounding the embedded canine were also curetted
(Figures 6 and 7). The incision was sutured with 4.0 silk suture
threads. Systemic antibiotic (1 g flomoxef sodium, twice a
day for three days) was intravenously administered to the
patient. Analgesic (tramadol hydrochloride/acetaminophen,
2 tablets for pain) was also prescribed to the patient. The
wound healed favorably and sutures were removed on the
seventh postoperative day, and the patient was discharged
from the hospital.
3. Discussion
The recognition and identification of an embedded tooth or
its fragment are important because continuous movement
and contraction of the muscles may dislocate the foreign
bodies. Moreover, oral bacteria flora can infect the wound
and deep tissues. Failure to remove an embedded tooth or its
fragment in the soft tissue may result in persistent chronic
infection, pus discharge, or disfiguring fibrosis [8]. Previous
Case Reports in Dentistry
Figure 5: Coronal and axial CT showing embedded canine into soft tissue of the vestibule of the mouth.
occurs, both hard and soft tissue structures must be examined
carefully for evidence of an embedded tooth.
Conflict of Interests
The authors declare that there is no conflict of interests
regarding the publication of the paper.
References
Figure 6: Intraoral view during operation showing exposure of
embedded canine into soft tissue of the vestibule of the mouth.
Figure 7: Identified and removed permanent canine.
reports have emphasized that radiography, including CT,
should be a routine diagnostic procedure in all cases with
associated missing anatomical structures in the oral and
maxillofacial region [2, 5]. Involving dental professionals in
the initial assessment of dentoalveolar injury in emergency
rooms in hospitals is important in order to identify how many
teeth might be missing after dentoalveolar injury.
This case report demonstrates the importance of an accurate patient history, physical examination, and radiographic
evaluation of such a patient. When dentoalveolar injury
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