Introduction
Trauma to the anterior teeth is a frequent occurrence, especially in young individuals, and can significantly impact function, esthetics, and psychosocial well-being. Ellis Class III fractures, characterized by enamel, dentin, and pulp involvement, demand immediate and precise intervention to preserve tooth vitality and restore esthetics. Frequently, such injuries are accompanied by lip swelling or soft tissue trauma, necessitating a multidisciplinary approach.
This case series discusses the comprehensive management of a patient with anterior maxillary trauma using endodontic therapy, nitrous oxide sedation, and adhesive restorative techniques.
Case Report
Patient Presentation
A 34-year-old female patient reported to the clinic following a trauma with complaints of swelling in the upper and lower lips, along with severe pain in the upper front-tooth region.
Clinical Examination
- Extraoral: Diffuse swelling of the upper and lower lip noted.
- Intraoral: Ellis Class III fracture was observed in tooth 11 with associated tenderness. Tooth 21 showed enamel and dentin involvement.
Investigations
- Orthopantomogram (OPG) was advised for overall evaluation.
- Cone-Beam Computed Tomography (CBCT) suggested if further assessment of periapical status or surrounding anatomical structures was required.
Management
- Endodontic Phase: Root canal treatment was performed in tooth 11 under nitrous oxide inhalation sedation (NOIS), ensuring patient comfort and cooperation.
- Restorative Phase: Composite resin restorations were carried out in teeth 11 and 21 to restore form, function, and esthetics.
- Supportive management for lip swelling included cold compress and anti-inflammatory medication as required.
Outcome
- Resolution of pain following RCT in tooth 11.
- Gradual subsidence of lip swelling.
- Excellent esthetic and functional outcome achieved with composite restorations.
Discussion
Dental trauma involving Ellis Class III fractures requires immediate endodontic intervention to eliminate pulpal infection and prevent periapical pathology. In the present case, the use of nitrous oxide inhalation sedation (NOIS) proved advantageous in reducing patient anxiety and facilitating smooth clinical procedures.
Composite resin restorations remain the material of choice in anterior teeth due to their esthetic potential, conservative nature, and ability to bond effectively to tooth structure. In cases involving multiple anterior teeth, direct composite restorations provide a chairside solution that restores both esthetics and function.
This case also underlines the importance of addressing associated soft tissue injuries such as lip swelling, which may complicate the patient’s overall discomfort and perception of trauma. Supportive care and reassurance play an essential role in holistic patient management.
Conclusion
Traumatic dental injuries involving anterior teeth require prompt diagnosis and interdisciplinary management. The integration of NOIS, endodontic therapy, and composite restoration ensures patient comfort, successful clinical outcomes, and satisfactory esthetics. Future studies involving larger case series will help strengthen clinical protocols for managing such injuries.
