Aim: To demonstrate management of a severely intruded permanent anterior tooth in a pediatric patient, showcasing the prevention of ankylosis, as evidenced by CBCT findings during follow-up.
Materials and Methods: An 11-year-old female patient arrived at the clinic with complaints of discomfort and a severely intruded upper anterior tooth (#21), displaying more than 7mm of intrusion and producing a metallic sound upon percussion. Surgical repositioning of tooth #21 and wire and composite splint was applied under LA. Root canal treatment was started one month later, when signs of necrosis was observed. After cleaning and shaping of the canal, the canal was dressed with intracanal medication. After 4 weeks, mineral trioxide aggregate (MTA) was placed as an apical plug (5mm). The canal was filled with warm gutta percha and restored. The patient was followed up starting 3 weeks, 4 weeks, 6 week, 8 week, 6 months, 1 year, and 2 years showed that there is increase in the bone radiopacity around the traumatic tooth.
Result: After 2 months, the CBCT showed a 2.2 mm periapical radiolucency near tooth #21, widened periodontal ligament space, and lamina dura resorption. By 10 months, bone formed around the tooth apex, while the lamina dura reformed. After 2 years, increased bone radiopacity surrounded the tooth without ankylosis or replacement root resorption.
Conclusion: Using surgical reposition in severely intruded tooth combined with splinting and MTA as an apical plug proved effective in maintaining the tooth and preventing ankylosis, as demonstrated by follow-up assessments and CBCT findings.