(TC72) ‘We’ve Nailed It!’- Iatrogenic Damage to Teeth From Trauma Plates

A patient attended a university dental hospital, having been referred by his general dental practitioner (GDP) with suspected resorption of his lower left premolar roots. The patient was asymptomatic and it was an incidental radiographic finding by his GDP. A thorough history elicited that the patient had sustained a mandibular fracture following an alleged assault 20 years prior which was managed with open reduction internal fixation. The history, in combination with Cone Beam Computed Tomography (CBCT), identified the lesions on the roots as iatrogenic damage caused by trauma plate screws.
This case highlights the iatrogenic damage that can occur to teeth as a result of mandibular fracture and the placement of trauma plates. Given the frequency of mandibular fractures, GDPs will see patients in practice who have had plates placed. It may be prudent for GDPs to carefully assess these patients by performing a thorough history, including any pain history, sensibility testing of the teeth and radiographic review. Onward Specialist referral for assessment and management may be prudent. The use of CBCT can be beneficial in aiding diagnosis.
The purpose of this table clinic is to highlight the diagnostic challenges the clinician may encounter in with diagnosis and management of these cases. This can include the presence of metal plates adjacent to the tooth resulting in scatter on the CBCT complicating assessment and diagnosis, there may be communication between the root canal system and the periodontal ligament due to perforation with a screw and apex locators may give inaccurate readings due to the presence of metal screws.