Maxillofacial Trauma with Dental Intrusions in Adults, Conservative Treatment of Pulp Vitality and Emotional Support for the Patient

In this clinical case of a 43-year-old woman who fell from a height of 3 meters, a preliminary clinical evaluation and vital signs were taken. She presented maxillofacial trauma without acute upper respiratory tract involvement, with a maxillary fracture and intrusive and lateral dislocation of five upper anterior teeth, as well as lacerations to the skin and oral mucosa.Antibiotic therapy with ceftriaxone 1 g IM and tetanus vaccination were immediately administered, along with bleeding control, disinfection, and cosmetic suturing of the facial skin and lower lip wounds. Complementary clinical and computed tomographic studies were performed to rule out cranial injuries. The day after the accident, after receiving medication, the intruded and luxated teeth were repositioned under local anesthesia. The multiple fractures were then reduced manually with digital pressure on the fractured ends, relocating the bone fragments to coincide with the pre-existing three-dimensional positions of the tooth roots. The maxillary fracture reduction was stabilized with a 19 × 25 stainless steel orthodontic archwire, secured to the maxillary teeth up to the first molars with composite adhesive fillings. This bone and tooth stabilization was maintained for 7 weeks. The patient was supplemented with transresveratrol 100 mg/day + Vitamin E 20 mg/day to promote bone healing. After removing the splint, the tooth fractures were reconstructed with nanoparticle resin. The bone fractures allowed for greater periapical free space for blood supply, which could explain the maintenance of pulp vitality. Maintaining splinting for 7 weeks was sufficient to consolidate the bone fractures and stabilize the repositioned teeth without any dental ankylosis. After healing and bone remodeling, all traumatized elements reduced the width of the thin buccal bone wall by up to 50%. At the 16-month follow-up, preservation of pulp vitality, periodontal health, and maintenance of the crest bone level of all traumatized teeth were observed, along with minimal linear scarring on the skin of the chin and lip. Pulp canal obliteration (PCO) was found in the right central incisor, with a 60% reduction in canal diameter. However, strict clinical/CT follow-up of the traumatized teeth for at least 5 years is required to verify and ensure pulp vitality and periodontal, bone, and periapical integrity. Emotional support of the patient was a priority to mitigate her distress. This promoted calm and relaxation throughout the surgical procedure, where music was a key factor and encouraged strict adherence to the instructions and prescriptions. Furthermore, the aesthetic results achieved positively influenced the patient’s social interaction and self-image. The repositioning of intrusive dislocations and the results obtained are encouraging. However, as this is a single case, there are no controls or comparative data, and this limitation suggests the need for more extensive research to validate this multifactorial treatment approach. Furthermore, systematic studies are needed to validate adjuvant therapy with resveratrol and emotional support protocols, encouraging research on patient psychology in dentistry.