Management of traumatic dental injury after periodontal surgery in patient with hereditary gingival fibromatosis: case report.

Traumatic Dental Injury (TDI) is often caused by a bruise from a sports-related incident or fall. In individuals with maxillary protrusion, the risk for TDI may be higher. We treated a patient with Hereditary Gingival Fibromatosis (HGF), a rare genetic disorder characterized by proliferative fibrous overgrowth of gingival tissue, who subsequently received a TDI after periodontal surgery. A 13-year-old Japanese boy was referred to the Division of Periodontics at Aichi Gakuin University Dental Hospital in March 2005 with the chief complaint of generalized severe gingival overgrowth involving the maxillary and mandibular arches covering nearly all teeth. Prior to orthodontic treatment, periodontal surgery was performed under general anesthesia in consideration of mastication, dental esthetics, and development. However, soon thereafter in August 2007, the protruded maxillary anterior teeth received an injury while he was playing basketball and the maxillary central incisors showed extrusive luxation. Two weeks after being reset, the maxillary anterior teeth were splinted with wire and adhesive resin cement, and then the splint was removed following evaluations of clinical and radiographic showing signs of normal periodontium. The marginal bone height corresponded to that seen in radiographic findings after the reset and orthodontic treatment was started 1 year later. At the 6-year follow-up examination, the teeth remained asymptomatic, pulpal response to sensitivity tests was normal, and healing was shown in radiographic images. In the present HGF case, we speculated that removal of thick gingiva around the teeth, which might have functioned as a mouth guard, increased the risk for TDI while playing sports. TDI is more likely to occur in patients with exposed protruded misaligned teeth after periodontal surgery. Therefore, it is important for HGF patients with such protruded maxillary anterior teeth to use a mouth guard when participating in sports following periodontal surgery to prevent TDI.