Iranian Endodontic Journal

Abstract

Accurate characterization of dentoalveolar trauma remains challenging when conventional radiography underestimates the spatial behavior of alveolar fracture segments. This case report introduces a previously underemphasized phenomenon of asymmetric displacement within a single alveolar fracture segment and its implications for biological healing under conservative management. A 26-year-old female patient presented one week after trauma to the maxillary anterior region. Initial clinical and periapical radiographic evaluation suggested a luxation injury of both maxillary central incisors; however, cone-beam computed tomography (CBCT) subsequently revealed a displaced alveolar fracture with buccal cortical plate displacement involving both teeth, with marked intra-segmental asymmetry, demonstrating approximately 1 mm displacement in one incisor region and 3 mm in the adjacent region within the same fracture unit. Management included continued stabilization, occlusal adjustment, and endodontic treatment initiated during the early post-traumatic phase because of concern regarding pulpal compromise associated with dentoalveolar injury. Calcium hydroxide was used as an intracanal medicament followed by definitive obturation. No surgical repositioning was performed. At the two-year follow-up, both teeth were asymptomatic and functionally stable. Radiographic and CBCT evaluation demonstrated complete osseous remodeling, restoration of normal periodontal architecture, and absence of pathological sequelae. This case suggests that asymmetric displacement within a single alveolar fracture segment may be compatible with favorable healing when adequate segmental stability is maintained. This observation also highlights the value of three-dimensional characterization of displacement patterns that may not be apparent on conventional radiography.