Multidisciplinary approach of complicated crown fractures of both superior central incisors: a case report

Management of a Complex Crown-Root Fracture in a Single Appointment Through Root Canal Therapy and Rebonding

A 10-year-old male presented with a mobile and fractured maxillary right central incisor following dental trauma. Clinical and radiographic examinations revealed a chisel-type crown-root fracture with supragingival labial and subgingival palatal extensions. A direct crown reattachment was planned, emphasizing biological width preservation. After removing the coronal fragment, endodontic treatment was performed using a rotary file system and was obturated with a bioceramic sealer. A fiber post was selected and integrated into the fractured fragment, which was reattached using resin cement. Additionally, a gingivectomy was performed to enhance margin visibility and restore biological width. The adjacent left central incisor was treated for an uncomplicated crown fracture using follow-up evaluations over 12 months revealed stable fragment reattachment, good periodontal health, and restored aesthetics and function. A custom mouthguard was provided to prevent future trauma. This case highlights the efficacy of a multidisciplinary approach combining endodontic, restorative, and periodontal techniques for managing crown-root fractures, achieving favorable long-term outcomes in pediatric patients.

Multidisciplinary Approach to Complicated Crown-root Fracture Treatment: A Case Report

Treatment of complicated crown-root fractures is one of the most challenging within the various types of dental trauma and requires a multidisciplinary approach. This paper reports the complicated crown-root fracture of a maxillary right central incisor, in which there was esthetic, functional, and biologic (endodontic and biologic width invasion) involvement. A 15-year-old male patient presented to the dental clinic one month after suffering trauma with a complicated crown-root fracture on tooth 8. The patient had previously undergone endodontic treatment and was sent to have periodontal surgery to reestablish the biological width on the palatal surface. Following the surgery, a fiberglass post was cemented, and the fragment was reattached. This approach allows the exposure of the cervical margin, adequate isolation, and subsequent fragment reattachment in the same clinical appointment. Fragment reattachment is a viable approach as it is a simple and conservative procedure that restores the natural esthetic of the tooth and has superior resistance compared to a composite restoration. The patient's cooperation in understanding the limitations of the treatment and maintaining adequate oral hygiene are very important to achieving a good prognosis of the case. After a 2-year clinical and radiographic follow-up period, the clinical protocol was found to be successful, and the tooth remained functional, esthetically favorable and asymptomatic.

Surgical extrusion to provide a ferrule for restoring a tooth with a compromised prognosis: A clinical report

A surgical extrusion technique was used to provide a ferrule for a tooth with significant tooth structure loss and an oblique coronal fracture. The maxillary lateral incisor was surgically repositioned coronally to provide sufficient dentinal wall for a good prognosis of the restorative treatment. The procedure is conservative and relatively straightforward and can be performed rapidly with minimal patient discomfort.

Influence of Storage Media and Duration of Fragment in the Media on the Bond Strength of the Reattached Tooth Fragment

Introduction

Fracture of anterior teeth is the most frequent type of injury in the permanent dentition. Composite materials have made possible the use of adhesive materials and techniques, but storage of fragment in the media can enhance the bond strength. The purpose was to evaluate the influence of storage media and duration of the fragment in the media on the bond strength of the reattached fragment of teeth.

Materials and methods

A total of 104 permanent maxillary central incisors were included. Samples were divided into four groups of 26 teeth each, further divided into eight groups of 13 teeth each and sectioned 3 mm apical to the incisal edge and stored in four storage media—tap water, artificial saliva, sodium fluoride, and Tooth Mousse at 12 and 24 hours. The bond strength was measured by universal strength testing machine.

Results

Tooth Mousse showed statistically significant difference (p-value 0.001) compared with sodium fluoride, artificial saliva, and tap water when stored in both 12 and 24 hours’ duration.

Conclusion

Tooth Mousse was a better storage media when compared with sodium fluoride, artificial saliva, and tap water.

Clinical significance

Tooth Mousse can be considered as a best storage media for fragment reattachment.

How to cite this article: Jalannavar P, Tavargeri A. Influence of Storage Media and Duration of Fragment in the Media on the Bond Strength of the Reattached Tooth Fragment. Int J Clin Pediatr Dent 2018;11(2):83-88.

Management of Complicated Crown Fracture by Reattachment Using Fiber Post: Minimal Intervention Approach

Anterior crown fractures are a common form of traumatic dental injuries that mainly affect the maxillary incisors, especially in children and adolescents. Complicated crown fractures although less common, pose a challenge to the clinician. The main objective while treating such cases is successful pain management and immediate restoration of function, esthetics and phonetics. Since the development of the adhesive dentistry, the patient's own fragment can be used to restore the fractured tooth. Reattachment of fractured tooth fragments offers a viable restorative alternative. The procedure provides good and long-lasting esthetics, because the original morphology, color, and surface texture are preserved. This article reports management of complicated crown fracture in a young adult and a middle-aged adult that were successfully treated by reattachment technique. The teeth were endodontically treated followed by esthetic reattachment of the fractured fragment using the glass fiber post. To improve the adhesion between fractured and remaining fragment, circumferential beveling and internal groove placement were done.

Multidisciplinary Management of Complicated Crown-Root Fracture of an Anterior Tooth Undergoing Apexification

The purpose of this case report was to present the multidisciplinary management of a subgingival crown-root fracture of a patient undergoing apexification treatment. A 12-year-old male patient was referred to the pediatric dentistry clinic with an extensive tooth fracture of the right permanent maxillary lateral incisor. Clinical and radiographic examinations revealed the presence of a complicated crown-root fracture, which had elongated to the buccal subgingival area. The dental history disclosed that the apexification procedure had been started to be performed after his first trauma experience and he had neglected his appointment. The coronal fragment was gently extracted; endodontic treatment was performed; flap surgery was performed to make the fracture line visible. The coronal fragment was reattached to the root fragment with a dual-cure luting composite. A fiber post was stabilized and the access cavity of the tooth was restored with composite resin. At the end of the 24th month, the tooth was asymptomatic, functionally, esthetically acceptable and had no periapical pathology. It is important for the patients undergoing apexification treatment to keep their appointments because of the fracture risk. Restoration of the fractured tooth by preparing retention grooves and a bonding fiber-reinforced post are effective and necessary approaches for successful management.

Tooth fragment reattachment: a case report

The aim of this article is to present a case report for the multidisciplinary treatment of anterior tooth fractures with invasion of the biologic width and pulpectomy. Successful esthetic and functional results were achieved by bonding the crown fragment, without any form of preparation or the utilization of intracanal posts.

Biomimetic approach to extensive fracture of anterior teeth--a case report

The fracture of anterior teeth in children and adolescents is a common injury. When most tooth structure is compromised and the broken fragment is not recovered, its restoration can become rather complex to both dentist and dental technician. Restoration of single anterior elements is one of the most demanding challenges in fixed prosthodontics. This article describes a clinical case of a 13-year-old patient with an extensive fractured central incisor and contra lateral incisor. Endodontic treatment was performed on both teeth, and a temporary removable appliance was made for esthetics. One month later, an indirect esthetic post and core was made for each tooth, and provisionals were placed. After a 6-month period of soft tissue stabilization, two pressed all-ceramic crowns were fabricated and bonded to the preparations. The authors believe this to be a stable long-term option relative to the reminiscent tooth structure, esthetic demand, and occlusal features of the case.

A new approach to endodontic treatment and operative procedure in nonendodontically treated posterior crown root fractures

We report a case of nonendodontically treated first upper premolar crown root fracture in which the palatal cusp fracture extended below the cementoenamel junction. Reattachment of the palatal cusp in its original position by acid-etch and flowable composite allowed the creation of a standard access opening as in an intact tooth, avoiding apex location errors and contamination of the root canal. During crown-lengthening surgery, the palatal cusp fragment was hollowed out and used as a natural individual matrix for placement of the core material.