Pathologic root migration secondary to vertical root fracture and full-coverage crowns: a report of 3 cases

Occasionally, tooth fractures may demonstrate exaggerated pathologic root migration (PRM), often resulting in tooth loss. The early propagation of the root fracture may not be readily identifiable through clinical inspection and conventional radiographic imaging. Ultimately, increased root separation, isolated deep periodontal probing depth, and characteristic radiolucent changes may facilitate the diagnosis. This article describes 3 patients with unusual presentations of PRM in endodontically treated teeth restored with full-coverage crowns. One case illustrates the use of cone beam computed tomography for restorative assessment following root separation. Although it is efficacious to place crowns on most posterior endodontically treated teeth to maintain structural integrity, patients may remain at risk for catastrophic PRM and tooth loss. Timely extraction of teeth with hopeless PRM may minimize underlying bone resorption and the need for osseous regenerative procedures, ultimately improving the dental implant recipient site.

Cerec omnicam and the virtual articulator--a case report

This case report demonstrates how two opposing teeth were restored with full crowns using Cerec software version 4.2 (pre-release version). In addition, an anterior tooth was provided with a veneer. The situation was scanned with the Cerec Omnicam. The new virtual articulator was used for the design to obtain correct dynamic contacts. The Cerec Omnicam can scan the entire situation prior to preparation without the help of an assistant, as no surface pretreatment is necessary. The locations of the occlusal contacts can be marked with articulating paper and are indicated on the virtual models. Selective deletion of individual areas allows the prepared teeth to be rescanned, considerably speeding up the workflow. A video demonstration is available of the acquisition and design procedure.

Mechanical, biological and clinical aspects of zirconia implants

The objective of this narrative overview is to discuss several in vitro and in vivo studies regarding the performance of one-piece zirconia implants in combination with the description of two clinical scenarios where zirconia implant prototypes were utilized with emphasis on the possible scientific and clinical concerns that may affect the functional, biological and esthetic long-term outcomes.

[The use of digital technology for care-dependent patients]

Several research reports have indicated that patients with dementia are likely to exhibit poor oral health. In the case of a 78-year-old women with Alzheimer's disease, tooth 22 had a crown fracture. The patient had always practiced good oral hygiene self care, but her self care was diminished drastically due to care dependency. It was decided to remove the root of tooth 22 and to fabricate an adhesive bridge. The digital technology was a welcome treatment aid.

Fixed partial overdenture creative and conservative solution

A patient presented with lower right first and second molars requiring full coverage restorations. A retained lower right primary second molar with a stainless steel crown was also present. The primary tooth was "submerged," creating an unfavorable plane of occlusion. An unconventional prosthesis was fabricated to restore the debilitated teeth and a proper plane of occlusion.

Multidisciplinary treatment approach for crown fracture and crown-root fracture ? a case report

The increased incidence of traumatic injuries to anterior teeth is a consequence of leisure activities, where the most common injuries are crown fractures. Treatment of the dental trauma is complex and requires a comprehensive and accurate diagnostic and treatment plan. It is also important to consider the biological, functional, esthetic and economic aspects, as well as the patient's desire. The purpose of this article is to report a case that shows the multidisciplinary approach required to successfully manage the rehabilitation of a maxillary central incisor with a complex crown fracture and a maxillary lateral incisor, that at first presented an oblique crown-root fracture, and after the orthodontic extrusion, suffered a more apical new crown-root fracture.

Achieving aesthetic success with an immediate-function implant and customized abutment and coping

The absence of teeth in the anterior region often results in a number of negative consequences compromising appearance and facial anatomy, as well as patients' self-esteem and social behavior. Dental implants have increasingly become a viable option for achieving natural-looking restorations. The success of anterior restorations, however, depends upon several factors. The following case presentation discusses these factors as well as the implementation of clinical and laboratory procedures for the restoration of a missing anterior tooth.

LEARNING OBJECTIVES

This article demonstrates an implant surgical procedure and restorative sequence used to replace a fractured single anterior tooth. Upon reading this article, the reader should: Understand how dental implants can be a viable solution based upon factors within the proximity of the region being restored. Realize that optimal aesthetics can be achieved when the final abutment is installed at the time of implant placement.

Clinical pearl In-treatment replacement of missing incisors

Four methods of in-treatment replacement of missing incisors are described.

Forced eruption: review and case reports

When developing a diagnosis and prognosis for a compromised anterior tooth, dentists often deem these teeth to be nonrestorable or hopeless without exploring some of the less common options for saving the tooth. This article reviews literature concerning forced eruption as a treatment alternative, discusses treatment planning considerations, and presents two cases in which forced eruption was used. The first case involves a deeply fractured central incisor; the second case deals with a periodontally involved central incisor that was used to prepare its own extraction site for implant placement.

Direct applications of a nanocomposite resin system: Part 2--Procedures for anterior restorations

Nanocomposite resins allow clinicians to create restorations with improved biocompatibility function, and aesthetics. By ensuring that the patient's condition is clearly and thoroughly evaluated preoperatively, the clinician can develope natural, harmonious integration of the restorative material with the patient's natural tooth structures. The critical information captured during the initial visit can also be used to ensure development of natural contours, light refraction, and characterization . This article describes two anterior applications of a contemporary restorative material for optimal results.

Treatment options of untreatable traumatized anterior maxillary teeth for future use of dental implantation

The anterior maxilla is the most traumatized region during childhood. Posttraumatic complications occasionally lead to tooth loss as well as the need for future implants. Unfortunately, it is contraindicated to place dental implants during childhood. A waiting period of approximately 8 to 10 years before completion of growth is required. For this patient to become a candidate for future dental implants, it is necessary to ensure the continuous growth and to preserve the dimensions of the alveolar process until growth has ceased from time of injury until joint maturation. To achieve these goals, it is essential to coordinate the treatment sequence at the time of trauma. After loss of a traumatized anterior permanent maxillary incisor in young adults, treatment options are limited: orthodontic closure of the gap and reshaping the adjacent teeth, or tooth extraction and maintaining the gap with a temporary restoration. Orthodontic space closure has limited indications and requires prosthetic restoration of at least 2 teeth. Extraction and temporary restoration will usually lead to bone augmentation before implantation. Other possible treatment options include orthodontic extrusion of the root remnant (in cases of untreatable root fracture or complicated crown-root fracture) and a temporary crown to serve the patient until the completion of growth and development, autogenous tooth transplantation, intentional extraction and immediate tooth replantation, distraction osteogenesis, and decoronation. Because general rules do not apply, individual treatment plans are necessary.

A multidisciplinary approach to enhance implant esthetics: case report

Esthetic implant-supported restorations in the anterior maxilla present a number of clinical challenges to the dentist, including the need to preserve or restore the periimplant hard and soft tissue architecture around the implant site. In this clinical case report, two implant systems were used to restore two missing maxillary central incisors to make use of the physical properties in each system. Two different surgical protocols were used to place each implant, and the deficient alveolar bone was restored with an autogenous bone graft. After a detailed clinical evaluation, a comprehensive treatment plan was developed to address the unique demands of the patient. Both teeth were fully restored with esthetic, implant-supported, single-tooth restorations, and clinical results were recorded postoperatively.

A modified impression technique for accurate registration of peri-implant soft tissues

Replacement of single missing teeth with an implant-supported restoration is recognized as a highly successful treatment. An impression technique for peri-implant soft-tissue replication in an anterior zone is described. The technique involves use of an interim restoration as an abutment for the final impression. This allows accurate duplication of the soft tissues and fabrication of a final restoration with the correct emergence profile.

Technique for repair of multiple abutment teeth under preexisting crowns

This technique describes a simple procedure for repairing multiple fractured or broken-down abutment teeth under existing crowns. The technique uses a Teflon tape polytetrafluoroethylene (PTFE) as a matrix and separating medium for fabrication of an autopolymerizing composite core material with digital pressure. This technique enables the dentist to solve an emergency clinical situation in a relatively short amount of time, pending further restoration with endodontic treatment and a cast post and core procedure.

The palatal advanced flap: a pedicle flap for primary coverage of immediately placed implants

The placement of implants immediately after tooth extraction has become a relatively common event. This approach has gained popularity because it reduces the time between tooth extraction and placement of the final prosthetic restoration. One problem that remains unresolved with this procedure, however, is that there is usually space left in the area surrounding the coronal portion of the implant. As none of the techniques published to date is completely satisfactory, we developed an approach that is a modification of the palatal pedicle flaps used for closure of oro-antral fistulas. This technique allows for precise rotational advancement of the palatal tissue in a coronal direction, thus facilitating complete coverage of the extraction site. The procedure was used on 38 patients treated for primary coverage of postextraction placed implants. Thirty-two of the patients required single tooth replacement, three patients received two implants each, and three patients received three implants each. In 27 of the cases, the procedure was performed in conjunction with barrier membranes; of the 38 cases, 25 patients required the use of DFDBA to fill the defect created by the extraction procedure. The average defect width was 4.70 +/- 0.2 mm. Complete primary coverage was obtained in all cases without any changes in the size or anatomy of the buccal vestibule; complete coverage was maintained over the entire healing period of 6-8 months (mean +/- SEM, 6.49 +/- 0.10 months). Even with guided tissue regeneration cases, there was no exposure of the barrier membrane or cover screw of the implant during healing. After a period of 1-5 years (mean +/- SEM, 39.35 +/- 2.69 months), none of the implants was lost. We conclude that the palatal advanced flap procedure is useful, fast, and easy to perform in cases of immediate implant placement after tooth extraction.

A single-appointment, definitive post-crown restoration: a case report

The marked advances made in restorative materials have allowed dentists to explore new techniques in restoring teeth. This paper describes a method of restoring extensively damaged endodontically treated teeth that are using the LightPost system and composite resin to build-up the broken crown directly. The treatment was completed in a single visit. Applying this direct technique in selected cases can simplify treatment planning and result in an acceptable restoration with pleasing aesthetics.

Achieving ultimate anterior esthetics with a new microhybrid composite

Direct bonding is one of the most commonly used forms of restoration for the conservative esthetic improvement of anterior teeth. The major challenges involve selecting composites that have adequate strength as well as provide lifelike optical properties that render the restoration functionally sound and esthetically pleasing. Properties such as high sculptability, wide shade range, varying opacities and translucency, as well as high polishability are essential for gaining absolute control over the restorative process and the attainment of natural-looking results. This article discusses a new composite restorative system and its application in the direct esthetic and functional rehabilitation of the anterior dentition.

Enhanced resilience and esthetics in a Class IV restoration

The purpose of this article is to give the reader a better understanding of the complex restorative challenge in achieving true harmonization of the primary parameters in esthetics (i.e., color, shape, and texture) represented by the replacement of a single anterior tooth. The case presented demonstrates the restoration of a Class IV fracture taking esthetic consideration of the anatomic variations of the adjacent teeth to produce a direct composite resin in harmony with the surrounding dentition. The basic procedure includes tooth preparation, development of the body layer, internal characterization with tints, development of the artificial enamel layers, shaping and contouring, and polishing. In understanding the total morphology of a tooth and using natural teeth as the basis for morphological thinking, the clinician possesses the knowledge to create restorations with a more natural appearance. Use of a recently developed optimized-particle composite and this morphological thinking allowed the author to achieve a restoration in harmony with the surrounding dentition. Continuing technological breakthroughs allow the clinician to implement and maximize new products to attain more predictable and esthetic results as demonstrated by this methodological protocol of incremental application of composite resins and modifiers to transform the Class IV fracture into a final restoration that mimics nature.

Interdisciplinary concepts in treating adult patients

Pre-prosthetics, as a part of orthodontic treatment in adults has gained increasing importance during recent years. Through coordinated orthodontic, prosthetic and periodontal treatment plans, patients with partial dentition can be offered further treatment possibilities. Such planning would allow for fixed prosthetic treatment possibilities and the survival of critical teeth. They would provide for better aesthetics and avoid functional disturbances. The aim of the present study was to present reports of patients treated by coordinated work at the Dental School of Hamburg University. In patients with partial dentition, premolars were uprighted and distally moved and molars were extruded to be used as abutments for fixed prosthetic reconstructions. Following trauma, the position of the remaining anterior teeth was improved to provide for optimal aesthetics after prosthetic treatment. Extraction of a subalveolarly fractured tooth is avoided through root extrusion and post-core reconstruction. The results demonstrate the advantages of pre-prosthetic treatment as regards stability, aesthetics and function. With the help of pre-prosthetic orthodontic treatment, complicated treatment situations could be handled more successfully than would have been the case without such treatment.

Anterior esthetic rehabilitation of all-ceramic crowns: a case report

A patient had a serious esthetic problem: One maxillary central incisor was discolored and the other was malpositioned and fractured. The fabrication of two all-ceramic crowns fulfilled both functional and esthetic objectives.

Dentine-bonded ceramic crowns: two case reports

The dentine-bonded ceramic crown is a full coverage restoration luted to the underlying tooth tissue via a dentine bond and resin composite luting system. The main advantage of using this technique is that removal of tooth tissue can be kept to a minimum. Additionally, the final aesthetic results may be excellent. In this paper, the provision of dentine-bonded crowns on the upper anterior teeth for two patients is described.

Post and core reconstruction for fixed prosthodontic restoration

If the previous restorative therapy or dental caries has resulted in substantial loss of tooth structure, the abutment teeth for fixed prosthodontic restorations require a core reconstruction or a post and core. Small dentin defects can be restored with bonded cores; more extensive dentin defects that are often accompanied by previous endodontic treatment generally require additional support for the core material. A direct procedure with a bonded post is a viable treatment method. The decision to use either light-conducting all-ceramic zirconium or titanium as a post material depends on the aesthetic requirements present. The indications for a cast post and core as an indirect procedure for prosthodontic reconstructions appear to be decreasing. The learning objective of this article is to review the past and current post and core materials and techniques. Indications for core reconstruction with vital teeth and posts and cores for pulpless teeth are discussed.

Predictable aesthetic reconstruction of fractured anterior teeth with composite resins: a case report

Full-coverage rehabilitation is generally the treatment modality indicated for restoration of severely fractured anterior teeth. However, the advanced formulations of composite resins present improved physical properties, an expanded range of shade selection, and high sculptability, allowing predictable restoration of the anterior dentition and replication of the polychromatic characteristics of natural teeth. The learning objective of this article is to present the utilization of composite resin materials in the treatment of fractured maxillary anterior incisors, implementing the concepts of polychromatic characteristics, hue, translucency, opacity, chroma, value, strength, and polishability. Also presented are several practical clinical observations that will assist the practitioner in attaining predictable aesthetic results with composite resin material.

Emergency direct fabrication of a resin fixed partial denture by using a ceramometal crown with reinforcing woven polyethylene ribbon as a pontic

In this emergency case of a fractured tooth, immediate short-term treatment was necessary to relieve pain and replace a missing coronal portion of the maxillary central incisor. The need to remove additional fractured root fragments subgingivally precluded accessibility to the remaining root for conventional restorative procedures. The patient could not decide which course of treatment to accept, so a fixed partial denture was fabricated, with the ceramometal crown restoration as a provisional pontic splinted to the adjacent teeth. Restoring and reinforcing the posterior composite splint with a gas plasma-treated woven polyethylene ribbon has been detailed and illustrated. This ribbon material reputed to be 10 times stronger than steel by volume, is a true reinforcing material because it is woven. Mechanically, it becomes an integral part of the splint. Because it is gas plasma-treated, the superficial layer, when placed in BIS-GMA or polymethyl methacrylate, reacts chemically with the resin. The pliable, memory-free fiber--together with the open, woven, lacelike, lock stitch leno--allows the ribbon to follow the contours of the teeth and dental arch easily. The ribbon design reduces and dissipates forces exerted onto the splinting resin. The neutral color of the material permits it to have a chameleonlike effect on the color of the resin into which it is positioned. This ribbon product has been used in other dental applications: periodontal splinting, orthodontic retention, indirect composite fixed partial dentures, long-term temporary restorations with applicability in implant treatments, repair and conversion of prostheses, and reinforcing endodontically treated teeth, and complete dentures and orthodontic retainers when weaknesses are anticipated, such as shallow palatal vaults of complete dentures against a full complement of mandibular natural teeth, and the horseshoe mandibular removable modified Hawley retainer.

Post-trauma replacement of maxillary central incisors utilizing implants: a case report

The ability to maintain or create aesthetics in the maxillary anterior area without affecting the adjoining healthy teeth has been the primary reason for the popularity of implant utilization in the anterior single tooth restoration. This article presents a sequence of several traumatic incidences involving the maxillary incisors. The options considered for restoration are discussed and the reasons for implant selection explained. The surgical phase and tissue augmentation procedures are presented, and the need for a multidisciplinary approach is emphasized. The learning objective of this article is to share the observations and experience gained from the restoration of a rather unusual case of traumatic sequences.

Accelerated forced eruption as a preparatory measure for the restoration of severely damaged maxillary incisors: a case report

Restoration of severely damaged teeth requires comprehensive, carefully planned pretreatment. This report of a patient who sustained traumatic injury to the maxillary anterior teeth demonstrates the use of accelerated forced eruption to strengthen damaged roots, allowing placement of crowns and eliminating the need for a fixed partial denture.

A single-appointment technique for reuse of a crown after tooth fracture

A single-appointment technique for the reuse of an existing crown, the margins of which are intact after tooth fracture, has been presented. Composite resin used in conjunction with a dentin bonding agent serves as a core and cement sealer. Para Posts or TMS pins and undercut areas in tooth structure are used for retention.

[Acid etching technic in the mixed dentition]

Clinical experience with defect and filling therapy has been good, even with deciduous teeth, a form of therapy which has not been considered promising because of the "prismless enamel of deciduous teeth". Examination with the scanning electron microscope supported our positive findings. If the aforementioned surface layer is removed mechanically prior to treatment with etching agents, the same retentive etching pattern could be obtained as was found on the remaining teeth. The best results were obtained with a 37% solution of phosphoric acid.