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A conservative bioadhesive approach to the reattachment of complicated crown fractures in permanent first molars: a case report with a 2-year followup.

Mirikar P - Case Rep Med (2012)

Bottom Line: To restore the coronal fracture with invasion of biologic width, flap surgery with osteotomy and osteoplasty localized on the fractured teeth was performed, and the tooth remnant was reattached to the crown with a self-etch adhesive system.Frank pulp exposure was treated by self-etch dentin adhesive after surface disinfection prior to sealing of the wound site.At 2-year recall, the teeth continue to be aesthetically and functionally stable with a favourable pulpal and periapical environment.

View Article: PubMed Central - PubMed

Affiliation: Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Maharashtra, Pune 411041, India.

ABSTRACT
This paper presents a clinical report demonstrating combined restorative bioadhesive treatment and prosthetic rehabilitation of uncommon type of dental injury in an eighteen-year-old female involving crown fracture of all the permanent first molars and left upper premolars due to a bicycle riding accident. To restore the coronal fracture with invasion of biologic width, flap surgery with osteotomy and osteoplasty localized on the fractured teeth was performed, and the tooth remnant was reattached to the crown with a self-etch adhesive system. Frank pulp exposure was treated by self-etch dentin adhesive after surface disinfection prior to sealing of the wound site. At 2-year recall, the teeth continue to be aesthetically and functionally stable with a favourable pulpal and periapical environment.

No MeSH data available.


Related in: MedlinePlus

Buccal view of dental fragments of fractured 36, after surface disinfection with 0.12% chlorhexidine and application of dentin bonding adhesive.
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fig11: Buccal view of dental fragments of fractured 36, after surface disinfection with 0.12% chlorhexidine and application of dentin bonding adhesive.

Mentions: Surgical treatment was initiated with 36 (Figure 9). To gain access to the cervical margin of the dental remnant and thus better evaluate the relation to the bone crest, a full thickness flap was planned. An exploratory flap was made with a no. 15 scalpel blade, using lingual intrasulcular and vertical releasing incisions. The fracture had occurred in the mesiodistal dimension, dividing the lingual aspect of the tooth into mesial and distal halves and a pin point pulp exposure (Figure 10). The two fractured fragments that were partially attached with the help of gingival fibres were separated and were maintained in normal saline (Figure 11) [7]. The fracture line had invaded the biologic width and the need of osteotomy of about 1 mm on the lingual aspect was evident, so as to restore the dimensions of the biologic space [8]. After disinfection of both the tooth and the fractured fragment and with 0.12% CHX solution [7, 8], an adhesive system (Clearfill SE) was applied to dentin and enamel and to hybridize the conditioned surfaces on both the tooth remnant and the fragment [9, 10] in accordance with manufacturer's instructions. The operative procedure was performed in a moisture-free field, which was maintained with the help of high volume suction and cotton roll isolation [3]. Since there were two fragments present, it was necessary to assemble the pieces with resin composite prior to trial in mouth [11]. Excess adhesive was removed with mild air jet. Usually, at this stage, polymerization would be the next step; however, in an effort to attain an adequate repositioning of fragment on remnant, light polymerization was not conducted, because the light-cured adhesive would make it impossible to seat the fragment correctly [11]. A microfilled flowable composite resin (A3, Flowable, 3 M ESPE) was used to perform attachment [12]. After receiving a slight layer of resin, the fragment was repositioned and kept in position until light polymerization was completed. The surgical site was closed, and interrupted sutures were placed (Figure 12).


A conservative bioadhesive approach to the reattachment of complicated crown fractures in permanent first molars: a case report with a 2-year followup.

Mirikar P - Case Rep Med (2012)

Buccal view of dental fragments of fractured 36, after surface disinfection with 0.12% chlorhexidine and application of dentin bonding adhesive.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3295587&req=5

fig11: Buccal view of dental fragments of fractured 36, after surface disinfection with 0.12% chlorhexidine and application of dentin bonding adhesive.
Mentions: Surgical treatment was initiated with 36 (Figure 9). To gain access to the cervical margin of the dental remnant and thus better evaluate the relation to the bone crest, a full thickness flap was planned. An exploratory flap was made with a no. 15 scalpel blade, using lingual intrasulcular and vertical releasing incisions. The fracture had occurred in the mesiodistal dimension, dividing the lingual aspect of the tooth into mesial and distal halves and a pin point pulp exposure (Figure 10). The two fractured fragments that were partially attached with the help of gingival fibres were separated and were maintained in normal saline (Figure 11) [7]. The fracture line had invaded the biologic width and the need of osteotomy of about 1 mm on the lingual aspect was evident, so as to restore the dimensions of the biologic space [8]. After disinfection of both the tooth and the fractured fragment and with 0.12% CHX solution [7, 8], an adhesive system (Clearfill SE) was applied to dentin and enamel and to hybridize the conditioned surfaces on both the tooth remnant and the fragment [9, 10] in accordance with manufacturer's instructions. The operative procedure was performed in a moisture-free field, which was maintained with the help of high volume suction and cotton roll isolation [3]. Since there were two fragments present, it was necessary to assemble the pieces with resin composite prior to trial in mouth [11]. Excess adhesive was removed with mild air jet. Usually, at this stage, polymerization would be the next step; however, in an effort to attain an adequate repositioning of fragment on remnant, light polymerization was not conducted, because the light-cured adhesive would make it impossible to seat the fragment correctly [11]. A microfilled flowable composite resin (A3, Flowable, 3 M ESPE) was used to perform attachment [12]. After receiving a slight layer of resin, the fragment was repositioned and kept in position until light polymerization was completed. The surgical site was closed, and interrupted sutures were placed (Figure 12).

Bottom Line: To restore the coronal fracture with invasion of biologic width, flap surgery with osteotomy and osteoplasty localized on the fractured teeth was performed, and the tooth remnant was reattached to the crown with a self-etch adhesive system.Frank pulp exposure was treated by self-etch dentin adhesive after surface disinfection prior to sealing of the wound site.At 2-year recall, the teeth continue to be aesthetically and functionally stable with a favourable pulpal and periapical environment.

View Article: PubMed Central - PubMed

Affiliation: Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Maharashtra, Pune 411041, India.

ABSTRACT
This paper presents a clinical report demonstrating combined restorative bioadhesive treatment and prosthetic rehabilitation of uncommon type of dental injury in an eighteen-year-old female involving crown fracture of all the permanent first molars and left upper premolars due to a bicycle riding accident. To restore the coronal fracture with invasion of biologic width, flap surgery with osteotomy and osteoplasty localized on the fractured teeth was performed, and the tooth remnant was reattached to the crown with a self-etch adhesive system. Frank pulp exposure was treated by self-etch dentin adhesive after surface disinfection prior to sealing of the wound site. At 2-year recall, the teeth continue to be aesthetically and functionally stable with a favourable pulpal and periapical environment.

No MeSH data available.


Related in: MedlinePlus