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Complicated crown-root fracture treated using reattachment procedure: a single visit technique.

Rajput A, Talwar S, Ataide I, Verma M, Wadhawan N - Case Rep Dent (2011)

Bottom Line: Because of impaired function, esthetics, and phonetics, such patients are quite apprehensive during their emergency visit.Successful pain management with immediate restoration of function, esthetics and phonetics should be the prime objective while handling such cases.After two and half years, the reattached fragment still has satisfying esthetics and excellent function.

View Article: PubMed Central - PubMed

Affiliation: Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi 110002, India.

ABSTRACT
Complicated crown-root fracture of maxillary central and lateral incisors is common in case of severe trauma or sports-related injury. It happens because of their anterior positioning in oral cavity and protrusive eruptive pattern. On their first dental visit, these patients are in pain and need emergency care. Because of impaired function, esthetics, and phonetics, such patients are quite apprehensive during their emergency visit. Successful pain management with immediate restoration of function, esthetics and phonetics should be the prime objective while handling such cases. This paper describes immediate treatment of oblique crown root fracture of maxillary right lateral incisor with reattachment procedure using light transmitting fiber post. After two and half years, the reattached fragment still has satisfying esthetics and excellent function.

No MeSH data available.


Related in: MedlinePlus

Fracture fragment removed from underlying tooth structure.
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fig2: Fracture fragment removed from underlying tooth structure.

Mentions: Since the fractured fragment of the maxillary left central incisor was attached to the underlying root at just one point so it was removed and stored in distilled water to be used at a later stage (Figures 2 and 3). Isolation was achieved using cheek retractor, cotton rolls, and saliva ejector placed in position. Gelatin sponge (Ab Gel, Sri Gopal Krishna Labs, Mumbai, India) was packed on palatal surface in the subgingival area to control any bleeding from that area (Figure 4). Single visit root canal treatment was completed, and the postspace was prepared. A light transmitting fiber post (D.T. Light post, Bisco, Schaumburg, USA) was tried in the canal and cut at the desired length. The fractured fragment was removed from the distilled water and tried on the cut end of fiber post. A groove was made on the fractured fragment so that it fits comfortably on the fractured root without any interference from overlying post (Figure 5). Remnants of pulp tissue from the fractured fragment were removed during this step. Care was taken not to remove excess dentin as it can alter the final esthetic appearance of the tooth. Once the desired fit was confirmed, it was again stored in distilled water. After acid etching with 37% phosphoric acid (Total etch, Ivoclar Vivadent AG, Bendererstrasse, Liechtenstein) of root canal, dual cure bonding agent (Prime and Bond NT dual cure, DENTSPLY Caulk, Milford DE) was applied as per the manufacturer's instructions, and the post was cemented with the help of dual cure resin cement (Calibra esthetic resin cement, DENTSPLY Caulk, Milford DE). Any excess cement oozing out of canal was removed with cotton applicator tips as it can alter the fit of the fragment. It was then light cured (QHL75 Curing Light, DENTSPLY, Addlestone, Surrey) for 40 sec. Gelatin sponge was then removed, and exposed root surface and fractured fragment were acid etched simultaneously. Groove in the fractured fragment was filled with dual cure resin cement, and the exposed fiber post was also luted with the same. The fragment was repositioned and cured for 40 sec. from palatal, labial, and incisal surfaces (Figure 6). Since the fracture line was visible on the labial surface, a groove was made app. 0.3 mm deep, extending app. 1.5 mm incisally and gingivally from the fracture line. It was then restored with Nanocomposite (Filtek Z350 Universal Restorative, 3M ESPE, St. Paul, Minn, USA) (Figures 7 and 8). Finishing and polishing was done using Sof-Lex polishing system (Sof-Lex Extra Thin Contouring and Polishing Discs, 3M ESPE, St. Paul, Minn, USA). Orthodontic extrusion of same tooth was planned after two week so as to bring the palatal fracture line supragingival and seal any defect, if present. But, the patient was so satisfied with the results after two weeks that he refused any further treatment.


Complicated crown-root fracture treated using reattachment procedure: a single visit technique.

Rajput A, Talwar S, Ataide I, Verma M, Wadhawan N - Case Rep Dent (2011)

Fracture fragment removed from underlying tooth structure.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3368170&req=5

fig2: Fracture fragment removed from underlying tooth structure.
Mentions: Since the fractured fragment of the maxillary left central incisor was attached to the underlying root at just one point so it was removed and stored in distilled water to be used at a later stage (Figures 2 and 3). Isolation was achieved using cheek retractor, cotton rolls, and saliva ejector placed in position. Gelatin sponge (Ab Gel, Sri Gopal Krishna Labs, Mumbai, India) was packed on palatal surface in the subgingival area to control any bleeding from that area (Figure 4). Single visit root canal treatment was completed, and the postspace was prepared. A light transmitting fiber post (D.T. Light post, Bisco, Schaumburg, USA) was tried in the canal and cut at the desired length. The fractured fragment was removed from the distilled water and tried on the cut end of fiber post. A groove was made on the fractured fragment so that it fits comfortably on the fractured root without any interference from overlying post (Figure 5). Remnants of pulp tissue from the fractured fragment were removed during this step. Care was taken not to remove excess dentin as it can alter the final esthetic appearance of the tooth. Once the desired fit was confirmed, it was again stored in distilled water. After acid etching with 37% phosphoric acid (Total etch, Ivoclar Vivadent AG, Bendererstrasse, Liechtenstein) of root canal, dual cure bonding agent (Prime and Bond NT dual cure, DENTSPLY Caulk, Milford DE) was applied as per the manufacturer's instructions, and the post was cemented with the help of dual cure resin cement (Calibra esthetic resin cement, DENTSPLY Caulk, Milford DE). Any excess cement oozing out of canal was removed with cotton applicator tips as it can alter the fit of the fragment. It was then light cured (QHL75 Curing Light, DENTSPLY, Addlestone, Surrey) for 40 sec. Gelatin sponge was then removed, and exposed root surface and fractured fragment were acid etched simultaneously. Groove in the fractured fragment was filled with dual cure resin cement, and the exposed fiber post was also luted with the same. The fragment was repositioned and cured for 40 sec. from palatal, labial, and incisal surfaces (Figure 6). Since the fracture line was visible on the labial surface, a groove was made app. 0.3 mm deep, extending app. 1.5 mm incisally and gingivally from the fracture line. It was then restored with Nanocomposite (Filtek Z350 Universal Restorative, 3M ESPE, St. Paul, Minn, USA) (Figures 7 and 8). Finishing and polishing was done using Sof-Lex polishing system (Sof-Lex Extra Thin Contouring and Polishing Discs, 3M ESPE, St. Paul, Minn, USA). Orthodontic extrusion of same tooth was planned after two week so as to bring the palatal fracture line supragingival and seal any defect, if present. But, the patient was so satisfied with the results after two weeks that he refused any further treatment.

Bottom Line: Because of impaired function, esthetics, and phonetics, such patients are quite apprehensive during their emergency visit.Successful pain management with immediate restoration of function, esthetics and phonetics should be the prime objective while handling such cases.After two and half years, the reattached fragment still has satisfying esthetics and excellent function.

View Article: PubMed Central - PubMed

Affiliation: Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi 110002, India.

ABSTRACT
Complicated crown-root fracture of maxillary central and lateral incisors is common in case of severe trauma or sports-related injury. It happens because of their anterior positioning in oral cavity and protrusive eruptive pattern. On their first dental visit, these patients are in pain and need emergency care. Because of impaired function, esthetics, and phonetics, such patients are quite apprehensive during their emergency visit. Successful pain management with immediate restoration of function, esthetics and phonetics should be the prime objective while handling such cases. This paper describes immediate treatment of oblique crown root fracture of maxillary right lateral incisor with reattachment procedure using light transmitting fiber post. After two and half years, the reattached fragment still has satisfying esthetics and excellent function.

No MeSH data available.


Related in: MedlinePlus