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Management of horizontal root fractures by fabrication of canine protected occlusion using composite resin.

Shin JH, Kim RJ - Restor Dent Endod (2012)

Bottom Line: Traumatic injuries of the face often involve root fractures especially in anterior teeth.The prognosis and the treatment of the root fracture depend on the extent of the fracture line, general health and patient compliance.Long term follow-up revealed that vitality, stability and aesthetics were maintained and the patient was satisfied with the outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Conservative Dentistry, Korea University Guro Hospital, Seoul, Korea.

ABSTRACT
Traumatic injuries of the face often involve root fractures especially in anterior teeth. The prognosis and the treatment of the root fracture depend on the extent of the fracture line, general health and patient compliance. This case report outlines a new conservative trial treatment modality to stabilize the maxillary central incisors with horizontal root fracture on the cervical to middle third by fabricating canine guidance to remove loading on the traumatized maxillary central incisors during eccentric movements and thus inducing spontaneous healing of the fractured line between the fragments. Radiographs after thirty months showed adequate healing with no signs of pathological changes including root resorption, ankylosis or displacement. Long term follow-up revealed that vitality, stability and aesthetics were maintained and the patient was satisfied with the outcome.

No MeSH data available.


Related in: MedlinePlus

Coronal and cross-sectional CBCT images of spontaneously healed root fractures of the central incisors without any signs of periradicular pathology or root resorption. (a) Coronal image; (b) Cross-sectional image of the maxillary right central incisor; (c) Crosssectional image of the maxillary left central incisor. CBCT, Cone-beam computed tomography.
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Figure 6: Coronal and cross-sectional CBCT images of spontaneously healed root fractures of the central incisors without any signs of periradicular pathology or root resorption. (a) Coronal image; (b) Cross-sectional image of the maxillary right central incisor; (c) Crosssectional image of the maxillary left central incisor. CBCT, Cone-beam computed tomography.

Mentions: Otherwise, the status of the traumatized teeth was within normal limits in terms of periodontal pocket, vitality on thermal and electrical test. For the management of soft tissue injuries, analgesic (Ibuprofen 400 mg) and antibiotic (amoxicillin 500 mg) were prescribed to take 3 times a day for the period of 3 adjustment of the opposing mandibular incisors was carried out to eliminate interference on the traumatized incisors in maximum intercuspation. The patient was advised to have a soft diet and avoid loading on the anterior teeth until the teeth become clinically stable. The patient was then referred to the Department of Conservative Dentistry, Korea University Dental Hospital for the management of the maxillary central incisors with horizontal root fractures and the maxillary right lateral incisor and canine with crown fracture. Ten days later, on his first visit to the Department of Conservative Dentistry, slightly increased patient's discomfort and visibly increased mobility of the maxillary central incisors were observed on protrusion and lateral excursion. Composite resin Filtek Z-250 (3M ESPE, St. Paul, MN, USA) was used to repair enamel chipping of the maxillary central incisors, the mesial tip of the maxillary right canine. The fractured incisal third of the maxillary right lateral incisor was restored with composite resin over resin-modified glass ionomer (RMGI) material FUJI II LC (GC, Tokyo, Japan) (Figure 2). In an attempt to eliminate loading on the traumatized maxillary central incisors upon unavoidable eccentric movements during function, the same composite resin material was added on the maxillary canines establishing canine protected occlusion (Figure 3). Contact points were marked with the articulating paper in centric occlusion. Composite resin was added incisal to the contact points marked on the occlusal surfaces of the maxillary canines. Selective adjustment of the composite resin build ups was carried out until uniform lines were marked on the resin during lateral excursion and until any interference on the damaged teeth in centric occlusion and during eccentric movement was not marked on the articulating paper. Calculus removal was carefully performed on the same visit to help maintain periodontal health. The patient returned for periodic monthly follow up for 4 month and 3 month follow up for next 2 years. At every recall, the teeth were clinically evaluated for vitality using an electric pulp tester (Digitest, Parkell, Farmingdale, NY, USA), thermal response to cold, pocket depth, percussion, mobility and occlusion, and periapical status with radiographs. After the construction of canine protected occlusion using composite resin, there was a gradual increase in comfort experienced by the patient owing to declining tooth mobility. At 4 month recall, the mobility of both maxillary central incisors exhibited in the range of physiological allowance and the patient did not report any discomfort associated with the injured teeth. At follow up 30 months later, the vitality, stability and esthetics of the maxillary central incisors were maintained (Figure 4). Despite the presence of noticeable discontinuation of the outlines of the maxillary central incisors between the middle and cervical third root, an increase in the density of the alveolar bone between the root fragments was observed. Radiographically, there were no signs of pathological changes including root resorption or ankylosis (Figures 5 and 6).


Management of horizontal root fractures by fabrication of canine protected occlusion using composite resin.

Shin JH, Kim RJ - Restor Dent Endod (2012)

Coronal and cross-sectional CBCT images of spontaneously healed root fractures of the central incisors without any signs of periradicular pathology or root resorption. (a) Coronal image; (b) Cross-sectional image of the maxillary right central incisor; (c) Crosssectional image of the maxillary left central incisor. CBCT, Cone-beam computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569405&req=5

Figure 6: Coronal and cross-sectional CBCT images of spontaneously healed root fractures of the central incisors without any signs of periradicular pathology or root resorption. (a) Coronal image; (b) Cross-sectional image of the maxillary right central incisor; (c) Crosssectional image of the maxillary left central incisor. CBCT, Cone-beam computed tomography.
Mentions: Otherwise, the status of the traumatized teeth was within normal limits in terms of periodontal pocket, vitality on thermal and electrical test. For the management of soft tissue injuries, analgesic (Ibuprofen 400 mg) and antibiotic (amoxicillin 500 mg) were prescribed to take 3 times a day for the period of 3 adjustment of the opposing mandibular incisors was carried out to eliminate interference on the traumatized incisors in maximum intercuspation. The patient was advised to have a soft diet and avoid loading on the anterior teeth until the teeth become clinically stable. The patient was then referred to the Department of Conservative Dentistry, Korea University Dental Hospital for the management of the maxillary central incisors with horizontal root fractures and the maxillary right lateral incisor and canine with crown fracture. Ten days later, on his first visit to the Department of Conservative Dentistry, slightly increased patient's discomfort and visibly increased mobility of the maxillary central incisors were observed on protrusion and lateral excursion. Composite resin Filtek Z-250 (3M ESPE, St. Paul, MN, USA) was used to repair enamel chipping of the maxillary central incisors, the mesial tip of the maxillary right canine. The fractured incisal third of the maxillary right lateral incisor was restored with composite resin over resin-modified glass ionomer (RMGI) material FUJI II LC (GC, Tokyo, Japan) (Figure 2). In an attempt to eliminate loading on the traumatized maxillary central incisors upon unavoidable eccentric movements during function, the same composite resin material was added on the maxillary canines establishing canine protected occlusion (Figure 3). Contact points were marked with the articulating paper in centric occlusion. Composite resin was added incisal to the contact points marked on the occlusal surfaces of the maxillary canines. Selective adjustment of the composite resin build ups was carried out until uniform lines were marked on the resin during lateral excursion and until any interference on the damaged teeth in centric occlusion and during eccentric movement was not marked on the articulating paper. Calculus removal was carefully performed on the same visit to help maintain periodontal health. The patient returned for periodic monthly follow up for 4 month and 3 month follow up for next 2 years. At every recall, the teeth were clinically evaluated for vitality using an electric pulp tester (Digitest, Parkell, Farmingdale, NY, USA), thermal response to cold, pocket depth, percussion, mobility and occlusion, and periapical status with radiographs. After the construction of canine protected occlusion using composite resin, there was a gradual increase in comfort experienced by the patient owing to declining tooth mobility. At 4 month recall, the mobility of both maxillary central incisors exhibited in the range of physiological allowance and the patient did not report any discomfort associated with the injured teeth. At follow up 30 months later, the vitality, stability and esthetics of the maxillary central incisors were maintained (Figure 4). Despite the presence of noticeable discontinuation of the outlines of the maxillary central incisors between the middle and cervical third root, an increase in the density of the alveolar bone between the root fragments was observed. Radiographically, there were no signs of pathological changes including root resorption or ankylosis (Figures 5 and 6).

Bottom Line: Traumatic injuries of the face often involve root fractures especially in anterior teeth.The prognosis and the treatment of the root fracture depend on the extent of the fracture line, general health and patient compliance.Long term follow-up revealed that vitality, stability and aesthetics were maintained and the patient was satisfied with the outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Conservative Dentistry, Korea University Guro Hospital, Seoul, Korea.

ABSTRACT
Traumatic injuries of the face often involve root fractures especially in anterior teeth. The prognosis and the treatment of the root fracture depend on the extent of the fracture line, general health and patient compliance. This case report outlines a new conservative trial treatment modality to stabilize the maxillary central incisors with horizontal root fracture on the cervical to middle third by fabricating canine guidance to remove loading on the traumatized maxillary central incisors during eccentric movements and thus inducing spontaneous healing of the fractured line between the fragments. Radiographs after thirty months showed adequate healing with no signs of pathological changes including root resorption, ankylosis or displacement. Long term follow-up revealed that vitality, stability and aesthetics were maintained and the patient was satisfied with the outcome.

No MeSH data available.


Related in: MedlinePlus