TOOTH CRAFT –

SKILL UNVEILED

Dr.Hyun Joong, BDS,

CHENNAI.

INTRODUCTION

Fractures to the anterior teeth-trauma

Minor to severe -vertical, diagonal or

horizontal fractures.

Dental emergency

Skill - career of every practitioner.

AIM

Uncomplicated crown fractures

Complicated crown fractures

Crown root fractures

Prevent tooth loss

Improve cosmetic results

Decrease risk of infection

CASE REPORT -1ENAMELOPLASTY

COMPLAINTS

• 19 yr old male

• Broken upper front teeth

HISTORY

• Recent trauma to upper

front

teeth

CLINICAL EXAMINATION

• Fracture involving enamel in

11,21

DIAGNOSIS

• Ellis Class I Fracture 11, 21

TREATMENT

Enamel reshaping (ENAMELOPLASTY)

Thin tapering diamond

Finishing and polishing

Pre & Post treatment

photographs

CASE REPORT 2

REATTACHMENT OF

FRACTURED FRAGMENT

COMPLAINTS

• 25 yr old male patient broken upper front

teeth

• Brought the fractured fragment

HISTORY

• Trauma to upper front teeth on same day.

CLINICAL EXAMINATION

• Fracture involving enamel and dentin 11

DIAGNOSIS

• Ellis Class II fracture 11

TREATMENT PLAN

Reattach fractured fragment.

PROCEDURE

Tooth preparation done

Fractured fragment was re-united using

Light Cure Composite Resin.

Pre & Post operative

photographs

CASE REPORT - 3

LAMINATE

RESTORATION

COMPLAINT

18 yr old male patient

Broken upper front teeth and sensitivity

HISTORY

Trauma to upper front tooth a month back.

CLINICAL EXAMINATION

Fracture involving enamel in 11

Fracture involving enamel, dentin in 21

Vitality test-normal 11,21

DIAGNOSIS

Ellis Class I Fracture 11

Ellis Class II Fracture 21

Enameloplasty – 11

Laminate restoration with Glass

Ionomer Cement and Light Cure

Composite Resin - 21

TREATMENT PLAN

Pre & Post operative

photographs

CASE REPORT – 4

MANAGEMENT OF

VERTICAL FRACTURE

COMPLAINTS

28 yr old female

Broken upper front teeth with pain

HISTORY

Injury on same day due to fall

CLINICAL EXAMINATION

Vertical fracture Involving enamel, dentin and pulp in 22 and evidence of associated oblique fracture involving pulp extending subgingivally

DIAGNOSIS –

Comminuted vertical & oblique fracture of 22

TREATMENT PLAN

STEP 1

Orthodontic banding

STEP 2

Access opened with the

band in place and

obturated using warm

sectional condensation

method

STEP 3

Band removed & Fracture

line reinforced with dual

cure composite

STEP 5

Tooth reduction done

STEP 7

Jacket crown luted in 22

Pre & Post Op

Photographs

CASE REPORT 5

REATTACHMENT

OF FRACTURED

TEETH

COMPLAINTS

35 yr old male

Broken upper front teeth with pain

HISTORY

Trauma due to RTA on same day.

CLINICAL EXAMINATION

Fracture involving enamel, dentin & pulp in 11

Oblique crown root fracture in 12,13 with fracture line extending subgingivally below the alveolar crest.

DIAGNOSIS

Ellis Class III fracture 11

Ellis class VI fracture 12,13

TREATMENT PLAN

STEP 2

Root canal treatment done in

11,12 and 13

STEP 1

Fractured crown extracted

STEP- 3

Flap raised surgically

STEP – 5

Surgical re-attachment of

fractured fragment done with

GIC

STEP - 4

Pre fabricated metal post

tried in and luted

STEP - 6

Flap re-positioned and

sutured

STEP – 7

Post operative X-ray

Pre-post operative

photographs

DISCUSSION Fractures involving enamel - Enameloplasty

Fractured fragment available –re-attachment -

quick esthetic rehabilitation

Crown fractures that involve only enamel or

both enamel and dentin should be tested for

vitality, before protecting the exposed dentin

with composite

If reversible pulpitis is diagnosed, the pulp

should be protected from further insult by

providing a restoration that reduces

microleakage and prevents fracture from

propogating

DISCUSSION

Modern dentin bonding materials serve as an

interim restoration providing occlusal

protection if prognosis is gaurded

Examination of the fractured fragment allows accurate assessment of the restorability of teeth

In cases the tooth is fractured but the fracture is still incomplete, crown should be supported with metal band, before RCT is commenced

Cont.

Cont.

Fractures involving gingival crevice & attachment may necessitate RCT to stop bacterial contamination that is likely to occur along the fracture line

o Longevity unknown – extraction

following treatment is a possibility

o Less esthetic –fragment dehydrated

o Need of continuous monitoring

SHORTCOMINGS OF RE-ATTACHMENT

PROCEDURES

ADVANTAGES

Rapid

Conservative

Colour match

Economical

Positive emotional social response

from patient

CONCLUSIONA DENTIST MAY ONLY BE SOMEONE

IN THE WORLD,

UNTIL WE PROCEED AS THOUGH OUR

LIMITS

OF ABILITIES DO NOT EXIST,

WHEN WE RAISE OUR SIGHT AND SEE

OUR

POSSIBILITIES,

FOR SOMEONE WHO HAS LOST HIS SMILE,

WE MIGHT BE HIS LUMINOUS SUNSHINE,

IT’S THE POINT WHERE DENTISTRY TURNS

DIVINE…

REFERENCES

James l Guttman. Problem solving in endodontics-prevention ,identification and management, 3rd

edition

Anderson JO, Anderson FM. Textbook and colouratlas of trumatic injuries to the teeth ,ed-3 Copenheagen 1994

Guttmann JL ,Evertt Guttman MS. Cause, incidence and prevention of trauma to teeth, Dent Clin North Am.

39;1-14 .1995

Roh BD, Lee ye. Analysis of 154 cases with cracks; Dent. Traumatology. 2006

Oliet S. Treating vertical fractures. J. Endont. 1994

John I Ingle, Bakeland. Tooth infarctions. Ingle’s

MY SINCERE THANKS

Dr. A. NANDHINI, MDSAssistant Professor

Dept. of Conservative Dentistry &

Endodontics