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Treatment of uncomplicated crown fracture & complicated crown fracture (minimal pulp exposure)

Treatment crown fracture

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Page 1: Treatment crown fracture

Treatment of uncomplicated crown fracture & complicated crown fracture (minimal pulp

exposure)

Page 2: Treatment crown fracture

ContentTreatment of fractured enamelTreatment of uncomplicated crown

fractureTreatment of complicated crown fracture

with minimal pulp exposure

Page 3: Treatment crown fracture

Treatment of fractured enamel

Page 4: Treatment crown fracture

Radiograph of lip or cheek lacerations to search for tooth fragments or foreign material

Treatment options1. Leave it2. Rounded – sharp

enamel edges3. Re-attach the fragment4. Restore with CR

Follow-upClinical and radiographic control -> 6-8 weeks &

1 year.

Page 5: Treatment crown fracture

Treatment of uncomplicated crown

fracture

Page 6: Treatment crown fracture

Radiograph of lip or cheek lacerations to search for tooth fragments or foreign material

Clean with water spray/ saline/ chlorhexidine

Disinfect with Chlorhexidie gluconate 0.12% (Peridex ®)

Page 7: Treatment crown fracture

Treatment optionsNo tooth fragment – Covered with GIC

(temporary)/ Restore with CR

Tooth fragment saved – Re-attach the fragmentFollow-upClinical and radiographic control -> 6-8 weeks

& 1 year.

Page 8: Treatment crown fracture

Reattachment of tooth fragmentGood and long-lasting esthetics Can restore function Positive psychological responseSimple procedureLess time-consuming More predictable long-term wear than when

direct composite is used

Page 9: Treatment crown fracture

StepsTry tooth fragment

intraorallyIsolation

Flour of pumice AdhesiveEtching

Tooth Fragment

Page 10: Treatment crown fracture

Composite resin was applied to both fragment and tooth surfaces.

Dentin and enamel

Flour of pumice Etching Adhesive

Page 11: Treatment crown fracture

Light-cured for 40 secondsAdditional compositeFinished with diamond bursPolished with Sof-Lex disks

Page 12: Treatment crown fracture

Treatment of complicated crown fracture with

minimal pulp exposure

Page 13: Treatment crown fracture

Complicated Crown Fracture

Clinical appearance:

Pulp with bright red,cyanotic or ischemic

appearance respectively.

Page 14: Treatment crown fracture

Diagnostic signs

Visual signs Crown fracture extending below gingival margin.

Percussion test Tenderness to percussion.

Mobility test Coronal fragment is mobile.

Sensibility test Primary teeth -Inconsistent results. Permanent teeth -Positive for apical fragment.

Radiographs recommended

An occlusal exposure.

Page 15: Treatment crown fracture

Radiographic appearance:

Fracture at tooth 21

involving enamel

dentine and pulp.

Page 16: Treatment crown fracture

Crown Fracture with Minimal Pulp Exposure

Treatment Objective:

To maintain pulp vitality In immature teeth - to continue root

development.To restore normal esthetics and function.

Page 17: Treatment crown fracture

Treatment:

1)Direct Pulp Capping

2)Pulpotomy

a)Cvek Pulpotomy

b)Cervical pulpotomy

3)Apexification

4)Root Canal Treatment

5)Extraction

Page 18: Treatment crown fracture

1)Direct Pulp Capping

Aim: Preserve vital pulp tissue by physiologically walled off with calcific barrier.

Page 19: Treatment crown fracture

1)Direct Pulp Capping

Indications: Exposure < 1mm

: Time elapsed since injury- within a few hours

: Vital pulp

: Complete root development

: Absence of root fracture

Page 20: Treatment crown fracture

Apply rubber dam

Tooth gently cleaned with water

Calcium hyroxide is applied to the pulp tissue

Cover exposed dentine with GIC

Review in 6-8 weeks

-No clinical sign & symptom-Radiographically lesion not showing any root resorption

-Tooth symptomatic with sign of pulp necrosis

-Radiographicaly,presence of lesionRestore tooth with

permanent restoration.Review in 1&5 years after injury and monitor for pulpal sensibility

Root canal treatment

Extraction

Restore with composite or strip crown in ant and SSC in posterior teeth.

Page 21: Treatment crown fracture

2 a)Partial Pulpotomy/Cvek Pulpotomy

Aim:Remove only inflamed tissue , leaving

healthy pulp tissue for physiologic maturation

of the root.

Page 22: Treatment crown fracture

2 a)Partial Pulpotomy/Cvek Pulpotomy

Indications : Exposure > 1mm

: Time elapsed since injury >24 hours

: Vital pulp

: Fractured primary teeth

: Young permanent teeth

with incomplete root development

: Absence of root fracture

Page 23: Treatment crown fracture

Pulp tissue removal- 2mm apical to the exposure .

Haemorrhage control - saline/diluted sodium hypochlorite(2.5%)

Partial Pulpotomy Procedure

Page 24: Treatment crown fracture

Pulp covered - MTA or calcium hydroxide

Restoration – GIC & CR

Re-evaluation- 1/12 and every 3/12 for the first year.

Partial Pulpotomy Procedure

Page 25: Treatment crown fracture

2 b) Full Coronal PulpotomyAim:Amputation of inflamed pulp tissue from coronal

chamber ,leaving healthy tissue to enhance physiologic

maturation of the root.

Indications :Large contaminated exposure

: Long duration of time elapsed since injury

: Vital pulp

: Fractured primary teeth

: Young permanent teeth with incomplete root

development

: Absence of root fracture

Page 26: Treatment crown fracture
Page 27: Treatment crown fracture

Apply FS on a pledget of cotton wool for 4 minutes

Step 7: Remove FS pledget after 4 mins & check that haemorrhage has stopped

Page 28: Treatment crown fracture

3)Apexification

Aims:to induce either closure of the open apical third of the root canal

or the formation of an apical “calcific barrier” against which obturation

can be achieved.

Page 29: Treatment crown fracture

3)Apexification

Indications :Large contaminated exposure

: Exposure >24 hours

: Necrotic pulp

: Immature permanent teeth with open apex

: Absence of root fracture

Page 30: Treatment crown fracture

4)Root Canal Treatment

Aims:

To remove all the infected material from the pulp chamber

and

root canal system and filling the root canal with inert

filling material.

Page 31: Treatment crown fracture

4)Root Canal Treatment

Indications :Large contaminated exposure

: Exposure >24 hours since the injury

: Necrotic pulp

: Permanent teeth with mature and closed apex

: Absence of root fracture

Page 32: Treatment crown fracture

5)Extraction

If patient’s condition do not permit early

intervention,

the potential for odontogenic infection must

weight against the advantages of preserving

the fractured teeth.

Page 33: Treatment crown fracture

References Macedo GV, Diaz PI, De O Fernandes CA, Ritter AV. Reattachment of anterior

teeth fragments: a conservative approach. J Esthet Restor Dent. 2008;20(1):5-

18

Terry DA. Adhesive reattachment of a tooth fragment: the biological

restoration. Pract Proced Aesthet Dent. 2003 Jun;15(5):403-9;

Peterson,L.J. ,Ellis,E. ,Hupp,J.R and Tucker,M.R. Contemporary Oral and

Mazillofacial Surgery.3rd Edition.Mosby1998

Andreasen JO,Andreasen FM,Bakland LK and Flores MT.Traumatic Dental

Injuries(A Manual)Munksgaard 2nd edition

Michael G.Stewart Head,Face,Neck Trauma Comprehensive management

http://www.dentaltraumaguide.com

http://www.aapd.org/media/Policies_Guidelines/G_trauma.pdf

Page 34: Treatment crown fracture

Thank you