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Treatment crown fracture

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  • 1. Content  Treatment of fractured enamel  Treatment of uncomplicated crown fracture  Treatment of complicated crown fracture with minimal pulp exposure
  • 2. Radiograph of lip or cheek lacerations to search for tooth fragments or foreign material Treatment options 1. Leave it 2. Rounded – sharp enamel edges 3. Re-attach the fragment 4. Restore with CR Follow-up  Clinical and radiographic control -> 6-8 weeks & 1 year.
  • 3. 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 ®)
  • 4. Treatment options  No tooth fragment – Covered with GIC (temporary)/ Restore with CR  Tooth fragment saved – Re-attach the fragment Follow-up  Clinical and radiographic control -> 6-8 weeks & 1 year.
  • 5. Reattachment of tooth fragment  Good and long-lasting esthetics  Can restore function  Positive psychological response  Simple procedure  Less time-consuming  More predictable long-term wear than when direct composite is used
  • 6. Steps  Try tooth fragment intraorally  Isolation Tooth Fragment Flour of pumice Etching Adhesive
  • 7. Dentin and enamel Flour of pumice Etching  Composite resin was applied to both fragment and tooth surfaces. Adhesive
  • 8.  Light-cured for 40 seconds  Additional composite  Finished with diamond burs  Polished with Sof-Lex disks
  • 9. Complicated Crown Fracture Clinical appearance: Pulp with bright red,cyanotic or ischemic appearance respectively.
  • 10. 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.
  • 11. Radiographic appearance: Fracture at tooth 21 involving enamel dentine and pulp.
  • 12. 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.
  • 13. Treatment: 1)Direct Pulp Capping 2)Pulpotomy a)Cvek Pulpotomy b)Cervical pulpotomy 3)Apexification 4)Root Canal Treatment 5)Extraction
  • 14. 1)Direct Pulp Capping Aim: Preserve vital pulp tissue by physiologically walled off with calcific barrier.
  • 15. 1)Direct Pulp Capping Indications: Exposure < 1mm : Time elapsed since injury- within a few hours : Vital pulp : Complete root development : Absence of root fracture
  • 16. Apply rubber dam Tooth gently cleaned with water Calcium hyroxide is applied to the pulp tissue Cover exposed dentine with GIC Restore with composite or strip crown in ant and SSC in posterior teeth. Review in 6-8 weeks -No clinical sign & symptom -Radiographically lesion not showing any root resorption Restore tooth with permanent restoration. Review in 1&5 years after injury and monitor for pulpal sensibility -Tooth symptomatic with sign of pulp necrosis -Radiographicaly,presence of lesion Root canal treatment Extraction
  • 17. 2 a)Partial Pulpotomy/Cvek Pulpotomy Aim:Remove only inflamed tissue , leaving healthy pulp tissue for physiologic maturation of the root.
  • 18. 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
  • 19. Partial Pulpotomy Procedure Pulp tissue removal - 2mm apical to the exposure . Haemorrhage control - saline/diluted sodium hypochlorite(2.5%)
  • 20. Partial Pulpotomy Procedure Pulp covered - MTA or calcium hydroxide Restoration – GIC & CR Re-evaluation- 1/12 and every 3/12 for the first year.
  • 21. 2 b) Full Coronal Pulpotomy Aim: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
  • 22. Apply FS on a pledget of cotton wool for 4 minutes Step 7: Remove FS pledget after 4 mins & check that haemorrhage has stopped
  • 23. 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.
  • 24. 3)Apexification Indications :Large contaminated exposure : Exposure >24 hours : Necrotic pulp : Immature permanent teeth with open apex : Absence of root fracture
  • 25. 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.
  • 26. 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
  • 27. 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.
  • 28. 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
  • 29. Thank you