The document discusses the restoration of traumatically fractured anterior teeth. It begins with Ellis and Davey's classification of anterior teeth fractures from 1960. It then discusses different treatment modalities like crown lengthening surgery to gain supracrestal tooth length for longer clinical crowns while reestablishing biological width. It highlights esthetic and functional concerns like exposure of subgingival caries or fractures. It also discusses concepts like biological width and ferrule length. It presents two case reports demonstrating crown lengthening procedures and final restorations for patients with fractured front teeth. The conclusion emphasizes the need for multidisciplinary treatment of complicated dental trauma cases.

1. “Restoration Of Traumatically
Fractured Anterior Teeth”
Presented By Dr. Anjana Maharjan
PG Resident NAMS

3. Ellis and Davey’s Classification of Anterior
Teeth(1960)

4. • Crown-root fractures comprise 5% of injuries in
permanent dentition, caused by direct trauma to
anterior teeth
V Zaleckiene, V Peciuliene, V Brukiene, S Drukteinis. Traumatic dental injuries: etiology,
prevalence and possible outcomes . Stomatologija, Baltic Dental and Maxillofacial
Journal.2014 16: 7-14

5. Different
Treatment
modalities

6. • Restoration margins located in gingival biological
width area

7. Crown lengthening
• Surgical removal of hard and soft periodontal
tissues to gain supracrestal tooth length, allowing
longer clinical crown and reestablishment of
biological width
Ingber FJS, Rose LF, Coslet JG. The “biological width”:A concept in periodontics and
restorative dentistry. Alpha Omegan 1977;70:62-65

8. Esthetic
and
Functional
Concerns
Rationale
Biological
Width
Ferrule
length
T Hempton, T Dominici. Contemporary Crown-Lengthening Therapy: A Review. JADA.
2010;141(6):647-655

9. Esthetic and Functional Concerns
• Exposure of sub gingival caries
• Exposure of sub gingival fracture
• High Lip line

10. Biological Width
• Dimension of soft tissue, which attached to
portion of tooth coronal to crest of alveolar
bone

11. Ferrule Length
• A ferrule effect is defined
as ‘‘360 metal collar of
crown surrounding parallel
walls of dentine extending
coronal to shoulder of
preparation” (Sorenson
and Engleman,1990)

12. Post and core

13. CASE REPORTS

14. Case - 1
Age- 45
Sex- Female
C/C- Wants removal of
fractured tooth followed by
false teeth

15. Crown Lengthening

16. Provisional restoration
• Final prosthetic impressions may begin at least 3
months after crown lengthening, though to be
safe, wait 6 months, when remodeling finishes
Brägger U, Lauchenauer D, Lang NP. Surgical lengthening of the clinical crown. J Clin
Periodontol.1992;19(1): 58-63

17. Post and core Restoration

18. Tooth preparation and Final
Restoration

19. Case 2
Age- 35
Sex- Female
C/C – Fractured Front
teeth and wants
restoration

20. Crown Lengthening

21. Provisional Restoration
For 3 months

23. Final Restoration
Follow up- After 9 months

24. Conclusion
• Traumatically fractured anterior teeth is common
finding in clinical practice
• The necessity for the multidisciplinary approach in
the treatment of complicated dental traumas
should be considered with respect to biological,
functional and esthetic aspects

25. Acknowledgement
• Prof. Dr. Sarita Joshi
Coordinator
Prosthodontics
NAMS, Bir Hospital
• Prof. Dr. Shaili Pradhan
Coordinator
Periodontology and Oral Implantology
NAMS, Bir Hospital
• Tutor. Dr. Ranjita Shrestha
• All PG Residents of NAMS