This document discusses various case reports of anterior tooth fractures treated with different techniques. It describes 5 cases: 1) enameloplasty to reshape a fractured enamel surface; 2) reattachment of a fractured fragment using composite resin; 3) laminate restoration with glass ionomer cement and composite for a fracture involving enamel and dentin; 4) management of a vertical fracture involving pulp using orthodontic banding and post-core buildup; and 5) surgical reattachment of fractured fragments involving pulp. The document discusses advantages of reattachment techniques and highlights factors like prognosis and esthetics. It emphasizes the importance of restoring smiles and improving patients' quality of life.

1. TOOTH CRAFT –
SKILL UNVEILED
Dr.Hyun Joong, BDS,
CHENNAI.

2. INTRODUCTION
 Fractures to the anterior teeth-trauma
 Minor to severe -vertical, diagonal or
horizontal fractures.
 Dental emergency
 Skill - career of every practitioner.

3. AIM
 Uncomplicated crown fractures
 Complicated crown fractures
 Crown root fractures
 Prevent tooth loss
 Improve cosmetic results
 Decrease risk of infection

4. CASE REPORT -1
ENAMELOPLASTY

5. 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

6. TREATMENT
 Enamel reshaping
(ENAMELOPLASTY)
Thin tapering diamond
Finishing and polishing

7. Pre & Post treatment
photographs

8. CASE REPORT 2
REATTACHMENT OF
FRACTURED FRAGMENT

9. 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

10. TREATMENT PLAN
 Reattach fractured fragment.
PROCEDURE
 Tooth preparation done
 Fractured fragment was re-united using
Light Cure Composite Resin.

11. Pre & Post operative
photographs

12. CASE REPORT - 3
LAMINATE
RESTORATION

13. 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

14.  Enameloplasty – 11
 Laminate restoration with Glass
Ionomer Cement and Light Cure
Composite Resin - 21
TREATMENT PLAN

15. Pre & Post operative
photographs

16. CASE REPORT – 4
MANAGEMENT OF
VERTICAL FRACTURE

17. 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

18. TREATMENT PLAN
STEP 1
Orthodontic banding
STEP 2
Access opened with the
band in place and
obturated using warm
sectional condensation
method

19. STEP 3
Band removed & Fracture
line reinforced with dual
cure composite

20. STEP 5
Tooth reduction done
STEP 7
Jacket crown luted in 22

21. Pre & Post Op
Photographs

22. CASE REPORT 5
REATTACHMENT
OF FRACTURED
TEETH

23. 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

24. TREATMENT PLAN
STEP 2
Root canal treatment done in
11,12 and 13
STEP 1
Fractured crown extracted

25. 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

26. STEP - 6
Flap re-positioned and
sutured
STEP – 7
Post operative X-ray

27. Pre-post operative
photographs

28. 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

29. 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.

30. 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

31. ADVANTAGES
 Rapid
 Conservative
 Colour match
 Economical
 Positive emotional social response
from patient

32. CONCLUSION
A 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

33. REFERENCES
 James l Guttman. Problem solving in endodontics-
prevention ,identification and management, 3rd
edition
 Anderson JO, Anderson FM. Textbook and colour
atlas 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

34. MY SINCERE THANKS
Dr. A. NANDHINI, MDS
Assistant Professor
Dept. of Conservative Dentistry &
Endodontics