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Treatment crown fracture
1.
2. Content
Treatment of fractured enamel
Treatment of uncomplicated crown fracture
Treatment of complicated crown fracture with
minimal pulp exposure
3.
4. 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.
5.
6. 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 ®)
7. 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.
8. 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
9. Steps
Try tooth fragment intraorally
Isolation
Tooth Fragment
Flour of pumice
Etching
Adhesive
10. Dentin and enamel
Flour of pumice
Etching
Composite resin was applied
to both fragment and
tooth surfaces.
Adhesive
11. Light-cured for 40 seconds
Additional composite
Finished with diamond burs
Polished with Sof-Lex disks
14. 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.
16. 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.
19. 1)Direct Pulp Capping
Indications: Exposure < 1mm
: Time elapsed since injury- within a few hours
: Vital pulp
: Complete root development
: Absence of root fracture
20. 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
21. 2 a)Partial Pulpotomy/Cvek Pulpotomy
Aim:Remove only inflamed tissue , leaving healthy pulp
tissue for physiologic maturation of the root.
22. 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
23. Partial Pulpotomy Procedure
Pulp tissue removal
- 2mm apical to the exposure .
Haemorrhage control
- saline/diluted sodium
hypochlorite(2.5%)
24. Partial Pulpotomy Procedure
Pulp covered - MTA or calcium hydroxide
Restoration – GIC & CR
Re-evaluation- 1/12 and every 3/12 for the first
year.
25. 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
26.
27. Apply FS on a pledget of
cotton wool for 4 minutes
Step 7: Remove FS pledget after 4 mins
& check that haemorrhage has
stopped
28. 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.
30. 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.
31. 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
32. 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.
33. 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