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Case Conference Endodontics

How would you manage this case: crown fracture with complicated chisel-type fracture?

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This case was presented in the Dental Traumatology journal (December 2013). We are asking for your feedback on how you would treat this case. The full-text article will be added to the case on November 22nd, 2013.

The Clinical Case

A 24-year-old male patient came to The Department of Restorative Dentistry and Endodontics at the Dental Clinic in Vojvodina with dental injury of the maxillary left central incisor. The patient reported a sport injury that had occurred the night before during a football match.

Patient 1

Clinical and radiographic examination revealed a complicated oblique crown fracture that extended subgingivally on the mesiopalatal area with a single fragment, attached only by periodontal ligament fibers as well as widely open pulp chamber.

Patient 2

 

Tell us how you would have dealt with this case. If you have other interesting cases, email those to us at oasisdiscussions@cda-adc.ca

4 Comments

  1. tomasz pater November 15, 2013

    Class III fracture through pulp. Exposed to oral microfluora. Mature apex. Treatment is root canal therapy in one visit. If looks good place a composite post immediately; although slightly risky this should be explained to the patient. Hollow out the pulp chamber of patient’s tooth; adjust to composite core. Acid etch, bond, bond existing tooth fragment back on. Monitor every 3 weeks for next 3 months. Tell patient that this tooth will eventually require a ceramic crown. Similar stuff happened to me and I got 10 years before I had to crown my tooth.

    Reply
    1. Dorothy Marko November 20, 2013

      I have bonded together a large fractured segment of an anterior tooth before but never thought of doing the same for a tooth requiring endodontic treatment. Thank you for the pearl.

  2. Domenico Aversa November 15, 2013

    Local anesthetic of your choice.
    Separate fractured segment from tooth and store in sterile saline.
    Immediately perform endodontic therapy on fractured tooth root.Do this so that you don’t allow blood products to engorge dentinal tubules and thus discolor the tooth.
    Place a bit of retraction cord in the area of subgingival fracture extension.
    Using bonding procedure, I would then bond the fractured coronal piece to the root using dentin bonding agent and a flowable composite of the appropriate shade.
    Reduce occlusion on the lingual aspect of the broken tooth.
    Patient is warned may need future post and core and crown.
    In one hour he has minimal pain and looks exactly the way he did prior to accident.

    Reply
  3. Terry Shaw November 22, 2013

    Had a similar case a few months ago and did RCT and placed composite post and core and bonded whole thing together. With a rubber dam and good technique managed to avoid any blood contamination. Using AllBond 2 I was able to get the crack etched and flowed primer down inside tooth and worked bonding resin into fracture and cured and then placed composite. You could place a small labial increment of composite on the labial for extra strength. Removing fractured piece of tooth will create a mess to try to replace or repair. Composite in bulk is strong and will reinforce the tooth.

    Reply

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