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Case Conference Endodontics

Updated post with full-text article: 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 is now available.

Full-text article (PDF)

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

 

Courtesy of Wiley Publishing: You can access the full text article for the next 3 month. 

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4 Comments

  1. Michael Zuk DDS November 22, 2013

    It would be an idea to perform endodontics, place a post and five surface composite followed by orthodontic eruption to gain the desired amount of natural tooth structure above the gumline. Splint to the adjacent teeth for about six to nine months and place a crown if desired (with any gingival procedures needed along the way).

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  2. Matt November 22, 2013

    I would extract the broken fragment and assess remaining tooth for adequate ferrule. If enough tooth structure remains for crown, then I would do a root canal, fiber post, composite core and crown. If not enough tooth structure, then extract and place immediate RPD for esthetics, with an implant retained crown as ultimate treatment.

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  3. Richard November 22, 2013

    Here’s a possibility: Anaesthetize. Take a sectional impression of the repostioned tooth with a bite registration material or alginate (to be make a provisional crown, in case it turns into a crown prep). Remove fragment and keep. Root canal (rubber dam may not be possible without a possible buildup). Fiber post prep in the root and in the coronal tooth fragment. Cement the post in the coronal aspect while trying in the post in the root. PA. Remove coronal fragment with attached post. Etch and bond both. Lentulo spiral in dual cure resin cement into root. Flowable composite at the interface and cure. Reduce occlusion. Night guard and or sport guard.

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  4. lenny November 23, 2013

    If there is a pulpal exposure, root canal treatment first.
    Depending on the shape of the fracture and its extent, i might consider orthodontic extrusion over 2.5 months (two weeks active treatment and then 2 months retention) Depending on whether or not the extrusion was rapid enough to prevent growth of bone and gingiva coronally with the extrusion, the gingival margin is assessed for symmetry. Otherwise corrective crow lengthening procedure would be needed.
    If the fracture was a very thin sliver that extended to the crest of bone, one would have to weigh the degree of extrusion required to expose the edge of fracture with just allowing reattachment of the gingiva on the exposed dentin and fabricating a porcelain crown supragingivally, and not obsessing with a smaller shaped tooth in an area that is not visible
    Although it is always ideal to extrude to expose the entirely to edge of fracture, the limitation is crown root ratio and the smaller emergence profile or width that may be visibly asymmetrical relative to the adjacent central incior.

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