Restoration of traumatically fractured anterior teeth

“Restoration Of Traumatically Fractured Anterior Teeth”

Presented By Dr. Anjana Maharjan

PG Resident NAMS

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

.Classification by Ellis and Davey (1960)

Classconsiderable dentin, but not the dental pulp.Classconsiderable dentin and exposing the dental pulp.Class(or) without loss of crown structure.ClassClasscrown structure.Classcrown (or) root.Class

• 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

Different Treatment modalities

• Restoration margins located in gingival biological width area

Direct or indirect restorations of tooth crown defects with margins located in the gingival biological width areainduce gingival inflammation, loss of connective tissue attachment and unpredictable bone loss. Clinically it couldbe manifested as:–bone resorption––

Crown lengthening

• Surgical removal of hard and soft periodontaltissues to gain supracrestal tooth length, allowinglonger clinical crown and reestablishment ofbiological width

Ensures retentive and resistance form and need to develop a ferrule for pulpless

Ingber FJS, Rose LF, Coslet JG. The “biological width”:A concept in periodontics and restorative dentistry. Alpha Omegan 1977;70:62-65

T Hempton, T Dominici. Contemporary Crown-Lengthening Therapy: A Review. JADA. 2010;141(6):647-655

Rationale

Esthetic and

Functional Concerns

Biological Width

Ferrule length

Esthetic and Functional Concerns

• Exposure of sub gingival caries

• Exposure of sub gingival fracture

• High Lip line

Biological Width

If tooth with extensive caries/fracture are restored violation of biological width may occur. mean values of 0.77 mm for the connective1.14 mm for epithelial attachment

Distance from restoration margin to alveolar crest

• Dimension of soft tissue, which attached to

portion of tooth coronal to crest of alveolar

bone

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)

A basic prosthetic concept is that the greatest amount of retention and resistance to dislodgement of the restoration occurs at the apical onethirdof the preparation.

If a tooth fracture extends to the level of the bone, it must be erupted 4 mm. The first 2.5 mm moves the fracture margin far enough away from the bone to prevent a biologic width problem. The other 1.5 mm provides the proper amount of ferrule for adequate resistance form of the crown preparation.

Post and core

If breakdown in tooth structure has impinged on pulp or if little residual structure remains, endodontic therapy and concomitant placement of a post and core may be necessary to allow the restorationThe placement of the foundation restoration results in an increase in clinical crown height, width or both, thereby increasing the retention of the full

CASE REPORTS

Case - 1

A 45 yrs female patient came to the Department of history of trauma to face and fractured maxillary lateral incisors involving pulp. The chief complaint was difficulty, loss of esthetics and wanted immediate restoration and preservation of his teeth. Treatment planning was done after a thorough clinical examination.

Age- 45Sex- FemaleC/C- Wants removal of fractured tooth followed by false teeth

Crown Lengthening

Provisional restoration

• Final prosthetic impressions may begin at least 3 months after crown lengthening, though to be safe, wait 6 months, when remodeling finishes

After a crowncommon question pertaining to restorative or prosthetic treatment regards when final tooth preparationcan begin and when impressions, if needed, can be taken. A key determinant for initiating prosthetic therapy is the final position of the freegingival margin. This is particularlytrue in cases in which the treated dentition is of esthetic concernto the patient.

Brägger U, Lauchenauer D, Lang NP. Surgical lengthening of the clinical crown. J ClinPeriodontol.1992;19(1): 58-63

Post and core Restoration

Tooth preparation and Final Restoration

Case 2

Age- 35Sex- FemaleC/C – Fractured Front teeth and wants restoration

Crown Lengthening

Provisional Restoration

For 3 months

Final Restoration

Follow up- After 9 months

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

Acknowledgement

• Prof. Dr. Sarita JoshiCoordinator

ProsthodonticsNAMS, Bir Hospital

• Prof. Dr. Shaili PradhanCoordinator

Periodontology and Oral ImplantologyNAMS, Bir Hospital

• Tutor. Dr. Ranjita Shrestha

• All PG Residents of NAMS