treatment crown fracture
TRANSCRIPT
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Treatment of uncomplicated crown fracture & complicated crown fracture (minimal pulp
exposure)
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ContentTreatment of fractured enamelTreatment of uncomplicated crown
fractureTreatment of complicated crown fracture
with minimal pulp exposure
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Treatment of fractured enamel
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Radiograph of lip or cheek lacerations to search for tooth fragments or foreign material
Treatment options1. Leave it2. Rounded – sharp
enamel edges3. Re-attach the fragment4. Restore with CR
Follow-upClinical and radiographic control -> 6-8 weeks &
1 year.
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Treatment of uncomplicated crown
fracture
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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 ®)
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Treatment optionsNo tooth fragment – Covered with GIC
(temporary)/ Restore with CR
Tooth fragment saved – Re-attach the fragmentFollow-upClinical and radiographic control -> 6-8 weeks
& 1 year.
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Reattachment of tooth fragmentGood and long-lasting esthetics Can restore function Positive psychological responseSimple procedureLess time-consuming More predictable long-term wear than when
direct composite is used
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StepsTry tooth fragment
intraorallyIsolation
Flour of pumice AdhesiveEtching
Tooth Fragment
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Composite resin was applied to both fragment and tooth surfaces.
Dentin and enamel
Flour of pumice Etching Adhesive
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Light-cured for 40 secondsAdditional compositeFinished with diamond bursPolished with Sof-Lex disks
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Treatment of complicated crown fracture with
minimal pulp exposure
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Complicated Crown Fracture
Clinical appearance:
Pulp with bright red,cyanotic or ischemic
appearance respectively.
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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.
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Radiographic appearance:
Fracture at tooth 21
involving enamel
dentine and pulp.
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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.
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Treatment:
1)Direct Pulp Capping
2)Pulpotomy
a)Cvek Pulpotomy
b)Cervical pulpotomy
3)Apexification
4)Root Canal Treatment
5)Extraction
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1)Direct Pulp Capping
Aim: Preserve vital pulp tissue by physiologically walled off with calcific barrier.
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1)Direct Pulp Capping
Indications: Exposure < 1mm
: Time elapsed since injury- within a few hours
: Vital pulp
: Complete root development
: Absence of root fracture
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Apply rubber dam
Tooth gently cleaned with water
Calcium hyroxide is applied to the pulp tissue
Cover exposed dentine with GIC
Review in 6-8 weeks
-No clinical sign & symptom-Radiographically lesion not showing any root resorption
-Tooth symptomatic with sign of pulp necrosis
-Radiographicaly,presence of lesionRestore tooth with
permanent restoration.Review in 1&5 years after injury and monitor for pulpal sensibility
Root canal treatment
Extraction
Restore with composite or strip crown in ant and SSC in posterior teeth.
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2 a)Partial Pulpotomy/Cvek Pulpotomy
Aim:Remove only inflamed tissue , leaving
healthy pulp tissue for physiologic maturation
of the root.
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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
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Pulp tissue removal- 2mm apical to the exposure .
Haemorrhage control - saline/diluted sodium hypochlorite(2.5%)
Partial Pulpotomy Procedure
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Pulp covered - MTA or calcium hydroxide
Restoration – GIC & CR
Re-evaluation- 1/12 and every 3/12 for the first year.
Partial Pulpotomy Procedure
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2 b) Full Coronal PulpotomyAim: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
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Apply FS on a pledget of cotton wool for 4 minutes
Step 7: Remove FS pledget after 4 mins & check that haemorrhage has stopped
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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.
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3)Apexification
Indications :Large contaminated exposure
: Exposure >24 hours
: Necrotic pulp
: Immature permanent teeth with open apex
: Absence of root fracture
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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.
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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
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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.
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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
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Thank you