Crown Fracture Research Articles

Fracture Resistance of Incisal Tooth Fragment reattached with different Materials and Preparation

The purpose of this study is to analyze the fracture resistance of reattached tooth according to the resin materials and tooth preparation type under physiological conditions. Uncomplicated crown fracture in the oblique direction was reproduced on the extracted 64 anterior teeth. Depending on the composite resin material, reattachment was performed using a flowable resin and a packable resin. Depending on retentive forms, reattachment was performed using simple reattachment, 1.0 mm × 1.0 mm labial chamfer bevel, 1.0 mm × 1.0 mm lingual chamfer bevel and 1.0 mm × 1.0 mm circumferential bevel. A load was applied to the palatal surface of the tooth using a universal testing machine at an angle of 125 degree, which is the interincisal angle of normal children. Under the masticatory pressure condition, fracture resistance of lingual chamfer groups was 28.28 ± 7.41 MPa and 27.54 ± 4.45 MPa, which was significantly higher than those of simple reattachment groups, 17.21 ± 5.87 MPa and 20.10 ± 6.00 MPa, in both flowable and packable resin groups. When considering the lingual force similar to masticatory pressure, the fragment retention was significantly improved when the lingual chamfer was formed compared to the simple reattachment. Clinicians may consider the design of the lingual chamfer in order to improve fracture resistance to masticatory pressure during fragment reattachment.

Pulpotomy for treatment of complicated crown fractures in permanent teeth: A systematic review.

BackgroundConsensus on the treatment of choice for complicated crown fractures of teeth is limited. Recent guidance recommends vital‐pulp‐therapy; however, the preferred type is not specified. Higher success rates for pulpotomy compared to pulp‐capping have been documented, which suggests pulpotomy may be a preferable option for complicated crown‐fractures.ObjectivesThe purpose of this systematic review was to determine the success rate of pulpotomy (partial and complete) on teeth that suffered complicated crown fractures. Participants: patients who have suffered a complicated crown fracture to an anterior permanent tooth. Intervention: pulpotomy (partial or complete). Comparator: pulp‐capping or root canal treatment. Outcome: combined clinical and radiographic success at or after 12 months.MethodsA systematic literature using key search terms was conducted using PubMed, Web of Science and Cochrane‐Central‐Register‐of‐Controlled‐Trials (CENTRAL) as well as a grey literature search from inception to May 2021 and without language restricted to English. Strict inclusion criteria were applied. A standardized tool with defined criteria to assess the risk of bias in each study was used. For non‐randomized comparative trials, the Robins‐I tool was used while the Newcastle‐Ottawa scale was used for non‐comparative non‐randomized studies.ResultsSeven retrospective clinical studies were included. The studies reported high success rates for pulpotomy with overall success ranges for partial or complete pulpotomy ranging from 75% to 96%. One study compared the success rates of pulpotomy to an alternative treatment option pulp capping (90.9% vs. 67%, respectively). Due to the lack of homogeneity in the included studies, a meta‐analysis was not possible.DiscussionThis review highlights the limited evidence based for the current guidance on treatment of complicated crown fractures. The findings of the review indicate high success rates for pulpotomy; however, there is a moderate risk of bias and small sample sizes in the included studies with the result that the overall results should be interpreted with caution.ConclusionWithin the limitations of this review, the benefits and high success rates reported for partial pulpotomy suggest this procedure, rather than pulp‐capping, should be considered as the treatment of choice for both immature and mature teeth that have suffered complicated crown‐fractures.

Decision-making in the management of complicated crown fractures in children

Complicated crown fractures of permanent teeth following dental trauma in children are a common presentation in the dental practice. The prognosis of these teeth largely depends on the emergency management provided by the dentist. Treatment options include direct pulp capping and partial pulpotomy. While both have been suggested as possible vital pulp therapies for the management of complicated crown fractures, there are no clear recommendations as to when each procedure is indicated to aid the clinician in decision making. This narrative review aims to provide evidence-based recommendations for the optimal management of complicated crown fractures in children. The factors affecting success rates of both direct pulp capping and partial pulpotomy are discussed and a step-by-step guide to carrying out a partial pulpotomy is presented. CPD/Clinical Relevance: This article will assist clinicians in making an evidence-based decision for the optimal management of complicated crown fractures of permanent teeth in children.

Prosthetic failures in dental implant therapy.

Both fixed and removable implant‐supported prostheses are well‐established methods for replacing missing teeth in partially or fully edentulous patients. Numerous systematic reviews have been performed in recent years to evaluate the survival and complication rates of implant‐retained fixed dental prostheses and implant‐retained overdentures, displaying high 5‐year survival rates ranging from 97.1% for fixed dental prostheses to 95%‐100% for implant‐retained overdentures. However, the survival rates only represent the prostheses remaining in use for a defined follow‐up time, and do not account for the potential prosthetic complications that may have arisen and influence the general success of the implant treatment. The most common technical complications of fixed implant‐retained single crowns are crown fracture, fractures of ceramic implant abutments, and esthetic problems. The predominant technical complication at multiple‐unit, implant‐retained fixed dental prostheses is fracture/chipping of the veneering ceramic. Reported technical complications for implant‐retained overdentures are overdenture fracture or chipping of the veneer materials, whereas mechanical complications include implant fracture, attachment failure, and attachment housing or insert complications. To reduce the risk of such failures, a comprehensive pretreatment diagnostic work‐up is essential, including defining the prosthetic goal with the aid of a wax‐up or set‐up and the associated ideal, prosthetically oriented three‐dimensional implant position. Furthermore, selection of the ideal type of prosthesis, including the respective implant components and materials, is important for clinical long‐term treatment success.

Rehabilitation of the Breached Tooth, Fragment– A Minimal Invasive Cosmetic Approach: An Original Case Series

Tooth fractures are often reported as emergencies in dental practice. Coronal fractures of the anterior teeth are a prevalent cause of dental trauma in children and teenagers. It's a tragic situation that necessitates prompt care and quick functional and esthetic repair. The clinician's main difficulty when dealing with these types of dental injuries is to re-establish the natural esthetics of the traumatized anterior tooth. There are several therapeutic options for this condition, one of which is reattachment of the fractured component itself. Because of its simplicity, natural esthetics, and preservation of tooth structure, reattachment of a tooth fragment should be the first choice and a feasible alternative to conventional approaches. For a successful prognosis, the patient's cooperation and comprehension of the treatment's limitations is essential. This paper presents a report of two clinical cases on managing complicated crown fractures, where the restoration of the fractured anterior teeth using the residual tooth fragment was supported by fiber post system.
 Keywords: Complicated Crown Fracture, Fiber post, Fractured Tooth Fragment, Internal grooving.

Dental fractures: types, causes, and treatment

Studies indicate that the management of dental fractures might be challenging because many cases present with minor, hard-to-discover traumas, requiring extensive evaluation and diagnostic procedures. Accordingly, adequate management can only be achieved by establishing a proper diagnosis, drawing an adequate treatment plan, and conducting regular follow-up appointments. We have discussed the different causes, types, and treatments of dental fractures. The commonest causes include impaction by trauma, whether direct or indirect. Many traumatic events were reported in the literature, and age and carious lesions are important factors to consider. Many types of dental fractures were also reported in the literature, including root fractures, crown root fractures, enamel-dentin fractures with and without pulp exposure or crown fractures, enamel infractions, and fractures. Other types include avulsion, intrusion, extrusion, lateral luxation, concussion or subluxation, splinting, and alveolar segment fractures. The treatment should be integrated based on the fracture type, and adequate follow-up should be established to achieve the best predictive outcomes.

Fragment Reattachment of Complicated Maxillary Central Incisor Crown Fracture in 8-year-old Female Child - A Case Report

Fragment Reattachment of Complicated Maxillary Central Incisor Crown Fracture in 8-year-old Female Child - A Case Report

Four-year clinical evaluation of CAD/CAM indirect resin composite premolar crowns using 3D digital data: Discovering the causes of debonding.

To analyze the causes of debonding of computer-aided design/computer-aided manufacturing (CAD/CAM) indirect resin composite premolar crowns with a focus on the morphological factors of the crown and abutment teeth. The clinical courses of 109 CAD/CAM indirect resin composite crowns were observed, and the patients' background characteristics, crown locations, luting methods, types of abutments, distal-most/non-distal-most molars, and types of resin blocks were confirmed. To investigate the influence of the morphology of the crown and abutment teeth, the 1) vertical dimension of the abutment teeth, 2) taper, and 3) thickness of the crown occlusal surface during events were measured from the three-dimensional digital data. The Kaplan-Meier method and multivariable Cox proportional hazard model were used for the statistical analyses. The nonlinearity of the effect of each comparison factor was included in the model. Complications included 21 debonding cases, two crown fractures, five root fractures, and two core debondings. The cumulative no-debonding and no-crown-fracture rate over 1423 days (3 years and 11 months) was 77.4%. The multivariable Cox regression analysis revealed that the abutment teeth type of tooth (first or second premolar) (P = 0.02) and luting materials (P < 0.01) significantly influenced the debonding frequency. All morphological factors (1-3) significantly influenced the debonding. The hazard ratios and nonlinear graph indicated that the crown thickness was less effective than the vertical dimension and taper. The combination analysis of clinical outcomes and 3D digital data revealed that preparation of the abutment is important for avoiding crown debonding.

Management of Complicated Crown Fracture by Partial Pulpotomy &amp; Fragment Reattachment: A Case Report

The management of complicated crown fractures require immediate intervention as it affects the pulp health and has psychological impact on patients. Vital pulp therapy combined with fragment reattachment is the most conservative and minimally invasive treatment strategy for the management of these fractures if the fragment is available. This case report discusses the conservative technique for the management of complicated crown fracture of maxillary right central incisor by performing partial pulpotomy with MTA followed by fragment reattachment done within 24 hours of trauma. A six month follow up revealed healthy vital pulp and retained fragment with acceptable aesthetics and function.nbsp

Management of cracked maxillary first molar with erbium-doped yttrium aluminum garnet laser

Treatment and diagnosis of fractured teeth present a big challenge to dentists. Treatment of traumatized teeth can be done with reattachment of a dental fragment both in simple and complicated coronal fractures. A 28-year-old male patient came to our department with a traumatic crown fracture of the permanent, left maxillary molar. The patient complained of pain upon mastication, and on examination left maxillary second molar has a fracture line extending in a mesiodistal direction. Partial pulpotomy with the help of erbium-doped yttrium aluminum garnet (Er: YAG) laser was done to relieve symptoms and to reduce microleakage and increase strength, the fracture line was sealed with the help of Er: YAG laser. The cavity was then sealed with biodentin and composite. For these types of cases, Er: YAG laser is used for biostimulation of exposed pulp, and also to improve strength and reduce microleakage through sealing of fracture line.

Evaluation of Knowledge Level and Awareness of Parents About Avulsion and Crown Fracture

Objective: The aim of this study was to evaluate the knowledge levels and awareness of avulsions and crown fractures of the parents. The study is important to understand how to improve parents' knowledge level related to dental treatment of avulsion and crown fracture.Methods: The parents of pediatric patients who applied to Ordu University Faculty of Dentistry, Department of Pediatric Dentistry during April-June 2017 were the target group for this study. A questionnaire was formulated to evaluate the parents’ knowledge levels and awareness of avulsions and crown fractures. Five hundred and seventy-five parents answered the questionnaire. The participation rate was 68.3%. Data were analyzed statistically.Results: Approximately one-half of the parents in this study were in their thirties, and 61.9% of the parents were males. Only 29.9% of the parents were university graduates, and more than one-half had not attended a first aid course. The chi-squared test indicated that there was no statistically significant difference between the correct answer percentage and the age, gender, and affected by dental trauma (P&amp;gt;0.05). However, a statistically significant difference was found between the correct answer percentage and the educational level, first aid course attendance, see a dental trauma, and preferred institution for emergency dental treatment (P&amp;lt;0.05). The parents’ level of knowledge and awareness of avulsions and crown fractures was 40.2% or “poor”.Conclusion: The parents’ knowledge levels and awareness of avulsions and crown fractures should be increased through educational programs.

Management of complicated crown fracture by tooth fragment reattachment with fiber post: a case report

Management of complicated crown fracture by tooth fragment reattachment with fiber post: a case report

Physics Forceps in Tooth Extraction—A Systematic Review of Randomized Controlled Trials

The present systematic review aims to evaluate the efficiency of Physics forceps over the conventional forceps for the extraction of a tooth. The study began with targeted electronic searches of MEDLINE, PubMed, Cochrane, Science Direct and Google Scholar databases. All selected articles were reviewed by four independent reviewers for eligibility. The Cochrane Risk of Bias tool was used to analyze the studies for bias. Due to heterogeneity of the selected studies, a meta-analysis of the current systematic review was not possible. A total of five studies were considered for the final analysis. The risk of bias showed high risk for all five included articles. Various parameters, such as fracture of the root, dry socket, healing, pain, postoperative infection, crown fractures, buccal bone fractures, extraction time, gingival and marginal bone loss, gingival laceration, bleeding and healing were assessed. Based on the data available, there is an insufficient quality of evidence to conclude the superiority of the Physics forceps over conventional forceps.

The Potential of Hydroxyapatite Toothpaste towards the Hypersensitive Tooth

Dental hypersensitivity is a communal problem that we may often encounter in the daily life of both men and women, especially in the elderly who can unconsciously affect every daily activity. Dentin hypersensitivity is defined as sharp pain caused by stimulation of exposed dentin and unprotected dentin by enamel which can be caused by attrition, abrasion, crown fracture, gingival recession, and orthodontic trauma. Aim: The aim of this study was to analyse the potential of hydroxyapatite toothpaste towards the hypersensitive tooth through literature review. Method: This study analyzed 35 journals from each database PubMed, Ebsco, Google Scholar, ResearchGate, Wiley Online Library, and other international journal websites with keywords hydroxyapatite, hypersensitive dentin, remineralization. Conclusion: Toothpaste containing hydroxyapatite was more effective than toothpaste without hydroxyapatite in inducing tooth remineralization process. The use of toothpaste containing hydroxyapatite in the long term and routine for 15 days is more effective in reducing dental hypersensitivity.

Study on fracture behavior of molars based on three-dimensional high-precision computerized tomography scanning and numerical simulation.

A series of three-dimensional (3D) numerical simulations are conducted to investigate the gradual failure process of molars in this study. The real morphology and internal mesoscopic structure of a whole tooth are implemented into the numerical simulations through computerized tomography scanning, digital image processing, and 3D matrix mapping. The failure process of the whole tooth subject to compressions including crack initiation, crack propagation, and final failure pattern is reproduced using 3D realistic failure process analysis (RFPA3D) method. It is concluded that a series of microcracks are gradually initiated, nucleated, and subsequently interconnect to form macroscopic cracks when the teeth are under over-compressions. The propagation of the macroscopic cracks results in the formation of fracture surfaces and penetrating cracks, which are essential signs and manifestations of the tooth failure. Moreover, the simulations reveal that, the material heterogeneity is a critical factor that affects the mechanical properties and fracture modes of the teeth, which vary from crown fractures to crown-root fractures and root fractures depending on different homogeneity indices.

Emergency management of maxillary dentoalveolar fracture: A case report

Dentoalveolar trauma occurs in relation to injuries of fall, road traffic accidents, sports injury or physical violence. There may be injury limited to the tooth, or may involve the periodontium around, or in severe cases, alveolar bone or oral mucosa may be traumatised. There can be myriad injuries of the same structure depending upon the severity of impact. The injuries of tooth most commonly being crown fractures, followed by root fractures, luxation or complete avulsion of the tooth. Every type of dentoalveolar injury requires a specific set of clinical protocols to be followed in order to successfully diagnose and manage the particular case.We hereby report a case of a 29-year-old male patient with a history of fall under the influence of alcohol, who had fallen flat on his face and had suffered intrusive luxation of permanent maxillary right central incisor and avulsion of permanent maxillary left central and lateral incisors. The exarticulated teeth still had slight soft tissue attachment to the socket. On the patients first visit to dental OPD, being a dental emergency, the avulsed teeth were immediately restored back into the socket under local anaesthesia after adequately irrigating and debriding the socket, followed by repositioning of the internally luxated tooth, so that all were in their correct anatomical position. After checking for occlusion, they were splinted in position with Erich’s arch bar and 26 gauge SS wire and after giving post-operative instructions patient was asked to follow up after 6 weeks. At 6 weeks, the affected teeth were found to be firm and so arch bar were removed. Patient was advised to follow up further. At periodic follow ups, the patient was asymptomatic and maintained adequate oral functioning of the injured teeth, thus with good patient compliance and proper diagnosis and treatment, dentoalveolar fractures can be managed successfully. The main purpose of this article is to lay emphasis on the timing of treatment of the dentoalveolar injuries. The earlier they are managed, the better is the outcome.

A case report of sub-gingival cervical crown fracture reattachment using fiber post- A 22 months follow up

A 15‐year‐old male presented to the Department of Conservative Dentistry and Endodontics immediately after a facial injury having complain of persistent pain in the teeth and the front upper lips. Upon examination it was revealed trauma of the upper incisors, also injury to the marginal gingiva of the front teeth. Further inspections showed slight laceration of the oral mucosa in the lower labial sulcus. Radiographic examination revealed fracture of crown of maxillary central incisor. The treatment plan which was decided comprised of complete removal of fractured crown followed by root canal therapy and immediate post placement and reattachment of the crown.

Effect of different tightening protocols on the probability of survival of screw-retained implant-supported crowns

PurposeThis study evaluated the effect of different tightening protocols on the probability of survival of screw-retained implant-supported anterior crowns. Materials and methodsSeventy-two implants with internal conical connections (4.0 × 10mm, Ti–6Al–4V, Colosso, Emfils) were divided into four groups (n = 18 each): 1) Manufacturer's recommendations torque (25 N.cm for abutment's screw and 30 N.cm for crown's screw) (MaT); 2) Retightening after 10 min (ReT); 3) Torque 16% below recommended to simulate an uncalibrated wrench (AgT), and; 4) Temporary crown simulation (TeT), where crowns were torqued to 13 N.cm to simulate manual tightening, subjected to 11,200 cycles to simulate temporary crown treatment time (190 N), and then retightened to manufacturer torque (TeT). All specimens were subjected to cyclic fatigue in distilled water with a load of 190 N until 250,000 cycles or failure. The probability of survival (reliability) to complete a mission of 50,000 cycles was calculated and plotted using the Weibull 2-Parameter analysis. Weibull modulus and number of cycles at which 62.3% of the specimens would fail were also calculated and plotted. The failure mode was characterized in stereo and scanning electron microscopes (SEM). ResultsThe probability of survival was 69.3% for MaT, 70% for ReT, 54.8% for AgT, and 40.3% for TeT, all with no statistically significant difference. Weibull modulus was approximately 1.0 for all groups. The characteristic number of cycles for failure was 105,000 cycles for MaT, 123,000 for ReT, 82,000 cycles for AgT, and 54,900 cycles for TeT, with no significant difference between groups. The chief failure mode for MaT, ReT, AgT groups was crown screw fracture, whereas abutment screw fracture was the chief failure mode for the TeT group. ConclusionTightening protocol did not influence the probability of survival of the screw-retained anterior crowns supported by internal conical implants (Ti–6Al–4V, Colosso, Emfils).

Fracture strength of secondary crown with different taper and thickness in zirconia double crown attachments.

The objective of this study was to clarify the influences of zirconia materials, one-half taper angle, and thickness of the secondary crown on the fracture strength of the secondary crown. For the primary and secondary crowns, Y-TZP and Ce-TZP/Al2O3 were used, respectively. Samples were prepared at one-half taper angles of 2° and 4°, and a secondary crown thickness of 0.5 and 1.0 mm (n=8). Regarding the fracture strength, the secondary crown was restored on the primary crown, all specimens were loaded until fracture using a universal testing machine. The load value added at the time of secondary crown fracture was regarded as fracture strength. Based on the analysis of variance, the fracture strength of Ce-TZP/Al2O3 was significantly higher than that of Y-TZP with regard to the material and that at 1.0-mm thickness was significantly higher than that at 0.5-mm thickness, but the taper angle had no influence.

The Management of Complicated Crown Fracture of Anterior Primary Teeth

Background: Injury in the primary teeth and their supporting structures is one of the most common dental health problems observed in children. Injuries in children occurred from an external forces which classified in to dental emergency treatment in pediatric growth and development. A child is perceived to be in a dynamic state of growth, both mentally and physically. Curiosity about surrounding environment and urging to explore may lead to dental injuries. A vital pulpectomy and continued selection of an appropriate restoration after a traumatic injury can mentain the primary tooth in its arch until the time of exfoliation. Purpose: Reported the management of complicated crown fractures in the upper left primary teeth. Case Report: This report presented a 2 years old boy with complicated crown fracture on the upper left primary teeth. The parents gave the history of trauma related to front region of the jaw and they wanted to restore the involved tooth without getting extraction. After an intra oral examinations, it was observed that crown was fracture with vital dental condition. Case Management: After removing the fractured fragment, a vital pulpectomy was conducted in three visit periods at the remaining upper left primary teeth with final glass ionomer cement restoration using strip crowns. Conclusion: The importance of reconstruction on anterior primary teeth after traumatic injury provides both functional and aesthetic restorations for the child, what reflects on masticatory efficiency, increased self-steam and also phonetic improvements.