Crown Fracture Research Articles

Innovative management of complicated crown-root fracture with biomimetic materials: A case report with a 2-year follow-up

Abstract The concurrent complicated horizontal crown-root fracture and complicated vertical crown fracture are rarely delineated in the literature. This case report suggests a twophase singlevisit treatment to reinstate the maxillary lateral incisor with bioinspired materials. In Stage 1, endodontic therapy was given, followed by fracture fragment stabilization innovatively in Stage 2. At 2 years of follow-up, clinical examinations revealed satisfactory periodontal condition without mobility or discoloration of the tooth. Cone-beam computed tomography revealed a close approximation of the vertical fracture line and healing of the horizontal crown-root fracture with a type II pattern. This case report concludes that a minimally invasive procedural approach with biomimetic materials can be performed instead of extensive therapy like extraction.

Prevalence and Pattern of Traumatic Dental Injuries in Children and Adolescents With Severe to Profound Hearing Impairment: A Hospital-Based Cross-Sectional Study.

Traumatic Dental Injuries (TDIs) are an emerging public health problem and a realm of research for oral health enthusiasts. Certain populations can be more vulnerable to injuries such as those with a sensory deficit. Nevertheless, literature is scarce, especially for those with hearing impairment. Therefore, the aim of the study was to compare the prevalence and patterns of TDI in children and adolescents with severe-to profound hearing impairments and children without hearing impairments. Three hundred and ninety participants (195 severe to profound hearing impaired and 195 age and sex-matched controls) between 4 and 18 years were recruited from a tertiary care setting. A single calibrated examiner evaluated TDI for both groups. Among those with TDI, a vestibular function test (VFT) was also performed to assess postural balance. A single examiner from the Department of Otorhinolaryngology evaluated the VFT results. The overall prevalence of TDI was found to be 12.82% among the severe to profound hearing-impaired individuals, and 11.79% in controls. The majority of participants were aged between 7 and 13 years, in the mixed dentition stage, and were males. Among the cases, the majority had profound hearing loss (≥ 91 dB HL) and bilateral ear involvement. The most common type of TDI was uncomplicated crown fractures. Falls were identified as the most common cause of TDI in both groups. Vestibular dysfunction and loss of postural control were identified in 12 out of 14 patients tested with VFT. A significant association was found between TDI and the dentition type, that is, primary dentition was more affected among the severe to profound hearing impaired as compared to controls (p < 0.05). There was no significant association between the severity of hearing impairment and the prevalence of dental trauma in children and adolescents with severe to profound hearing impairment. However, hearing-impaired individuals were susceptible to trauma at an early age compared to their healthy counterparts.

Complications of Intracanal Irrigation During Root Canal Therapy of a Maxillary Canine Tooth in a Cat.

This case describes a previously unreported complication of maxillary canine root canal therapy in a cat. A 5-year-old Russian Blue cat was presented with a complicated crown fracture (pulp exposure) of its left maxillary canine tooth (204). To salvage the tooth, root canal therapy was initiated but not completed due to hemorrhage within the canal. The procedure was staged. On recovery from the procedure, unilateral facial swelling and corneal ulceration were observed. This was consistent with retrograde passage of sodium hypochlorite through the nasolacrimal duct, inducing chemical injury to the cornea. The patient was treated with topical antibiotics, ophthalmic lubrication and systemic analgesia. After seven days of treatment, vast improvements to the eye were noted, with a full recovery confirmed at subsequent follow-up. Rather than complete stage two of the root canal therapy, the affected tooth was extracted; due to progression of pathology affecting the periapical bone. Clinicians should be aware of retrograde chemical irrigation as a potential complication when undertaking root canal therapy of maxillary canine teeth in cats. The close association between the maxillary canine tooth root and the nasolacrimal duct in cats needs to be taken into consideration and may require further evaluation prior to undertaking endodontic treatment. Advanced imaging should be considered. Immediate management of chemical corneal injuries should include copious flushing of the corneal surface, followed by swift referral for ophthalmic assessment.

Fracture Resistance of Different Monolithic Zirconia Crowns with Horizontal and Vertical Finishing Lines: A Comparative in Vitro Study

Objective: The primary objective was to examine how different preparation techniques and zirconia materials affected fracture strength. Materials and methods: 48 sound human maxillary first premolars of similar shape and size were used, categorized into two main groups of 24 teeth, as per the preparation technique: Group A: chamfer preparation design. Group B: vertical preparation design. Then, based on the type of material, each main group was subcategorized into three subgroups of eight teeth: IPS emax Zircad LT, IPS emax MT and IPS emax Prime (IvoclarVivadent). All the samples, prepared by the same operator, with the assistance of a dental surveyor. Intra-oral scanning was performed on the prepared teeth. The SironaInLab CAD 20.0 software was used to design crowns and were subsequently generated using a 5-axis milling machine. Self-adhesive resin cement was used to bond crowns to their respective teeth. To assess the crown's fracture strength, a computer-controlled universal testing system was used, which records the fracture strength automatically in each sample in Newton (N) during a single load-to-failure test. Burke's classification was employed to assess the fracture mode by analyzing each sample under a 40x digital microscope. The collected data were evaluated using statistical analysis using the independent t-test and ANOVA, with a 0.05 significance level. Results: Vertical preparation technique had higher fracture strength than the chamfer preparation technique with a statistically significant difference (p &lt; 0.05). While comparable fracture resistance was identified across various monolithic zirconia crowns. All samples demonstrated a severe fracture of the crown and/or tooth (Code V). Conclusion: The vertical preparation design illustrated significantly better fracture strength than the chamfer preparation design, Materials comparisons showed comparable fracture resistance.

Long-Term Evaluation of Direct Composite Resin Restoration for Traumatic Anterior Crown Fractures in Children and Adolescents

Direct composite resin restorations are often the first choice in children and adolescents with anterior crown fractures. This study aimed to assess the long-term outcomes of direct composite resin restoration in children and adolescents with traumatic dental injuries. Patients with anterior crown fractures treated with direct composite resin restoration at the Department of Dentistry of Wonju Severance Hospital between March 2011 and February 2022 were included. A total of 86 teeth from 59 patients were evaluated. The survival rate according to the sex, age, history of pulp treatment, and ratio of the resin restoration to the clinical crown were statistically calculated using chi-square test, Fisher’s exact, and Kaplan-Meier methods. Factors associated with failure were evaluated using Cox regression analysis. Survival rates during the follow-up period were significantly different according to the patient’s age at the time of trauma (p = 0.036). The survival rate was not significantly different between the sexes (p = 0.632). The survival rate was not influenced by pulp treatment before resin restoration (p = 0.617). Based on the Kaplan-Meier method, the mean retention time of teeth with and without pulp treatment was 99.35 ± 9.98 and 79.68 ± 9.07 months, respectively. Additionally, there was no significant difference between both survival curves (p = 0.215). Furthermore, the survival rate was not significantly different according to the ratio of the resin restoration to the clinical crown (p = 0.334). Similar to the results from Fisher’s exact test, there was no significant difference in survival rates between Group I (ratio of the resin restoration to the clinical crown &lt; 0.5) and Group II (ratio of the resin restoration to the clinical crown ≥ 0.5) (p = 0.228). This study demonstrates the clinical efficacy of direct composite resin restorations for anterior crown fractures in children and adolescents, with favorable survival rates observed over 10 years of follow-up suggesting it as a conservative and effective primary treatment option across various clinical conditions.

Fracture Resistance and Initial Penetration Time of a Novel Zirconia Crown Design for Simplifying Future Endodontic Treatment: An In Vitro Study.

Objectives: This study aimed to investigate the fracture strength of a novel-designed Zirconia crown before and after access opening, and to evaluate the mode of fracture and the time needed for initial penetration through the crown. Methods: This study involved the design and testing of 60 zirconia crowns, divided into three groups (20 crowns each) to compare different structural designs. Group 1 (Control) used a conventional full zirconia crown. Group 2 (Novel Design) featured a zirconia crown with an impermeable ceramic-filled opening. Group 3 (Modified Novel Design) included a zirconia crown with a permeable composite-filled opening. Each crown was designed using CAD/CAM technology with digital and cone beam CT scans to locate the pulp chamber accurately. The crowns were tested in two experiments. Experiment (A): Ten crowns from each group underwent a fracture test. Experiment (B): Ten crowns per group underwent an access cavity penetration followed by a fracture test. Key variables assessed included fracture strength, penetration time, and failure mode for each crown design, both before and after access opening. Data were analyzed using SPSS, with a significance threshold of p < 0.05. Results: The highest value of fracture strength before initial penetration was recorded for zirconia porcelain crowns (760.2 ± 25.2 MPa), while the lowest value was recorded for zirconia composite crowns (652.4 ± 25.9 MPa). The least time for initial penetration was recorded for zirconia composite crowns (2.5 ± 0.8 s). The difference in failure mode among the crowns was significant (p < 0.05) before initial penetration. All zirconia composite crowns showed crown fracture and core cracked, while all full zirconia crowns showed crown fracture only. The difference in failure mode before and after penetration was only significant for zirconia composite crowns. Conclusions: The modified novel-design crown (zirconia composite) could be an excellent choice when placing new prosthesis, since the crown provides easy access and a predictable guide to the root canal system and has good resistance to fracture before and after performing root canal therapy (RCT).

How Did the COVID-19 Pandemic Affect Emergency Dental Trauma Settings in Permanent Dentition? A Retrospective Study.

Background: The purpose of this study was to examine how the COVID-19 pandemic influenced the patterns, distribution, and circumstances of dental trauma (DT) cases at a German cranio-maxillofacial trauma center. Materials and Methods: This retrospective analysis compared DT cases from the PreCovid (PC) period (February 2019-January 2020) with those from the IntraCovid (IC) period (February 2020-January 2021). It included an examination of baseline characteristics, types of DT, circumstances leading to DT, and the treatment approaches applied. Results: In the IC period, there was an increase in the number of DT, a significant increase in uncomplicated crown fractures, crown-root fractures, subluxations, avulsions, alveolar fractures, combined tooth fractures and dislocations, and concomitant soft tissue injuries. There were no differences regarding the location of DT. During the IC period there was a significant reduction in sports accidents, road traffic accidents, interpersonal violence, and alcohol-related DT. Simultaneously, there was a marked increase in falls, syncopal episodes, home accidents, and DT incidents occurring on weekdays. Furthermore, during the IC period, the number of cases of DT increased in the morning and decreased at nighttime. Conclusions: The COVID-19 pandemic significantly affected the types of DT, the treatment approaches, and the circumstances under which DT occurred. Investigating these impacts can help to predict the effects of a future pandemic on DT and/or maxillofacial trauma and possibly reduce these effects through establishing appropriate preventive measures.

Zirconia in fixed prosthodontics: a review ofthe literature.

The purpose of this narrative review is to organize information and knowledge about the properties of the clinical evidence of zirconia-applied dental restorations and to provide relevant information to establish application methods to obtain long-term clinical prognosis of zirconia-applied dental prostheses. From PubMed and manual searches, found "zirconia," "crown," "survival," and "success" keywords were searched. Case reports, case series, reviews, abstracts, in vitro studies, and observational studies were excluded. Additionally, implant superstructures not supported by the periodontal ligament and partially covered crowns were excluded. A total of 42 studies were identified. According to the studies in this review, the most common complication of porcelain-layered zirconia restorations is porcelain fracture, but the long-term prognosis is stable. However, complications of monolithic zirconia restorations include crown fractures and fractures of the abutment tooth and root, and long-term clinical evidence is not available yet. Additionally, bruxism can be a complication factor with both types of restorations, so it is important to carefully examine the oral habits, including bruxism, before treatment. Therefore, the success of zirconia-based restorations in clinical practice requires a careful approach in addition to accurate knowledge of the zirconia material and identification of applicable cases.

Clinical management of an orofacial trauma including multiple avulsions, lateral luxation, and alveolar fracture: A case report with a seven-year follow-up

The occurrence of different types of trauma concomitantly can complicate the establishment of the most appropriate treatment. This report describes the clinical management of orofacial trauma including multiple avulsions, lateral luxation, alveolar fracture, and their sequelae after 7 years of follow-up. A 19-year-old woman presented to emergency care 4 hours after an accidental fall that resulted in the avulsion of teeth #8, #9, and #25; a complicated crown fracture and lateral luxation of tooth #7; an uncomplicated crown fracture of tooth #10; and a fracture of the maxillary alveolar bone. Only teeth #8 and #9 were located by the patient. The immediate treatment included surgical reduction and extrusion of the lateral luxation, delayed replantation of the avulsed central incisors, nonrigid splint stabilization, and suturing of gingival lacerations. Subsequent visits involved removal of the splint, root canal treatment of the maxillary incisors, implant placement to replace the avulsed mandibular incisor, and esthetic rehabilitation with composite resin. At the 5-year follow-up, cone beam computed tomography revealed advanced surface root resorption in the replanted incisors. At the 7-year follow-up, an aggravation of inflammatory resorption in the replanted incisors was observed. This report demonstrates that adequate knowledge of trauma management by clinicians is essential for the effective management of more complex cases. It also highlights the importance of long-term follow-up in cases of avulsion and replantation due to potential long-term sequelae.

Effect of Pulp Chamber Access, Instrumentation, Obturation, and Restoration on the Fracture Resistance of Endodontically Treated Canine Teeth in Dogs.

Veterinary studies documenting the effect of endodontic treatment on tooth fracture resistance are scarce. The objective of this ex vivo study was to evaluate the effects of mesial access preparation and restoration, as well as pulp chamber access, instrumentation, obturation, and restoration, on the fracture resistance and characteristics of canine teeth in dogs. Sixty-five dog canine teeth were divided into 4 groups: 1. Standard endodontic treatment through a mesial access only; 2. Treatment as per group 1, adding an incisal access, instrumentation and obturation of the pulp chamber, and restoration of the access; 3. Treatment as per group 2, without pulp chamber obturation or restoration of the incisal access; and 4. Untreated teeth. The fracture resistance and characteristics of each group were documented using axial compression testing, angled 45° disto-occlusal to the long axis of the crown. The maximum force prior to fracture in groups 1, 3, and 4 were not statistically different, demonstrating that restored mesial and incisal accesses with pulp chamber instrumentation did not statistically affect fracture resistance. However, obturated and restored group 2 teeth demonstrated decreased fracture resistance compared to all other groups (P < .001). Additionally, 26.7% of group 1 teeth sustained complicated crown fractures, while 100% of group 2 teeth fractured within the obturation or restorative materials, preventing pulp exposure in these cases. Although the cause and clinical importance of decreased tooth fracture resistance following pulp chamber obturation and restoration remains unknown, it may provide protective value for maintaining a coronal seal in the event of tooth fracture.

Treatment Modalities of Uncomplicated Crown Fracture in Anterior Maxillary Permanent Teeth: A Systematic Review.

Several treatment modalities have been used to restore crown fractures in case of uncomplicated crown fractures. Although many treatment modalities have been reported, there is no consensus on which one has the best results in terms of success and durability. This systematic review of treatment modalities in uncomplicated crown fractures aims to provide the most common and successful treatment modality for each patient's unique needs, balancing conservation, aesthetics, and long-term durability. Three electronic databases (PubMed, Scopus, and Google Scholar) were searched for articles regarding treatment modalities in uncomplicated crown fractures in anterior maxillary teeth. Following the application of the inclusion and exclusion criteria, 10 case reports, four case series, and two retrospective studies were selected for the review. These studies reported on fragment reattachment, direct composite resin, and veneers for the management of uncomplicated crown fractures. Fragment reattachment was the most preferred treatment modality, with milk, water, or sterile saline used as storage mediums. Direct composite restoration was preferred for missing or bad-shaped fragments or longevity. Veneers were given for aesthetic consideration and fracture resistance when the crown structure was majorly affected by the fracture. Fragment reattachment was favored in 63% of the articles included in the review followed by direct composite restoration in 26% of the articles. Venners were used in about 11% of the articles. Composites depicted a higher survival rate and a better outcome than fragment reattachment. Follow-up periods ranged from 1 week to 4 years, and all articles successfully re-established function and aesthetics, except for one tooth that required root canal treatment. Fragment reattachment, direct composite restoration, and veneers are successful treatment modalities in uncomplicated crown fractures of anterior teeth. The choice of treatment depends on various factors like availability of fragments, age, and financial condition of the patient. PROSPERO Registration ID: CRD42020153091.

Electrosurgical Adjunct for Soft Tissue Management of the Paediatric Dental Trauma Patient

The interface between dental restorations and the neighbouring soft tissue is of key significance for restorative success and longevity. Trauma-related enamel–dentine fractures are frequently present with the restorative challenge of subgingival margins and little remaining tooth structure. This report looks at two paediatric dental trauma patients with extensive crown fractures resulting in subgingival margins, which posed a poor long-term tooth survival. Electrosurgery was used before definitive composite restorations to allow for supragingival margins and access. Each patient attended the Child Dental Health Department at the University of Manchester Dental Hospital for assessment and treatment provision. CPD/Clinical Relevance: This article identifies electrosurgery as an increasingly useful adjunct to restorative management of traumatized permanent incisor teeth in paediatric patients.

Tooth fragment reattachment using cyanoacrylate tissue adhesive and flowable composite: An in vitro study

ABSTRACT Aim: Crown fractures in anterior teeth represent 18%–22% of dental hard tissue injuries. Immediate reattachment of the fragment using composite resin is the preferred treatment option. However, the reattached fragments are prone to fracture. The use of topical cyanoacrylate tissue adhesive has been reported for managing painful fractured molar teeth and maxillary incisors. Rural population of India does not have access to basic health care; hence, over-the-counter availability of cyanoacrylate may prove beneficial for reattaching the tooth fragment until a patient receives professional care. The present study aimed to evaluate and compare the methods of fractured fragment reattachment using isoamyl 2-cyanoacrylate tissue adhesive and flowable composite. Methods: Eighty intact human permanent maxillary central incisors were randomly divided into four groups (n = 20). Except for the control Group D, other teeth were cut through the middle third of the crown horizontally. Fragments were reattached using flowable composite in Group A, cyanoacrylate tissue adhesive in Group B, and in Group C fragments were attached using cyanoacrylate tissue adhesive, and filling flowable composite circumferentially in chamfer placed along the fracture line. Fracture resistance was tested using a universal testing machine by applying load to each tooth perpendicular to the line of reattachment from labial to lingual direction. The force required to fracture the tooth was recorded in Newtons, and data were statistically analyzed. Results: The highest fracture resistance was exhibited by Group D, followed by Group A, Group C, and Group B, respectively. There was no statistically significant difference between Groups A and C. Conclusion: Composite remains most efficacious in reattaching fractured fragments to the tooth. However, the use of isoamyl 2-cyanoacrylate followed by composite restoration in chamfer offers comparable bonding. The experimental over-the-counter available isoamyl 2-cyanoacrylate may be useful for reattaching uncomplicated fractured teeth when emergency dental care is inaccessible, and needs to be clinically and esthetically evaluated by a professional. However, this in vitro experiment needs to be evaluated clinically for long-term bond strength and under various intraoral forces.

Treatment of Complicated Crown Fracture with Cvek Amputation

Treatment of Complicated Crown Fracture with Cvek Amputation

Treatment Options For Complicated Crown Fractures In Permanent Teeth

Treatment Options For Complicated Crown Fractures In Permanent Teeth

Fiber Reinforced Aestetic Resin Restoration of Trauvma-caused Crown Fracture

Fiber Reinforced Aestetic Resin Restoration of Trauvma-caused Crown Fracture

Management of complicated crown fracture in maxillary incisor using fragment reattachment - 5-year follow-up

Complicated crown-root fractures of maxillary incisors are a relatively common occurrence in cases of trauma to the facial region. Patients with such fractures are in acute pain and usually require emergency care on their first clinical visit. Pain management and restoration of function, esthetics, and phonetics should be the prime objective in handling such patients. The reattachment of fractured tooth fragments is a relatively simple procedure that provides natural esthetics and conservation of tooth structure. This case report describes such a reattachment procedure in a complicated crown-root fracture and its success at 5 years of follow-up.

Reattachment of Fractured Tooth Segment in Minimally Invasive Way - A Case Report

Dental trauma frequently results in coronal fractures of the front teeth. Root canal therapy followed by reattaching the fractured segment with fiber post reinforcement is a viable alternative in cases of complex fractures where the fractured segment is present and there is close approximation of the segment to the intact tooth. Reattaching a fractured piece is a quicker, less involved process that offers immediate relief, better aesthetics, and function restoration. The present case report is of a 11-year-old boy with an uncomplicated crown fracture of permanent maxillary right central incisor and a palatal uncomplicated crown–root fracture of his permanent maxillary left central incisor . The fractured fragment was reattached using nano-filled dual-cure composite resin and tooth restored with composite resin. The fragment showed opaque discoloration that reduced over time but still persisted after 1 year. During the follow-up period, no unfavorable radiographic changes were seen. The prognosis of the teeth was favorable with good esthetic results. Keywords: Fragment reattachment, Fragment rehydration, Periodontal health, Root fracture, Uncomplicated crown.

Complicated Crown Fracture and Reattachment: Case Report

Complicated Crown Fracture and Reattachment: Case Report

Effect of temperature on rehydration and fracture resistance of reattached tooth fragments after crown fracture: An in vitro study.

Uncomplicated crown fractures of maxillary anterior teeth are common dental injuries, and the bonding of fractured fragments is recommended for management. Rehydration of fragments improves bonding and fracture resistance. Therefore, the aim of this study was to compare the fracture resistance of the reattached tooth fragment of the incisor crown after rehydration using either a steamer or a humidifier. Bovine teeth were used as a model. Fractured fragments were divided into three groups: Group I (no rehydration), Group II (rehydration by humidifier), and Group III (rehydration by steamer). Fragments were reattached using a standard bonding protocol. Fracture resistance was tested using a universal testing machine. Statistical analysis was performed using analysis of variance and Chi-square tests. The force required to fracture the reattached fragments was significantly higher in Group II (humidifier) compared to Group I (no rehydration) (P = 0.005). Group III (steamer) had a force value similar to Group I, indicating no significant improvement in fracture resistance with steamer rehydration. The temperature inside the steam-based chamber reached an average of 95.7°C with 95% humidity, whereas the conventional humidification chamber had an average temperature of 39.2°C and 84% humidity. Within the limitations of the present study, the rehydration protocol using a steam-based chamber was found to have a significantly lower force required to fracture the reattached fragments as compared to humidifier-based chamber. This was not significantly different from the fragments which were reattached without rehydration.