Fractured Incisors Research Articles

Research on the cone-beam CT of the fracture morphology and location of a single oblique complicated crown-root fracture of maxillary incisors

Objective: To study the morphological pattern of single oblique complex crown fracture and its relative location to periodontal hard tissues from a three-dimensional perspective by using cone-beam CT, which provides a more intuitive and comprehensive understanding for the pathological features and rules of single oblique complex crown fracture. Methods: Primary cone-beam CT images of 56 maxillary permanent anterior teeth with oblique complex crown root fractures were collected from the Department of Integrated Emergency Dental Care, Capital Medical University School of Stomatology during January 2015 to January 2019. Fracture pattern, fracture angle, fracture depth, fracture width, and the relative location of the fracture line to the crest of the adjacent alveolar ridge were retrospectively analyzed. Independent samples t-test was used to compare the differences in angle, depth and width of fractures between sexes and tooth locations, as well as the pre-and post-fracture crown-to-root ratios between different tooth locations. Then the affected teeth were divided into juvenile group (≤18 years), young group (19-34 years) and middle-aged and elderly group (≥35 years). One-way ANOVA was applied to compare the differences in angle, depth and width of fracture between age groups, and Fisher exact test to compare the differences in fracture pattern of the teeth and the relative position of the fracture line to the crest of the adjacent alveolar ridge. Results: There were 35 males and 21 females in 56 patients, aged (28.2±13.2) years. Among the 56 affected teeth, forty-six were maxillary central incisors and 10 were lateral incisors. According to the patients' age and growing stage, they could be divided into the juvenile group (19 cases), the young group (14 cases), and the middle-aged and elderly group (23 cases). Forty-six (82%) affected teeth had an S-shaped fracture pattern, and ten (18%) had a diagonal pattern, in which the fracture angle of the S-shaped fracture line (47.85°±10.02°) was significantly greater than that of the diagonal line (28.30°±8.07°) (P<0.001). The fracture nadir was flush with or below the top of the alveolar crest in 98% (55/56) of cases. The fracture depth was significantly greater in the juvenile group [(1.75±0.73) mm] than in the young group [(1.21±0.68) mm](P=0.042) and in the middle-aged and elderly group [(1.12±0.90) mm] (P=0.001). The width of fractures among 56 patients was (4.75±1.44) mm, which had no statistically significant differences between different age, sex and tooth location groups (P>0.05). There were no statistically significant differences in the crown-to-root ratios after fracture of maxillary central incisors (1.18±0.13) compared to maxillary lateral incisors (1.14±0.20) (t=1.90, P=0.373). Conclusions: The fracture patterns of single oblique complex crown fracture were mainly S-shaped and oblique alignment; the fracture nadir was mostly located within 2.0 mm below the palatal alveolar crest.

Aesthetic Rehabilitation of Anterior Fractured Teeth with Partial Veneer: A Case Report

A variety of approaches can be employed to restore dentinal enamel fracture such as reattachment of the tooth fragment, direct composite restorations and indirect veneers. Thus, ceramic partial veneers or ceramic fragments are the most suitable option due to the increasing interest in minimally invasive dentistry and their superior optical behavior. They are considered as an innovative ultra-conservative approach that covers only the fractured part of the tooth surface without any preparation. Clinical protocol was however delicate. Bonding procedures must be highly respected and sectional veneer must be positioned carefully and checked regularly.Nowadays, Ceramic partial veneers are becoming a more popular approach but there are still concerns about the fracture strength and the survival rate of such restorations. This following report discusses the case of a patient presenting a fractured incisor that was rehabilitated using a ceramic partial veneer.

Pulp neurovascular plexus response as a result of crown-root horizontal fracture and uncomplicated crown fracture in permanent dentition: a case report

Dental trauma often have severe and complex injuries to the dentoalveolar system. Objective: To report the treatment of crown-root horizontal fracture and uncomplicated crown fracture in permanent dentition. Case report: Child patient attended the dental trauma service 30 days after the fall. On clinical and imaging examination, an uncomplicated crown fracture in the right central incisor and crown-root fracture in the left central incisor was possible to identify (tooth 11 and tooth 21 respectively). The conventional restorative treatment (tooth 11) and repositioning (tooth 21) were performed. The endodontic treatment was performed at 6 months of follow-up (tooth 11). At the new imaging exam, cement neoformation was evidenced between the fragments of the crow-root fracture (tooth 21). After 24 months of follow-up, there was a decrease in periapical lesion (tooth 11), and maintenance of pulp vitality (tooth 21). Conclusion: There is a possibility of maintaining pulp vitality in crown-root fractures and highlights the importance of follow-up in non-complicated fractures.

Unconventional Endodontics for the Aesthetic Rehabilitation of Fractured, Discolored and Rotated Maxillary Central Incisor

Management of traumatic injuries to the teeth is a challenge to the practicing dentist. It has no prescriptive method for occurring, possesses no significant predictable pattern of intensity or extensiveness and occurring at times when dentists are least prepared for it. Ninety-two percent of traumatic injuries results in fracture of maxillary permanent central incisors because of its protrusive and anterior positioning. The young permanent maxillary central incisor root canal chamber is large and tapered. This case report describes the management of Ellis Class III fractured tooth in a young permanent maxillary central incisor by an innovative clinical procedure.&#x0D; Keywords: tooth fracture, cast post core, trauma, metal ceramic

Relevance of Class II interceptive treatments. Synthesis of the valid conventional means of study

The relevance of Class II interceptive therapy is controversial. The objective of this literature review was to note its indications and if a benefit is proven. We carried out a systematic search on PubMed from 1999 to 2019 by keywords on randomized trials. Fourteen articles were selected, mainly grade B or C. The criteria evaluated were dental, skeletal, psychological, aesthetic, as well as cost, duration, incisor fractures, rate of stroke, complexity and treatment need. Overjet is an important criterion for the indication of interceptive treatment, but it is not the only one. The skeletal criterion, assessed mainly by the ANB, is only significant for three articles; the improvement of self-esteem is proven in one article and the interceptive treatment allows an aesthetic improvement (alignment of the maxillary incisors). The overall cost of treatment would be higher for two-step treatment. In only two articles, the authors wonder if the interceptive treatment facilitates future treatment. The rate of compensatory strokes and extractions are widely studied. The main criteria studied are ANB (controversial indicator), incisor fracture rate (trauma) and overjet. Certain non-significant results must be put into perspective with the aim of the studies and the methods used.

Reattachment of Crown in Anterior Fractured Tooth-A Case Report

In dentistry, traumatic injuries are most common in the anterior teeth due to its anatomic position. The various treatment modalities have been used depending on the extent of injury on teeth and supporting structures. Esthetic concerns are the most important challenges in modern dental practice. Adhesive dentistry is an excellent approach regarding esthetics, especially for fractured anterior teeth. This case report describes the successful treatment of reattachment procedure in a 17-year-old male patient presented with a fractured maxillary left central incisor.

Pulpal Response After Fragment Reattachment of Uncomplicated Fractured Incisors

Pulpal Response After Fragment Reattachment of Uncomplicated Fractured Incisors

Effect of chamfer design on load capacity of reattached incisors

ObjectiveThis study aimed to evaluate the effect of different chamfer preparations on the load capacity of reattached fractured incisors under lingual loading. MethodsEighty #8 typodonts were randomly assigned to four groups (n = 20 each). They were sectioned to simulate crown fracture, and reattached with a self-etch adhesive and a resin composite. The preparation for each group was: (1) no chamfer; (2) buccal chamfer; (3) lingual chamfer; and (4) circumferential chamfer. Forty-eight human lower incisors were grouped and prepared similarly (n = 12 each). These teeth were tested for their load capacity under a lingual load on a universal testing machine. Finite element models were used to examine the stresses on the reattached surfaces to help interpret the experimental results. ResultsThe buccal chamfer did not increase the load capacity when compared with the no-chamfer group. Lingual and circumferential chamfers respectively increased the fracture load by 36.9% and 32.3% in typodonts, and 78.5% and 33.3% in human incisors. The increase was statistically significant (p < 0.05). A higher fracture load tended to be accompanied by a larger area of deflected cohesive fracture. Finite element analysis showed that lingual and circumferential chamfers reduced the fracture-causing tensile stress at the lingual margin of the reattachment interface by approximately 70% and 60%, respectively, in human upper incisors. SignificanceIt was the joint design, and not the size of the bond area, that affected the load capacity of reattached incisors. Among the preparations considered, only those with a lingual chamfer could increase the load capacity of reattached incisors under a lingual load.

Restoring a fractured incisor of a teenager with partial veneer

Since trauma is a common incident that adolescents are faced with, the post-traumatic therapeutic solution presents a challenge for the clinicians .This case report demonstrates how a young patient with minimal extended fracture of incisor was rehabilitated with non-invasive adhesive restoration known as partial veneer or chip with Feld spathic porcelain. Those restorations fit into the anatomy and shape of the teeth perfectly and restore only the fractured part which integrates in tissue economy dynamic. Feldspathic porcelain is the material that best reproduces the characteristics of enamel, in terms of surface properties, modulus of elasticity, resistance to fracture and the reproduction of the optical properties of the dental structure, especially at minimal thickness. In this paper we describe the details of the treatment and the final result which was aesthetic and surpass the patient’s expectation.

Fracture of upper incisors: a three-year follow-up of a multidisciplinary approach

ABSTRACT Multiple clinical specialties are usually needed for a successful long-term treatment in buccal cavity. The aim of this article is to report a clinical case of multi-disciplinary rehabilitation of fracture upper incisors without pulp exposure, concerning about endodontics, periodontics and restorative dentistry comments or procedures. A case of a patient reporting trauma that resulted in fracture and substantial loss of hard tissue, in mesial angle of both upper central incisors (11 and 21). In palatal side, fracture extended beyond cingulum up to subgingival region. Periodontal surgery was performed in order to reestablish biological space. Clinical and radiographic assessments demonstrated no need for endodontic treatment, since pulp was vital and non-altered. Preparations for restorative procedures were minimally invasive, followed by composite direct. A three-year follow-up was performed, consisting in re-assessment of clinical and radiographic aspects, re-polishing of the restorations and photographic documentation. No pulp tissue alteration was observed after the follow-up period. Restorative procedures, adjacent tissues and pulp vitality were considered adequate, and the patient was satisfied with the treatment.

Restoration of the fractured permanent incisor in young patients

This article describes the immediate and definitive options for treating a child or young person presenting with a fractured permanent incisor. Furthermore, it considers three common clinical problems that dentists may encounter when restoring these teeth, and provides advice on how to overcome these difficulties. This article also aims to increase the reader's awareness of the importance of providing an optimal restoration for young patients, and the potential short- and long-term consequences of failing restorations. CPD/Clinical Relevance: This article aims to guide the reader through the recommended techniques for restoring fractured permanent incisors in young patients and demonstrate how to manage common clinical challenges, while highlighting the importance of providing an optimal restoration.

Partial Pulpotomy with Mineral Trioxide Aggregate in Permanent Incisors with Complicated Crown Fracture: 5-Year Follow-Up

Traumatic dental injuries are highly prevalent among children. This article describes a case report of a patient who has experienced dental trauma at 8 years old, which has led to enamel-dentine fracture with pulp exposure in the left central incisor and crown-root fracture with pulp exposure in the right central incisor. Partial pulpotomy was performed with the aim of maintaining the neurovascular bundle, thus allowing normal radicular formation. During follow-up 5 years later, teeth were asymptomatic and with no evidence of radiolucent lesions in radiographic examinations. This report demonstrates that traumatic fractures with pulp exposure can be treated effectively by the described technique.

Conservative Approach for Management of Complicated Crown Facture using Tooth Fragment Reattachment Technique

The restoration of a fractured anterior tooth by fragment reattachment is biological, conservative, and the most currently acceptable treatment option. In addition, the advancements in adhesive dentistry, tooth fragment reattachment procedure has become simpler and clinically reliable. This article presents management of two cases of complicated crown fracture of maxillary incisors by reattachment of the fractured tooth segment.

Effect of Casein Phosphopeptide-Amorphous Calcium Phosphate on Fracture Resistance of Reattached Tooth Fragments Using Conventional and Self-Adhesive Bioactive Flowable Composite.

Objectives The present study aimed to investigate the effect of casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) complex and the type of flowable composite (conventional or self-adhesive bioactive) on the fracture resistance of fractured incisors restored through reattachment technique. Materials and Methods In this experimental in vitro study, 60 extracted bovine central mandibular incisors were randomly divided into six groups ( n = 10) according to the reattachment technique. Their incisal edges were cut off to represent an enamel–dentin fracture. The fragment edges were reattached as follows: Group 1—selective etching and bonding followed by conventional flowable composite; Group 2—selective etching and bonding followed by bioactive flowable composite; Group 3 was like Group 2 but without applying bonding; Groups 4, 5, and 6 were similar to Groups 1, 2, and 3, respectively, but both tooth fragments were pretreated with CPP-ACP-containing paste for 3 minutes. Fracture resistance was assessed by a universal testing machine. Statistical Analysis Data were analyzed by SPSS—Statistical Package for the Social Sciences—software using one-way analysis of variance and Tukey post-hoc tests (α= 0.05). Results The highest and lowest fracture resistance was recorded in Groups 5 (15.96 MPa) and Group 6 (1.95 MPa), respectively, being significantly different from the other groups. The mean fracture resistance of Groups 3 and 6 was significantly lower than the other groups ( p < 0.05). However, Groups 1, 2, and 4 showed no difference in fracture resistance. Conclusion Bioactive composite was not superior to conventional composite for fragment reattachment, but using it in self-adhesive mode reduced the fracture strength significantly. Yet, pretreatment with CPP-ACP, followed by application of adhesive, improved the fracture resistance of bioactive composite.

Prevalence and Occlusal Risk Factors for Fractured Incisors among 11-12-Year-Old Children in the Trinidad and Tobago Population.

This cross-sectional survey was carried out to ascertain the prevalence of fractured incisors in 11–12-year-olds. In addition we explored the relationship with overjet, incompetent lips, incisor inclination and to determine if there was any association with ethnicity and gender. All permanent incisors were examined in 672 children comprising 356 females (53.1%) and 315 males (46.9%). The sample comprised 11–12-year-olds in high schools across Trinidad and Tobago. Statistical analysis was undertaken using Chi-square test, independent t-test, and binary logistic regression. The prevalence of fractured incisors was 18.9%. Boys presented with an increased incidence of fractured incisors than girls. 86.3% of dental trauma was untreated. The average overjet of subjects with fractured incisors was 4.2 mm. 18.62% of subjects with fractured incisors had incompetent lips. The most common malocclusion (18.81%) with fractured incisors was class 2 division 1. The Afro-Trinidadian ethnicity had the highest prevalence of fractured incisors (11.0%) when compared to mixed ethnicities, which was statistically significant. Maxillary central incisors were the most commonly injured teeth. Most patients delayed in seeking dental treatment for fractured incisors in our population. Early orthodontic treatment is recommended to help reduce the risk of dental trauma.

Reattachment of a Dehydrated Tooth Fragment Using Retentive Screws

Coronal fracture of the anterior teeth is mainly common among children and adolescents. Though diverse treatment modalities are available, tooth fragment reattachment is generally considered a viable treatment option due to simplicity, natural aesthetics, and functional success. This paper presents a case of a 10.5-year-old female patient with a fractured maxillary central incisor with a dehydrated fragment. The dehydrated fragmented part was reattached with the help of retentive holes using an adhesive bonding agent and a resin composite cement. Follow-up at 15 months showed that the tooth was vital and functional with natural aesthetics.

Home management of crown fractures of two central incisors complicated by exposure of the pulp

Aim: As dental trauma is an unpredictable event, the patient is sometimes unable to receive dental care immediately in case of tooth fracture complicated by exposure to the pulp. It is conceivable that a long wait may favor bacterial contamination that can lead to necrosis of the pulp. The aim of this paper is to present a clinical case in which the pulp has been protected domiciliary to reduce post-traumatic hypersensitivity and the risk of pulpal necrosis. Materials and methods: In the presented clinical case, the nail polish was used as an emergency material for the direct capping of the pulp of two fractured incisors. In thisway itwas possible to protect the pulp and seal the dentinal tubules for 5 days, such it is the time between trauma and therapy. Results: application of the nail polish led to a reduction in hypersensitivity; at 2-year follow-up both teeth were still vital. Conclusions: Based on this experience, it is suggested the possibility to recommend the use of nail polish as a protective material for the pulp and for reducing symptoms in case of complicated and uncomplicated fractures, if the dentist is consulted by telephone and the patient is not in condition to reach it quickly.

Endodontic management of blunderbuss canal with open apex and Ellis Class IV fracture using mineral trioxide aggregate and compo-post

The permanent teeth with open apex, blunderbuss canal, and Ellis Class IV fracture are difficult to treat as a traditional root canal procedure. Apexification is induction of apical closure, the treatment of choice for necrotic teeth with immature or resorbed root. Mineral trioxide aggregate (MTA) has been proposed as a potential material for formation of hard tissue apical barrier. Use of anatomical post results in better prognosis of the present case. This case report presents endodontic management of a fractured maxillary right central incisor with apexification and compo-post to support weak canal and to provide tooth structure. A 21-year-old male patient came to the Department of Conservative Dentistry and Endodontics, Jaipur Dental College and Hospital, Jaipur, with the chief complaint of broken upper front tooth due to accidental fall (6–7 years). Dental history of discontinued endodontic treatment 1-year back was observed. Treatment includes two phases – endodontic phase and re-construction phase followed by full-crown porcelain-fused metal prosthesis. This case report discussed an improved option of application of chairside customized made fiber posts are preferred as they stimulate the root canal anatomy, provides increased retention and adaptation and also esthetics.

Management of a traumatized and luxated maxillary incisor with customized computed-aided design and computer-aided manufacturing zirconia post–core and crown

The incidence of maxillary anteriors being injured during any assault to the facial region is nearly 37% owing to its position in the arch. Treatment planning always depends on the clinical scenario. Coronal fracture of teeth involving the pulp may need conventional endodontic treatment and aesthetic reconstruction. When there is not enough tooth structure to retain a crown, it may often need post–core to retain final post endodontic restoration. Various types and advancements of post-and-core systems have been documented in the literature over the years, with an excellent long-term prognosis. Although the traditional custom cast post-and-core system has been considered to be cumbersome and time-consuming, it has an added advantage of allowing modification in the angle of insertion and the position of the core to obtain optimal aesthetics. This case report presents the successful management with aesthetic rehabilitation of a fractured maxillary central incisor with customized computer-aided design–computer-aided manufacturing zirconia post–core and crown

In vitro Study Comparing Fracture Resistance of Nanocomposites with and without Fiber Reinforcement with Different Cavity Designs Used for Obliquely Fractured Incisal Edge Restoration

The aim of the study is to evaluate fracture resistance of nanocomposites with and without fiber reinforcement with different cavity designs used for obliquely fractured incisal edge restoration. In the present study, 60 sound extracted maxillary central incisors were mounted on autopolymerizable acrylic resin up to the cementoenamel junction, out of which, 10 intact teeth were kept as control (group 1) and the remaining 50 samples were reduced incisally in an oblique manner up to 3 mm. All incisally reduced samples were divided into five groups (n = 10) based on the restoration techniques as follows: group 2 (conventional bevel), group 3 (single central palatal slot on the incisal edge), group 4 (single palatal slot with central 2 mm fiber), group 5 (two palatal slots on the incisal edge with a distance of 0.5 mm to 1 mm between them), and group 6 (two slots on the incisal edge with two 2 mm fibers). All samples were built incrementally with nanocomposites followed by finishing and polishing. All samples including control were then stored in distilled water before their fracture resistance was measured using a universal testing machine. Failure modes were visually examined and the results were subjected to statistical analysis. The mean fracture resistance among the experimental groups was observed, group 4 with single fiber in the central position had the highest (832.68 N) followed by group 3 (490.84 N), group 5 (446.175), and group 2 (270.1359), and the least in group 6 (223.443). The mean fracture resistance of group 4 is comparable to intact teeth, i.e., group 1 (1096.40). The mean of all samples was compared using the one-way Anova test, and it was found that there is statistically significant difference in fracture resistance among groups (p < 0.001**). Fibers certainly have the reinforcing effect and the position of fibers determines their reinforcing effects. A single central slot with fiber (Ribbond) showed maximum fracture resistance almost equivalent to natural teeth. Modifying conventional beveled cavity design with an additional slot in the center also increases the fractural strength of restoration. Nanocomposites reinforced with single fiber in the central palatal slot used for restoring fractured incisors provide strength almost equivalent to natural teeth. In case when the fiber is not available for preparing a single palatal slot also, we can increase the fracture resistance.