Fractured Maxillary Incisor Research Articles

Management of Severely-Intruded and Fractured Maxillary Incisor

Management of Severely-Intruded and Fractured Maxillary Incisor

Survival evaluation of surgical extrusion for the management of complicated crown-root fractured maxillary incisors: A clinical study.

This study aimed to clinically evaluate the survivability of surgically extruded teeth, to assess the success rate and predictable factors pertaining to alterations in both hard and soft tissues adjacent to extruded teeth. A total of 46 complicated crown-root fractured maxillary central and lateral incisors with >75% tooth structure loss relatively due to trauma were included. Preoperative clinical and radiographic variables were recorded. Single operator performed endodontic treatment before surgical extrusion. Patients were recalled for review at 6, 12, 18, 24 and 36 months. Survivability was assessed using Kaplan-Meier survival analysis. With a mean follow-up of 2.8 years, survival rate was 95.7%. Mobility observed in only two cases. The crown-root ratio was favourable (1:2) in all the cases except for five teeth. Only two teeth displayed non-progressive root resorption. Survival of surgically extruded teeth relies on significant predictors like favourability of CRR and implementation of atraumatic extrusion.

Clinical evaluation of corono-radicular restorative design with fibre post restoration for fractured endodontically treated maxillary incisors: A randomised control trial

ABSTRACT Aim: The primary aim was to evaluate and compare the survivability of corono-radicular direct composite (CRDC) restoration and fiber-reinforced composite post (FRC) followed by coronal restoration for fractured root canal-treated maxillary incisors with a tooth structure loss of 50%–70%. Methods: A total of 56 teeth from 49 patients with fractured maxillary central and/or lateral incisors due to trauma were recruited for the study. The teeth were randomly allocated to two groups randomly by lot method. The two treatment groups were as follows: Group I – CRDC and Group II – FRC followed by coronal restoration. The postoperative review was performed at 3-, 12-, 18-, and 24-month period using intraoral periapical radiographs and clinical photographs. The Patient Satisfaction Questionnaire was administered during 24-month review visit. Kaplan–Meier survival analysis was used to assess the longevity of the restorations. Results: There was no significant difference (P > 0.05) in the survivability of the restorations among the two treatment groups. The mean survival period for CRDC was 24 months and FRC followed by coronal restoration was 23.74 months. The patient’s satisfaction assessed using the questionnaire was higher in CRDC (100%) than FRC followed by coronal restoration (81.5%). Conclusion: Within the limit of the present study, both CRDC and FRC followed by coronal restoration were equally effective in the management of fractured maxillary incisors with 50%–70% tooth structure loss.

Managing fractured Maxillary incisor using Vanini’s stratification technique: Right way of achieving aesthetics

Tooth fractures are fairly common these days and cosmetic rehabilitation is vitalif appropriate layering methods are incorporated. There are various techniques for managing fractured anterior teeth and it is always important to consider the natural aesthetic principles before selecting the technique. Here we have incorporated theVanini’s stratification technique for composite layering. Keywords: Elli's class Ⅱ fracture, Vanini’s Stratification Technique, Composite Layering.

Surgical extrusion of immature permanent tooth with crown-root fractures: a case report with 36-month follow up

A 8-year-old patient presented with a crown-root fracture of the maxillary right central incisor with an oblique subgingival fracture line. A multidisciplinary treatment approach including endodontic treatment, surgical extraction and intraalveolar repositioning was used to gain sufficient crown length of the fractured maxillary incisor. The coronally repositioned maxillary right central incisor was stabilized by a resin wire splint. Apexification using MTA was performed. Resin core and direct resin restoration(Cl IV) on fractured teeth was built up. Clinical and radiographic follow-up of the maxillary right central incisor after 36 months showed no signs of root resorption or pathology and acceptable aesthetics and functions were maintained. Surgical extrusion can be considered as a good treatment modality for young patients.

Management of fractured maxillary incisor with biodentine, everstick glass fiber as post and composite resin

The most common type of dental trauma occur in the maxillary incisor region and could cause tooth fractures. Tooth fracture involving the crown and root may need special emphasis regarding endodontic treatment. Many alternative approaches have been suggested, with the aim of developing a one-step procedure for the completion of the endodontic treatment. One of these alternatives, Biodentine, has been introduced as a dentin substitute. The endodontically treated teeth are often restored by using a post and core. The use of everStick glass fiber as post offers a special feature having glass fibers to be flexible but does not fray from within the matrix when it adapts to a surface. The aim of this article is to show the management of fractured maxillary incisor involving crown and root with Biodentine, everStick glass fiber as post and composite resin followed by fixed prosthesis in order to rehabilitate the maxillary incisor region.

Reattachment of fractured maxillary incisors using fiber-reinforced post: Two case reports

The reattachment of the crown fragment to a fractured tooth is a conservative treatment that should be considered for young patients with crown-root fractures to the maxillary incisors if the subgingival fracture can be exposed to provide isolation. Gingivectomy, the surgical or orthodontic extrusion of the apical fragment is necessary to expose the subgingival fracture. This report demonstrates the treatment of two cases with the combination of gingivectomy or resective osseous surgery, reattachment of coronal fracture and fiber-reinforced polymer posts and shows three years long term follow-up. Subgingivally extended crown-root fractures of maxillary incisors were restored with a combination of chemically cured resin material, light cured resin material and polyethylene fiber. Within the limitations of this case report, it was demonstrated that reattachment of tooth fragments can successfully benefit periodontal health, aesthetic needs and normal functioning after three years.

Fracture resistance of composite resin restorations and porcelain veneers in relation to residual tooth structure in fractured incisors

The aim of the present study was to investigate whether there is a direct correlation between the amount of residual tooth structure in a fractured maxillary incisor and the fracture resistance of composite resin restorations or porcelain veneers after cyclic loading. Sixty human-extracted maxillary central and lateral incisors were mounted in an acrylic block with the coronal aspect of the tooth protruding from the block surface. The teeth were assigned to two groups: 2-mm incisal fracture and 4-mm incisal fracture. Then, the teeth were further divided into two different restoration subgroups, porcelain laminate veneer and composite resin restoration, therefore obtaining four groups for the study (n=15). The specimens were subjected to 1000 cycles of thermocycling and were mechanically tested with a custom-designed cyclic loading apparatus for 2×106 cycles or until they failed. The specimens that survived the cyclic loading were loaded on the incisal edge along the long axis of the tooth with a flat stainless steel applicator until they fractured using a universal testing machine to measure the failure load. Two-way anova was used to assess the significance of restoration, amount of fracture, and interaction effect (α=0.05). During the cyclic loading, for the composite resin group, two specimens with 2-mm fracture and three specimens with 4-mm fracture failed. For the porcelain veneer group, two specimens with 2-mm fracture and one specimen with 4-mm fracture failed. The 2-way anova did not show statistical significance for restoration (P=0.584), amount of fracture (P=0.357), or interaction effect (P=0.212). A composite resin restoration and a porcelain veneer could perform similarly for replacing a fractured incisor edge up to 4mm. Other factors such as esthetic and/or cost would be considerations to indicate one treatment over the other.

Biomechanical behaviour of a fractured maxillary incisor restored with direct composite resin only or with different post systems

To compare stress distribution between a fractured maxillary central incisor restored with direct composite resin only (CR) or associated with different post materials, using finite element analysis. A three-dimensional model of a sound maxillary central incisor and supporting structures was constructed, using data from the dental literature. Changes were made in the crown region to create a tooth with a restored crown fracture. A composite resin restoration only and restorations associated with different tapered post systems (glass fibre, carbon fibre, titanium and zirconia ceramic) were also evaluated, resulting in six experimental models. A static chewing pressure of 2.16Nmm(-2) was applied to two areas of the palatal surface of the tooth. Stress distribution was analysed under a general condition and in the structures of the models separately. The maximum stresses were concentrated as follows: at the cemento-enamel junction in the model with a sound maxillary central incisor, restored with CR and with a composite resin restoration associated with fibre posts; in the enamel at the post-enamel interface on the palatal surface of the model with a titanium post; and in the post of the model with zirconia ceramic post. None of the restorations evaluated was able to recover the stress distribution of the sound tooth. The models restored with composite resin associated with a glass or carbon fibre post had similar stress distributions to that of the model restored with CR. The different post materials were shown to have a substantial influence on stress distribution, with less stress concentration when fibre posts were used.

Replantation of three avulsed permanent incisors with complicated crown fractures

To report a rare case of multiple avulsions of permanent teeth associated with complicated crown fractures. The case describes a 3-year follow-up of the treatment of three avulsed maxillary incisors with complicated crown fractures. The teeth were replanted after an extra-oral time of 90 min (extra-oral dry time 6 min). After root canal treatment, the fractured maxillary incisors were restored with a layered hybrid composite material to re-establish aesthetics and function. Follow-up visits showed signs of replacement resorption affecting the maxillary central incisors but only minor signs of root resorption on the maxillary right lateral incisor. These findings were supported by digital volume tomography, which was performed 18 and 36 months post-trauma in order to assess extent, severity and progression of root resorption more accurately. *Healing of avulsed teeth depends on the degree of periodontal ligament (PDL) damage. *Digital volume tomography might improve diagnostics of root resorption.

A T.E.M. stereological analysis of blood vessels and nerves in marmoset periodontal ligament following endodontics and magnetic incisor extrusion.

Maxillary incisor fracture is a common dental injury. It is frequently treated by endodontic therapy, orthodontic extrusion, and a retention period. The aim of the study was to mimic this regime and stereologically quantify the vascular and neural reconstitution of the periodontal ligament (PDL). Ten marmosets (Callithrix jacchus) had the right maxillary incisor crown removed, root canal treatment, and magnetic incisor root extrusion of 1.2 mm. After incisor retention for 9 weeks, the animals were perfusion fixed for electron microscopy. The incisor PDL was sectioned at 250 micron intervals from the cervical to apical region and recorded for stereological evaluation. Further evaluations were conducted with a two-way analysis of covariance using program 3V of the BMDP-81 statistical software package. The total luminal PDL vascular volume was statistically unchanged. An increased occurred in the mean number of venous capillaries from 0.07 +/- 0.3 to 0.17 +/- 0.3 per 560 microns 2 of PDL (P < 0.05). Vessel wall and luminal volume of post-capillary-sized venules decreased from 1.64 to 1.03 per cent, and 5.32 to 3.04 per cent (P < 0.05), respectively. Mean luminal and abluminal diameters for post-capillary-sized venules were reduced (P < 0.05). Myelinated and unmyelinated axons showed no significant change in volume (Vv), length (Lv), or surface (Sv) densities. Axon number/unit, PDL area, and mean diameters demonstrated no statistical differences. Since the PDL demonstrated almost complete morphological re-establishment of the microvascular and axon systems, it is considered that this clinical treatment is a justifiable rationale.

An evaluation of factors and craniofacial characteristics which predispose to maxillary incisor fracture

An evaluation of factors and craniofacial characteristics which predispose to maxillary incisor fracture

An individual mold and resin restoration for the fractured angle of incisors

The use of an individual mold for the acid-etched enamel technique for fractured maxillary incisors may seem complex. However, the technique assures accurate morphology of the restoration and guarantees good polymerization, less discoloration, and less abrasion, and it saves time in finishing.