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Case Study
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Restorative Aspects in Crown Fractures

A Case Report

Learning Objectives:

This case study shows some frequent complications that occur following dental trauma, as well as various provisional and permanent treatment options for the restoration of coronal fractures. Upon reviewing this case study, the reader should:

  • Have an understanding of the various classifications of crown fractures
  • Demonstrate an awareness of the hard and soft tissue concerns associated with traumatic injuries
  • Be able to explain the various treatment modalities available for the treatment of traumatic injuries

Crown fractures are the most common form of traumatic dental injuries encountered in permanent dentition. Restorative treatment modalities incorporate adhesive materials to effectively maintain function and aesthetics. While uncomplicated injuries of the enamel and/or dentin can be treated solely with adhesive procedures, complicated trauma that involves pulp exposure requires the incorporation of a multidisciplinary treatment approach. This article discusses the application of provisional and permanent restorative options for the treatment of complications following traumatic injuries.

Stabilization, improvement, or reestablishment of function and aesthetics in traumatized teeth (and their periodontal support) remains a challenging endeavor, particularly when restorative procedures must be performed in emergency situations, or within a limited period following the trauma. Numerous lesions can occur as a result of trauma that involves the hard tissue or -- in advanced cases -- the pulp, periodontal ligament, and bone. Provisional and permanent treatment planning is dependent upon the extent and severity of the dental and periodontal lesions. The long-term prognosis of traumatized tissues requires restoration of functional integrity, tooth vitality, and prevention of root resorption. This article discusses the more frequent complications following traumatic injuries, as well as various provisional and permanent treatment modalities for treatment of coronal fractures.

Therapeutic difficulties caused by mutilated anterior teeth and traumatic loss, as well as the rising socioeconomic expense of dental trauma, reinforce the need to increase clinicians' knowledge of emergency primary dental care and the multidisciplinary approach in related restorative procedures. These restorative procedures provide predictable and functional aesthetic results that will subsequently enhance patient satisfaction, while improving the clinician's ability to provide optimum service and support.

*Senior Lecturer, Department of Cariology, Endodontics, and Pediatric Dentistry, University of Geneva, Geneva, Switzerland

Related Reading:

  1. Andreasen JO, Andreasen FM. Textbook and Color Atlas of Traumatic Injuries of the Teeth. 3rd ed. Copenhagen, Denmark: Munksgaard Publishers, 1993.        
  2. Andreasen FM, Noren JB, Andreasen VO, et al. Long-term survival of fragment bonding in the treatment of fractured crowns: A multicenter clinical study. Quint Int 1995;26(10):660-681.     
  3. Andreasen FM. Pulpal healing after luxation and root fracture in the permanent dentition. [thesis] Copenhagen, Denmark: University of Copenhagen; 1995.   
  4. Ravn JJ. Follow-up study of permanent incisors with enamel cracks as a result of acute trauma. Scand J Dent Res 1981;89:117-123.
  5. Ravn JJ. Follow-up study of permanent incisors with enamel fractures as a result of an acute trauma. Scand J Dent Res 1981;89(3):213-217.          
  6. Ravn JJ. Follow-up study of permanent incisors with enamel-dentin fractures as a result of acute trauma. Scand J Dent Res 1981;89(5):355-365.         
  7. Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Traumatic dental injuries: A manual. Copenhagen, Denmark: Munksgaard Publishers, 1999.      
  8. Andreasen FM, Steinhardt U, Bille M, Munksgaard EC. Bonding of enamel-dentin crown fragments after crown fractures. An experimental study using bonding agents. Endod Dent Traumatol 1993;9(3):111-114.          
  9. Farik B, Munksgaard EC, Kreiborg S, Andreasen JO. Adhesive bonding of fragmented anterior teeth. Endod Dent Traumatol 1998;14(3):119-123.
  10. Farik B, Munksgaard EC. Fracture strength of intact and fragment-bonded teeth at various velocities of the applied force. Eur J Oral Sci 1999;107(1):70-73.      
  11. Dietschi D, Krejci I. Traitements chimiques des dyschromies dentaires. RŽalitŽs Cliniques 1999;10:7-24.           
  12. Dietschi D. Free-hand composite restorations: A key to anterior aesthetics. Pract Periodont Aesthet Dent 1995;7(7):15-25.        
  13. Dietschi D. Free-hand bonding in the esthetic treatment of anterior teeth: Creating the illusion. J Esthet Dent 1997;9:156-164.         
  14. Diestchi D, Dietschi JM. Current developments in composite materials and techniques. Pract Periodont Aesthet Dent 1996;8(7):603-613.      
  15. Fahl N Jr. Optimizing the esthetics of Class IV restorations with composite resins. J Can Dent Assoc 1997;63(2):108-115.  
  16. Portalier L. Diagnostic use of composite in anterior aesthetics. Pract Periodont Aesthet Dent 1996;8(7):643-652.    
  17. Vanini L. Light and color in anterior composite restorations. Pract Periodont Aesthet Dent 1996;8(7):673-682.    
  18. Feilzer AJ, de Gee AJ, Davidson CL. Setting stress in composite resin in relation to configuration of the restoration. J Dent Res 1987;66:1636-1639. 
  19. Krejci I, Dietschi D. Amalgam and adhesive restorations - Some aspects on economy and quality of life. In: Novakova V. Amalgam and Health - New Perspectives on Risks. Swedish Council for Planning Coordination of Research. Stockholm, Sweden; 1999: 217-223.        
  20. Andreasen JO, Pedersen BV. Prognosis of luxated permanent teeth - The development of pulp necrosis. Endod Dent Traumatol 1985;1(6):207-220.  
  21. Dietschi D, Schatz JP. Current restorative modalities for young patients with missing anterior teeth. Quint Int 1997;28(4):231-240.  
  22. Zitzmann NU, Marinello CP. Anterior single-tooth replacement: Clinical examination and treatment planning. Pract Periodont Aesthet Dent 1999;11(7):847-858.  
  23. Dietschi D. Indications and potential of bonded metal-ceramic fixed partial dentures. Pract Periodont Aesthet Dent 2000;12(1):51-58.        
  24. Andreasen JO, Ravn JJ. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg 1972;1:235-239.
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