A fr a g m e n t of to o th m issing fo r th re e years w as fo u n d in th e p a tie n t’s lo w e r lip. T h e fr a g m e n t w as surg ic ally rem o v ed and c leaned. It w as restored to its original position on th e m axillary left in cis or w ith an acid etch resin te c h n iq u e . A fter th re e m o n th s , th e restoratio n w a s satisfactory.
Restoration of a fractured anterior tooth
Carson Mader, DMD, MSD, Rockville, Md
In recent years, acid etch resin techniques have be come comm on methods of treating fractured an terior teeth. With these techniques, the missing por tion of the tooth is replaced with some type of re storative material. This paper describes an unusual case in which a fractured portion of tooth structure was restored to its original position to produce an esthetic and functional “ restoration.”
A p a tien t w ith a fra c tu re d a n te rio r to o th is u su ally e m o tio n a lly u p set a b o u t his o r h er a p p e a ra n c e , and su ffe rs s o m e d is co m fo rt a s w e ll. Q u ic k r e s to ra tio n o f th e e s th e tic a p p e a ra n ce and r e lie f o f d isco m fo rt fo r th e s e p a tie n ts is o n e o f the m ore ch a llen g in g ta s k s fa cin g th e d e n tist. M a n y te c h n iq u es, in clu d in g th o se using a cid e tc h in g , hav e b ee n d e s c rib e d to tre a t th is p ro b le m .1-11 M o st o f the a rtic le s and te c h n iq u e s reg ard ing the r e s to ra tion o f fra c tu re d a n te rio r te e th d e s c rib e som e p ro ce d u re in w h ich th e m issin g p o rtio n o f to o th is re p la ced w ith so m e ty p e o f re s to ra tiv e m a te ria l. A n un usual c a s e is d e sc rib e d in w h ich th e fr a c tu red p o rtio n o f a to o th w as re sto re d to its origin al p o sitio n .
THE AUTHOR
D
Dr. Mader is form er chief of oral m edicine, S chofield Barracks Dental C linic, Hawaii 96557. Ad dress re questsfor reprints to him at 9 Pebble Ridge Court, Rock ville, Md 20854.
¿mm*“' *0$ \ j
J# \ ~ _--------------MADER
JADA, Vol. 96, January 1978 ■ 113
Fig I ■ P hotograph of an terior teeth shows
Fig
radiograph
Fig 3 ■ Periapical radiograph of m andibular
loss o f tooth stru cture from incisal edge o f left central incisor.
shows fractured p o rtion of too th in so ft tissue o f lip.
2 ■ M andibular
occlusal
an terior teeth show s fractured p o rtion of tooth.
R eport of case A 2 7 -y e a r-o ld w h ite m an ca m e to th e d en tal clin ic co m p lain in g th a t his lo w e r lip ap p ea red to be slo w ly en largin g during th e p a st s e v e ra l d a y s. C lin ic a l e x a m in a tio n re v e a le d a firm , p a in le ss, 1-cm m ass in th e lo w er lip ju s t left o f th e m id line. S e v e ra l m illim eters o f the in cisa l ed ge o f th e m ax illary left ce n tra l in c is o r had b e e n b ro k e n o ff (F ig 1). T h e p a tien t re p o rted th a t th is to o th had b e e n ch ip p ed th re e y e a rs p re v io u sly w hen he w as s tru ck w ith a h o c k e y s tic k . T h e b low a lso cu t his lo w e r lip , and he had b e e n u n a b le to find the m issin g p o rtio n o f to o th a fte r th e a c c id e n t. R ad io g rap h s sh ow ed th e fra c tu re d p o rtio n o f the m ax illary left ce n tra l in c is o r w as em b ed d ed in the lo w e r lip (F ig 2 , 3). T h e to o th fra g m en t w as su rg ica lly rem o v ed fro m th e lip (F ig 4 ), th o ro u g h ly cle a n e d , and sto red in a m o ist gau ze sq u a re w h ile th e su rg ical site w as c lo s e d . T h e fra c tu re d p o rtio n o f th e to o th w as th en retu rn ed to its origin al p o sitio n using a m od ified acid e tc h resin te c h n iq u e sim ila r to th at d e scrib e d by B u o n o c o re and D a v ila 9 (F ig 5). T h r e e m o n th s la te r th e re s to ra tio n w as s a tis fa c to ry b o th fu n ctio n a lly and e s th e tic a lly . T h e to o th resp o n d ed w ithin n orm al lim its to e le c tr ic a l pulp te s ts at b o th the initial and fo llo w -u p v isits.
D i s c u s s io n A v u lsed and fra ctu re d te eth a re co m m o n ly e n co u n te re d in d en tal p ra c tic e . In re c e n t y e a rs , th e re has b e e n a g rea t in c re a se in th e n u m b er o f reim p lan tatio n p ro c e d u re s. C o n s e q u e n tly , m any te e th that o n c e would hav e b ee n lo st h av e again b e co m e fu n ctio n a l. In s e le c te d c a s e s , a cid e tch re sin te c h n iq u e s allow c le a n ly fra c tu re d , large p ie c e s o f to o th stru ctu re to b e re sto re d to th e ir 114 ■ JADA, Vol. 96, January 1978
Fig 4 ■ Fractured po rtion of tooth after it was surgically removed from low er lip.
Fig 5 ■ P hotograph o f anterior teeth after fractured po rtion of too th had been restored to its original position.
origin al p o sitio n . T h e fra c tu re d p o rtio n o f the to o th p ro v id e s, in le ss tim e and w ith less p a in , a m o re e s th e tic and d u ra b le re s to ra tio n th an cou ld be atta in e d by o th e r te c h n iq u e s . T h e re sto re d en a m e l is m o re re s is ta n t to stain and a b ra sio n than a re sin re s to ra tio n ; h o w e v e r, the resin b ond un it ing th e tw o p o rtio n s o f th e fra c tu re d to o th is, o f c o u r s e , s u b je c t to clin ic a l fa ilu re , fo r fu n ctio n a l or e sth e tic re a s o n s . T h is te c h n iq u e a lso a v o id s the gingival p ro b lem s a s s o c ia te d w ith im p e rfe ct cro w n m arg in s. It is c o m m o n k n ow led g e am ong th e g en eral p u blic th a t av u lse d te e th shou ld be sa v e d , k ep t moist-, and ta k e n to th e d en tist a s q u ick ly a s p o ssi-
b le fo r re im p la n ta tio n . I t is h o p ed th a t in th e fu tu re n ew m a te ria ls and te c h n iq u e s w ill b e p e r fe c te d so th a t p a tie n ts w ill a lso b e a b le to b rin g la rg e , c le a n ly fra c tu re d p o rtio n s o f te e th to th e d e n tis t, w h o w ill b e a b le to “ r e s to r e ” th em to th e ir o rig in a l p o sitio n .
Summary A n u n u su al c a s e is d e s c rib e d in w h ich a fra c tu re d p o rtio n o f to o th s tru ctu re w as re m o v ed fro m th e lo w e r lip an d re s to re d to its orig in al p o sitio n w ith a m o d ified a c id -e tc h re sin te c h n iq u e .
I thank Drs. Loren J. W endelburg and Dean A. Hudson fo r th e ir assistance in the c o m pletion o f the surgical and restorative aspects of th is report, as w ell as Prof. Paul Barton, Indiana U niversity School of Dentistry, fo r his assistance in the preparation o f this article. 1. Kopel, H.M., and Beaver, H.A. C om prehensive restorative pro cedures fo r prim ary anteriors. J Dent Child 34:412 Sept 1967.
2. Granville, S., Jr.; Bugg, J.L., Jr.; and C arruth, K.R. Restoration of prim ary incisors w ith acrylic jacket crow ns— one appointm ent procedure. J Dent C hild 33:182 May 1966. 3. Stewart, R.E.; Luke, L.S.; and Pike, A.R. Preformed polycar bonate crow ns fo r the restoration of an te rio r teeth. JADA 88:103 Jan 1974. 4. S taffanou, R.S. R estoration of fractured incisal angles. JADA 84:146 Jan 1972. 5. M ichon, F.J., and Carr, R.F. Repair o f a coronal fra ctu re that involved the pu lp o f a deciduous in cisor: re port of case. JADA 87:1416 Dec 1973. 6. Laswell, H.R.; Welk, D.A.; and Regenos, J.W. A ttachm ent of resin restoration to acid pretreated enamel. JADA 82:558 March 1971. 7. Roberts, M.W., and M offa, J.P. R estoration o f fractured incisal angles w ith an ultraviolet-activated sealant and a com posite resin— a case report. J Dent Child 39:364 Sept 1972. 8. Roberts, M.W., and M offa, J.P. Repair of fractured incisal angles w ith an ultraviolet-light-activated fissure sealant and a com posite resin: tw o-year re port o f 60 cases. JADA 87:888 Oct 1973. 9. Buonocore, M.G., and Davila, J. R estoration of fractured an te rio r teeth w ith ultraviolet-light-polym erized bo nding m aterials: a new technique. JADA 86:1349 June 1973. 10. Bizga, C.A. The fractured an terior to o th : restoration made permanent. JADA 88:823 A pril 1974. 11. Chosack, A., and Eidelman, E. R ehabilitation of a fractured incisor using the pa tient’s natural crow n— case report. J Dent Child 31:19 Jan 1964.
Mader: RESTORATION OF FRACTURED TOOTH . 115
Restoration of a fractured anterior tooth
Carson Mader, DMD, MSD, Rockville, Md
In recent years, acid etch resin techniques have be come comm on methods of treating fractured an terior teeth. With these techniques, the missing por tion of the tooth is replaced with some type of re storative material. This paper describes an unusual case in which a fractured portion of tooth structure was restored to its original position to produce an esthetic and functional “ restoration.”
A p a tien t w ith a fra c tu re d a n te rio r to o th is u su ally e m o tio n a lly u p set a b o u t his o r h er a p p e a ra n c e , and su ffe rs s o m e d is co m fo rt a s w e ll. Q u ic k r e s to ra tio n o f th e e s th e tic a p p e a ra n ce and r e lie f o f d isco m fo rt fo r th e s e p a tie n ts is o n e o f the m ore ch a llen g in g ta s k s fa cin g th e d e n tist. M a n y te c h n iq u es, in clu d in g th o se using a cid e tc h in g , hav e b ee n d e s c rib e d to tre a t th is p ro b le m .1-11 M o st o f the a rtic le s and te c h n iq u e s reg ard ing the r e s to ra tion o f fra c tu re d a n te rio r te e th d e s c rib e som e p ro ce d u re in w h ich th e m issin g p o rtio n o f to o th is re p la ced w ith so m e ty p e o f re s to ra tiv e m a te ria l. A n un usual c a s e is d e sc rib e d in w h ich th e fr a c tu red p o rtio n o f a to o th w as re sto re d to its origin al p o sitio n .
THE AUTHOR
D
Dr. Mader is form er chief of oral m edicine, S chofield Barracks Dental C linic, Hawaii 96557. Ad dress re questsfor reprints to him at 9 Pebble Ridge Court, Rock ville, Md 20854.
¿mm*“' *0$ \ j
J# \ ~ _--------------MADER
JADA, Vol. 96, January 1978 ■ 113
Fig I ■ P hotograph of an terior teeth shows
Fig
radiograph
Fig 3 ■ Periapical radiograph of m andibular
loss o f tooth stru cture from incisal edge o f left central incisor.
shows fractured p o rtion of too th in so ft tissue o f lip.
2 ■ M andibular
occlusal
an terior teeth show s fractured p o rtion of tooth.
R eport of case A 2 7 -y e a r-o ld w h ite m an ca m e to th e d en tal clin ic co m p lain in g th a t his lo w e r lip ap p ea red to be slo w ly en largin g during th e p a st s e v e ra l d a y s. C lin ic a l e x a m in a tio n re v e a le d a firm , p a in le ss, 1-cm m ass in th e lo w er lip ju s t left o f th e m id line. S e v e ra l m illim eters o f the in cisa l ed ge o f th e m ax illary left ce n tra l in c is o r had b e e n b ro k e n o ff (F ig 1). T h e p a tien t re p o rted th a t th is to o th had b e e n ch ip p ed th re e y e a rs p re v io u sly w hen he w as s tru ck w ith a h o c k e y s tic k . T h e b low a lso cu t his lo w e r lip , and he had b e e n u n a b le to find the m issin g p o rtio n o f to o th a fte r th e a c c id e n t. R ad io g rap h s sh ow ed th e fra c tu re d p o rtio n o f the m ax illary left ce n tra l in c is o r w as em b ed d ed in the lo w e r lip (F ig 2 , 3). T h e to o th fra g m en t w as su rg ica lly rem o v ed fro m th e lip (F ig 4 ), th o ro u g h ly cle a n e d , and sto red in a m o ist gau ze sq u a re w h ile th e su rg ical site w as c lo s e d . T h e fra c tu re d p o rtio n o f th e to o th w as th en retu rn ed to its origin al p o sitio n using a m od ified acid e tc h resin te c h n iq u e sim ila r to th at d e scrib e d by B u o n o c o re and D a v ila 9 (F ig 5). T h r e e m o n th s la te r th e re s to ra tio n w as s a tis fa c to ry b o th fu n ctio n a lly and e s th e tic a lly . T h e to o th resp o n d ed w ithin n orm al lim its to e le c tr ic a l pulp te s ts at b o th the initial and fo llo w -u p v isits.
D i s c u s s io n A v u lsed and fra ctu re d te eth a re co m m o n ly e n co u n te re d in d en tal p ra c tic e . In re c e n t y e a rs , th e re has b e e n a g rea t in c re a se in th e n u m b er o f reim p lan tatio n p ro c e d u re s. C o n s e q u e n tly , m any te e th that o n c e would hav e b ee n lo st h av e again b e co m e fu n ctio n a l. In s e le c te d c a s e s , a cid e tch re sin te c h n iq u e s allow c le a n ly fra c tu re d , large p ie c e s o f to o th stru ctu re to b e re sto re d to th e ir 114 ■ JADA, Vol. 96, January 1978
Fig 4 ■ Fractured po rtion of tooth after it was surgically removed from low er lip.
Fig 5 ■ P hotograph o f anterior teeth after fractured po rtion of too th had been restored to its original position.
origin al p o sitio n . T h e fra c tu re d p o rtio n o f the to o th p ro v id e s, in le ss tim e and w ith less p a in , a m o re e s th e tic and d u ra b le re s to ra tio n th an cou ld be atta in e d by o th e r te c h n iq u e s . T h e re sto re d en a m e l is m o re re s is ta n t to stain and a b ra sio n than a re sin re s to ra tio n ; h o w e v e r, the resin b ond un it ing th e tw o p o rtio n s o f th e fra c tu re d to o th is, o f c o u r s e , s u b je c t to clin ic a l fa ilu re , fo r fu n ctio n a l or e sth e tic re a s o n s . T h is te c h n iq u e a lso a v o id s the gingival p ro b lem s a s s o c ia te d w ith im p e rfe ct cro w n m arg in s. It is c o m m o n k n ow led g e am ong th e g en eral p u blic th a t av u lse d te e th shou ld be sa v e d , k ep t moist-, and ta k e n to th e d en tist a s q u ick ly a s p o ssi-
b le fo r re im p la n ta tio n . I t is h o p ed th a t in th e fu tu re n ew m a te ria ls and te c h n iq u e s w ill b e p e r fe c te d so th a t p a tie n ts w ill a lso b e a b le to b rin g la rg e , c le a n ly fra c tu re d p o rtio n s o f te e th to th e d e n tis t, w h o w ill b e a b le to “ r e s to r e ” th em to th e ir o rig in a l p o sitio n .
Summary A n u n u su al c a s e is d e s c rib e d in w h ich a fra c tu re d p o rtio n o f to o th s tru ctu re w as re m o v ed fro m th e lo w e r lip an d re s to re d to its orig in al p o sitio n w ith a m o d ified a c id -e tc h re sin te c h n iq u e .
I thank Drs. Loren J. W endelburg and Dean A. Hudson fo r th e ir assistance in the c o m pletion o f the surgical and restorative aspects of th is report, as w ell as Prof. Paul Barton, Indiana U niversity School of Dentistry, fo r his assistance in the preparation o f this article. 1. Kopel, H.M., and Beaver, H.A. C om prehensive restorative pro cedures fo r prim ary anteriors. J Dent Child 34:412 Sept 1967.
2. Granville, S., Jr.; Bugg, J.L., Jr.; and C arruth, K.R. Restoration of prim ary incisors w ith acrylic jacket crow ns— one appointm ent procedure. J Dent C hild 33:182 May 1966. 3. Stewart, R.E.; Luke, L.S.; and Pike, A.R. Preformed polycar bonate crow ns fo r the restoration of an te rio r teeth. JADA 88:103 Jan 1974. 4. S taffanou, R.S. R estoration of fractured incisal angles. JADA 84:146 Jan 1972. 5. M ichon, F.J., and Carr, R.F. Repair o f a coronal fra ctu re that involved the pu lp o f a deciduous in cisor: re port of case. JADA 87:1416 Dec 1973. 6. Laswell, H.R.; Welk, D.A.; and Regenos, J.W. A ttachm ent of resin restoration to acid pretreated enamel. JADA 82:558 March 1971. 7. Roberts, M.W., and M offa, J.P. R estoration o f fractured incisal angles w ith an ultraviolet-activated sealant and a com posite resin— a case report. J Dent Child 39:364 Sept 1972. 8. Roberts, M.W., and M offa, J.P. Repair of fractured incisal angles w ith an ultraviolet-light-activated fissure sealant and a com posite resin: tw o-year re port o f 60 cases. JADA 87:888 Oct 1973. 9. Buonocore, M.G., and Davila, J. R estoration of fractured an te rio r teeth w ith ultraviolet-light-polym erized bo nding m aterials: a new technique. JADA 86:1349 June 1973. 10. Bizga, C.A. The fractured an terior to o th : restoration made permanent. JADA 88:823 A pril 1974. 11. Chosack, A., and Eidelman, E. R ehabilitation of a fractured incisor using the pa tient’s natural crow n— case report. J Dent Child 31:19 Jan 1964.
Mader: RESTORATION OF FRACTURED TOOTH . 115
