006 – Management of Fractured Upper Incisor – Part 1

Management of Fractured Upper Incisor – Part 1 (Uncomplicated fractured – not exposed the pulp tissue)

If we having a fractured upper incisor caused by trauma on the tooth (either due to motor vehicle accident or a fall), depending on the everity of fractured, we might have a change to restore it conservatively with direct composite filling material. we sub-classified it to uncomplicated fractured (where pulp chamber not involve and pulpal tissue are not exposed) and complicated fractured (where the fractured extended into the pulp chamber and pulpal tissue is exposed to the oral cavity and subject to contamination). Here, I am showing you the conservative way to restore the fractured tooth with direct composite restoration. Of course, restoring the fractured tooth with crowning is one of the option.

A 15 years old school girl fractured her upper right central incisor due to fell down from staircase in school. The tooth fractured at one third from the incisor margin and she was lucky as no pulpal involvement.

Check the occlusion (biting surface) to rule out any factors that might affect the longevity of the final restoration.

 The tooth was prepared and isolated with rubber dam.

The tooth was then been disinfected with chlorhexidine to kill any remaining bacterias that may be present due to the contact with the floor.

The tooth been isolated from adjacent teeth by using Teflon tape. A layer of bonding agent (adhesive) applied on the tooth surface.

Step by step to show the reconstruction of the tooth. First building the palatal shelf (back wall) by using a translucent composite material.

Follow by building the body with composite with dentin colour. Notice the “finger like” extension to mimic the natural tooth structure.

Then build up the translucent area between the “finger extension” and incisor edge. A opaque band is build up at the incisor edge to copy the appearance of normal tooth.

The whole facial surface covered by composite material that possessed the optical and physical properties similar to Enamel.

 

The appearance of the restoration after removed the rubber dam and proper contouring.

 

The final result after polishing. The girl gained back her smile 2 hours after the incident. The girl was on 3 months recall to check the vitality of the tooth.

 

Prepared by,
Dr Goon Yong Por
Dental Surgeon
BDS, FICD, FADI, FICCDE