Management of Fractured Upper Incisor – Part 2
(Complicated Fractured – exposed the pulp tissue)
In the last blog, we discussed about the management of the uncomplicated fractured upper central incisor. What to do if the fractured involved the pulp chamber and leads to pulpal tissue exposure. It will depends on the situation to judge clinically what are the available treatment option.
If the exposure is less than 2mm diameter and you manage to go to dental clinic less than half an hour, then the dentist can perform a procedure known as Cveks Pulpotomy to removed the affected pulp tissue and preserving the remaining unaffected pulp tissue. Then the tooth restore with direct composite material. The vitality of the tooth over the time is depending on the degree of traumatization and the healing process of the pulp tissue.
Assuming the tooth was fractured half of the crown, and exposed the pulp tissue. The dentist will need to take a Periapical radiograph to confirm no root fractured, then proceed to do root canal therapy on the same day, known as “Selective Endodontic Treatment”. If the patient is young or teenager, we can restore the fractured tooth with Direct Composite Restoration first till the cranio-facial & skeletal growth completed. In adult, we proposed to crown the tooth for more esthetic and function.
16 years old girl, fractured her upper left central incisor during a motor vehicle accident. Presented to me 2 weeks after the incident.
Almost half of the crown was fractured.
Complicated fractured, exposed the pulp tissue. The pulp tissue are necrotising (started to die off).
Periapical radiograph (x-ray) confirmed no root fractured. The tooth was isolated with rubber dam for root canal therapy.
Selective endodontic was done. (Cleaning and shaping of the root canal, disinfected and obturation to seal the root canal in the same visit within the day.)
Because she still young, so we decided to restore it with Direct Composite Technique. The photo shown the inner layer was built first to mimic the enamel layer at the back (Palatal surface) of the tooth.
Follow by the core of the tooth, the dentin layer. Noticed the finger-like’ structure was built near to the incisor edge, this is to allow the tooth to have natural light reflection at the end of restoration.
Covered the remaining surface with composite that have slight translucency property, to mimic the natural enamel layer.
Finished by duplicate the morphology of the contra-lateral tooth (the upper right central incisor) to get the same light reflection pattern. Lastly, polished the restoration to achieve optimum shine.
Dr Goon Yong Por
BDS, FICD, FADI, FICCDE