KOMPLİKE KRON KÖK KIRIĞININ RESTORE EDİLMESİNDE YENİ BİR YAKLAŞIM

Abstract

Amaç: Bu olgu sunumu, travma sonucu servikal bölgeden kırılmış maksiller kesici dişe, fiber post-kor yapımını ve kırık parçanın modifiye reataçman tekniği ile uyumlandırılarak yapılan tedavi prosedürünü anlatmaktadır. Olgu Sunumu: Otuz iki yaşındaki kadın hasta maksiller orta keser dişinde 2 ay önce travma sonucu oluşan kırık şikayeti ile kliniğimize başvurdu. Hastanın herhangi bir sistemik probleminin bulunmadığı saptandı. Klinik ve radyografik muayenede maksiller orta keser dişin servikal bölgeden kırıldığı, kırılan koronal parçanın da kaybolduğu belirlendi. Kök kanalı %5,25 NaOCl ile irrige edilerek, NiTi döner eğe sistemi ile genişletildi. Daha sonra güta-perka ve kök kanal patı ile dolduruldu. Hasta, protetik diş tedavisi bölümüne yönlendirildi. Hasta randevusunu beklerken, kayıp diş parçasını evde buldu ve tekrar kliniğimize başvurdu. Öncelikle santral dişe, fiber post-kor uygulaması yapıldı. Kırık parçanın iç yüzeyi kor yapıya uyumlandırıldı ve kırık parça, dual cure rezin siman kullanılarak yapıştırıldı. Yapılan klinik ve radyografik muayenede ilgili dişte herhangi bir semptom gözlenmediği ve periapikal dokuların sağlıklı olduğu belirlendi. Sonuç: Komplike kron kök kırığı olan bir dişte, reataçman tekniğiyle hastanın kronunun fiber post-kor yapıya uyumlandırılması, alternatif bir tedavi yöntemidir. Anahtar sözcükler: Komplike Kron Kök Kırığı, Travma, Reataçman Tekniği, Endodonti, Restorasyon A New Approach for the Restoration of Complicated Crown Root Fracture ABSTRACT Aim: This case report describes the treatment procedure of a traumatized maxillary incisor tooth with a cervical fracture adapted a fiber post-core and modified reattachment technique. Case Report: A 32-year-old female patient applied to our clinic with a fractured central incisor due to a previous trauma that occurred 2 months prior. The patient’s medical history was non-contributory. A clinical and radiographic examination revealed horizontal crown fractures in the cervical of the crowns of maxillary incisors. The refracted coronal fragment was detected that was disappeared. Under copious irrigation with 5.25% NaOCl, the teeth were instrumented with NiTi rotary instruments. Root canals were obturated with gutta-percha and sealer. The patient was referred to the prosthetic dental treatment department. While the patient was waiting for her appointment, she found the missing fragment at home and returned to our clinic. Afterwards, the tooth was restorated with fiber post-core. The refracted coronal fragment’s internal surface was adapted to the core. The fragment was bonded using a dual cure composite resin cement. A clinical and radiographic examination revealed that the tooth was not observed symptomatic condition and had healthy periapical structures. Conclusion: The patient crown fragment adjusted to post-core structure with reattachment of a tooth with cervical crown fracture is an alternative treatment method. Key words: Complicated Crown Root Fracture, Trauma, Reattachment Technique, Endodontics, Restoration

Keywords

• Komplike Kron Kök Kırığı
• Travma
• Reataçman Tekniği
• Endodonti

References

1. 1. Dietschi D, Jacoby T, Dietschi JM, Schatz JP. Treatment of traumatic injuries in the front teeth: Restorative aspects in crown fractures. Pract Periodontics Aesthet Dent. 2000;12: 751–8.
2. 2. Hamilton FA, Hill FJ, Holloway PJ. An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 1: The prevalence and incidence of injuries and the extent and adequacy of treatment received. Br Dent J. 1997;182: 91–5.
3. 3. Andreasen JO, Andreasen FM, Andersson L. Crown-root fractures. Textbook and Color Atlas of Traumatic Injuries to the Teeth. 4thed. Oxford: Blackwell; 2007. p.314-36.
4. 4. Fariniuk LF, Sousa MH, Westphalen VPD, Carneiro E, Silva Neto UX, Roskamp L, Cavali AE. Evaluation of care of dentoalveolar trauma. J Appl Oral Sci 2010; 18: 343-5.
5. 5. Patni P, Jain D, Goel G. A holistic approach to managment of fractured teeth fragments: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 70-4.
6. 6. Kırzıoğlu Z, Karayılmaz H. Surgical extrusin of a crown-root fractured immature permanent incisor: 36 month follow-up. Dent Traumatol 2007; 23: 380-5.
7. 7. Olsburg S, Jacoby T, Krejei I. Crown fractures in the permanent dentition: pulpal and restorative considerations. Dent Traumatol 2002; 18: 103-15.
8. 8. Abdulkhayum A, Munjal S, Babaji P, Chaurasia VR, Munjal S, Lau H, Olekar ST, Lau M. In-vitro evaluation of fracture strength recovery of reattached anterior fractured tooth fragment using different re-attachment techniques. J Clin Diag Res. 2014;8: 208–11.

9. 9. Pagliarini A, Rubini R, Rea M, Campese M. Crown fractures: effectiveness of current enamel-dentin adhesives in reattachment of fractured fragments. Quintessence Int 2000;31: 133–6.
10. 10. Yanıkoğlu N, Bayındır F. Post-core yapımında kullanılan restoratif materyaller ve özellikleri. Atatürk Üniv Diş Hek Fak Derg. 2004; 13-14: 39-47.
11. 11. Say EC, Özel E. Travma sonucu meydana gelen ön diş kuron kırıklarının restorasyonu. Türk Diş Hek Derg 2006; 63: 15-21.
12. 12. Demarco FF, Fay RM, Pinzon LM, Powers JM. Fracture resistance of reattached coronal fragments influence of different adhesive materials and bevel preparation. Dent Traumatol 2004;20: 157–63.
13. 13. Sengun A, Ozer F, Unlu N, Ozturk B. Shear bond strengths of tooth fragments reattached or restored. J Oral Rehabil 2003;30: 82–6.
14. 14. De Sousa, Amanda Pinto Bandeira Rodrigues, et al. In vitro tooth reattachment techniques: A systematic review. Dental Traumatol. 2018; 34: 297-310.
15. 15. Nysether S. Dental injuries among Norwegian soccer players. Community Dent Oral Epidemiol. 1987;15: 141– 43.
16. 16. Dhingra A, Srivastava DK. Immediate reattachment of fractured crown fragment: a case report. Endod. 2006;18: 94–96.
17. 17. Demarco FF, Fay RM, Pinzon LM, Powers JM. Fracture resistance of reattached coronal fragments influence of different adhesive materials and bevel preparation. Dent Traumatol 2004;20: 157–63.
18. 18. Sengun A, Ozer F, Unlu N, Ozturk B. Shear bond strengths of tooth fragments reattached or restored. J Oral Rehabil 2003;30: 82–6.
19. 19. Costa CAS, Giro EMA, Nascimento ABL, Teixeira HM, Hebling J. Short term evaluation of the pulp-dentin complex response to a resin-modified glass-ionomer cement and a bonding agent applied in deep cavities. Dent Mater 2003;19: 739–46.
20. 20. Cavalleri G, Zerman N. Traumatic crown fractures in permanent incisors with immature roots: a follow-up study. Endod Dent Traumatol 1995;11: 294–6.
21. 21. Eden E, Çiçek YS, Sönmez S. Reattachment of subgingivally fractured central incisor with an open apex. Dent Traumatol 2007; 23: 184–9.
22. 22. Durkan RK, Özel MB, Çelik D, Bağış B. The restoration of a maxillary central incisor fracture with the original crown fragment using a glass fiber-reinforced post: a clinical report. Dent Traumatol 2008; 24: e71-75.
23. 23. Dikbaş İ, Dülger J. Endodontik tedavi görmüş dişlerin güncel Post-core sistemleriyle restorasyonlarına genel bakış. Akademik Dental Diş Hek Derg 2003; 5:1-9.
24. 24. Pest LB, Cavalli B, Gagliani M. Adhesive-post endodontic restorations with fiber posts:push-out tests and SEM observations. Dent Mater 2002;18: 596-602.
25. 25. Peroz I, Blankenstein F, Lange KP, Naumann M. Restoring endodontically treated teeth with posts and cores-a review. Quintessence Int 2005; 36: 737-46.
26. 26. Lindemann M, Yaman P, Dennison JB, Herrero AA. Comparison of the efficiency and effectiveness of various techniques for removal of fiber posts. J Endod 2005; 31:520-2.
27. 27. Cheung W. A review of the management of endodontically treated teeth. Post, core and the final restoration. J Am Dent Assoc 2005;136: 611-9.
28. 28. Sorensen JA, Engelman MJ. Ferrule design and fracture resistance of endodontically treated teeth. J Prosthet Dent 1990; 63: 529-36.
29. 29. al-Hazaimeh N1, Gutteridge DL. An in vitro study into the effect of the ferrule preparation on the fracture resistance of crowned teeth incorporating prefabricated post and composite core restorations. Int Endod J 2001; 34: 40-46.