A Conservative Treatment of A Tooth with Complicated Crown-Root Fracture: Relative Success

Yıl 2020, Cilt: 2 Sayı: 1, 35 - 39, 28.08.2020

Şeref Nur Mutlu Makbule Bilge Akbulut Ayçe Ünverdi Eldeniz

Öz

Dental traumatic injuries are highly prevalent among children and adolescents. Crown-root fractures of anterior teeth present
difficulties for restoration. This case report describes the treatment of a complicated crown-root fracture of maxillary right
lateral incisor with extensive loss of tooth structure and uncomplicated crown fracture of maxillary right central incisor in a
young adult. The 15-year-old male patient was presented to Endodontic clinic with post-traumatic injury. After the mobile
crown-root fragment of lateral incisor was removed, root canal therapy was performed in two visits. Calcium hydroxide was
used as an intra-canal dressing. Root canal filling, glass fiber post cementation and adhesive tooth fragment reattachment were
performed. Central incisor was restored with composite restoration. Early stage success was achieved with the observance of
good functional and aesthetic outcomes. However the patient did not attend follow-up visits and returned after 14 months with
secondary trauma which resulted fracture of the reattached part and minor fractures extending to middle root so the tooth was
extracted. As it is crucial to retain the tooth to maintain space and to protect alveolar bone height, clinicians should always
consider trying reattachment of tooth fragments. The case presented here is sufficient and effective in postponing fixed prosthetic restorations or implant treatments.

Anahtar Kelimeler

Complicated crown-root fracture, Glass fiber post, Reattachment, Traumatic injury

Komplike Kron-Kök Kırıklı Bir Dişin Konservatif Tedavisi: Göreceli Başarı

Öz

Travmatik diş yaralanmaları çocuklar ve ergenler arasında oldukça yaygındır. Ön dişlerdeki kron-kök kırıkları restorasyon
açısından zorluk teşkil etmektedir. Bu olgu sunumu, genç yetişkin bir hastada maksiller sağ lateral kesici dişin aşırı madde
kaybıyla sonuçlanan komplike kron-kök kırığı tedavisini ve maksiller sağ santral kesici dişteki komplike olmayan kron kırığının
tedavisini açıklamaktadır. 15 yaşında erkek hasta travma sonrası yaralanma ile Endodonti kliniğine başvurdu. Lateral kesici
dişin mobil olan kron-kök parçası çıkarıldıktan sonra kök kanal tedavisi iki seansta tamamlandı. Kanal içi medikament olarak
kalsiyum hidroksit kullanıldı. Kök kanal dolgusu, cam fiber post simantasyonu ve kırık parçanın adeziv reataçmanı yapıldı.
Santral kesici diş kompozit ile restore edildi. İyi bir fonksiyon ve estetik sonuçların gözlenmesi ile erken aşamada başarı elde
edildi. Ancak, hasta kontrol randevularına gelmedi ve 14 ay sonra, yeniden yapıştırılan parçanın kırılması ve kökün ortasına
kadar uzanan minör kırıkların oluşmasıyla sonuçlanan ikinci bir travma ile geri geldi, bu yüzden hastanın dişi, çekildi. Alveoler
kemik yüksekliğini korumak için dişi ağızda tutmak çok önemli olduğundan, klinisyenler her zaman kırık diş parçalarının reataçmanını bir tedavi seçeneği olarak düşünmelidir. Burada sunulan olguda uygulanan tedavi sabit protez restorasyonlarının
veya implant tedavilerinin ertelenmesinde yeterli ve etkilidir

Anahtar Kelimeler

komplike kron-kök kırığı, cam fiber post, reataçman, travmatik yaralanma

Kaynakça

• 1. Andreasen JO, Bakland LK, Flores MT, Andreasen FM, Andersson L. Traumatic dental injuries: a manual: John Wiley & Sons; 2011.
• 2. Andreasen JO, Andreasen FM, Andersson L. Textbook and color atlas of traumatic injuries to the teeth: John Wiley & Sons; 2018.
• 3. Andreasen J, Ravn J. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. International journal of oral surgery. 1972;1(5):235-9.
• 4. Baratieri LN, Monteiro Jr S, de Andrada MAC. Tooth fracture reattachment. Quintessence International. 1990;21(4).
• 5. Ehrmann EH. Restoration of a fractured incisor with exposed pulp using original tooth fragment: report of case. The Journal of the American Dental Association. 1989;118(2):183-5.
• 6. Patni P, Jain D, Goel G. A holistic approach to management of fractured teeth fragments: a case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2010;109(5):e70-e4.
• 7. Fortunato Ferreira Santos J, Bianchi J. Restoration of severely damaged teeth with resin bonding systems. Quintessence International. 1991;22(8).
• 8. Baratieri L, Ritter A, Monteiro SJ. Tooth fragment reattachment: an alternative for restoration of fractured anterior teeth. Practical periodontics and aesthetic dentistry: PPAD. 1998;10(1):115-25; quiz 27.
• 9. Reis A, Loguercio A. Tooth fragment reattachment: current treatment concepts. Practical procedures & aesthetic dentistry: PPAD. 2004;16(10):739.
• 10. Al‐Jundi SH. Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: a longitudinal and retrospective study. Dental Traumatology. 2004;20(1):1-5.
• 11. Glendor U, Koucheki B, Halling A. Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teeth. Dental Traumatology. 2000;16(5):205-10.
• 12. Stockwell AJ. Incidence of dental trauma in the Western Australian school dental service. Community dentistry and oral epidemiology. 1988;16(5):294-8.
• 13. Öz İA, Haytaç MC, Toroǧlu MS. Multidisciplinary approach to the rehabilitation of a crown‐root fracture with original fragment for immediate esthetics: a case report with 4‐year follow‐up. Dental Traumatology. 2006;22(1):48-52.
• 14. Vilela EA, Baratieri LN, Caldeira de Andrada MA, Monteiro Jr S, Medeiros de Araújo J. Tooth fragment reattachment: Fundamentals of the technique and two case reports. Quintessence International. 2003;34(2).
• 15. Burke F. Reattachment of a fractured central incisor tooth fragment. British dental journal. 1991;170(6):223-5.
• 16. Dikbaş İ, Köksal T. Post-core uygulamalarında başarısızlıklar. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2006;2006(2):41-51.
• 17. Baba N. et alli.(2009). Nonmetallic prefabricate dowels: a review of compositions, properties, laboratory, ans clinical test results. J Prosthodont.18:527-36.
• 18. Möllersten L, Lockowandt P, Lindén L-A. A comparison of strengths of five core and post-and-core systems. Quintessence international. 2002;33(2).
• 19. Purton DG, Chandler NP, Qualtrough AJ. Effect of thermocycling on the retention of glass-fiber root canal posts. Quintessence international. 2003;34(5).
• 20. Vichi A, Ferrari M, Davidson CL. Influence of ceramic and cement thickness on the masking of various types of opaque posts. Journal of Prosthetic Dentistry. 2000;83(4):412-7.
• 21. Reis A, Loguercio A, Kraul A, Matson E. Reattachment of fractured teeth: a review of literature regarding techniques and materials. OPERATIVE DENTISTRY-UNIVERSITY OF WASHINGTON-. 2004;29(2):226-33.
• 22. Sharma D, Garg S, Sheoran N, Swami S, Singh G. Multidisciplinary approach to the rehabilitation of a tooth with two trauma episodes: systematic review and report of a case. Dental Traumatology. 2011;27(4):321-6.
• 23. Ravn J. Dental injuries in Copenhagen schoolchildren, school years 1967–1972. Community dentistry and oral epidemiology. 1974;2(4):231-45.