Current aspects of restoring traumatically fractured teeth

Abstract

Endodontic and restorative considerations are of primary significance in the treatment of tooth fractures. Since exposed dentinal tubules permit invasion of bacteria into the endodontic system, a protective dressing must be applied as part of the emergency treatment. Provided the dentin wound has been sealed, restorative treatment can also be carried out at a later stage. The fractured tooth fragment can be reattached using adhesive protocols in order to restore function and esthetic appearance. If reattachment is difficult or impossible, eg, in cases of multiple or missing fragments, current composite materials enable excellent esthetic results. Minimally-invasive direct composite restorations are preferred over the more invasive indirect restorations, at least in immature teeth with an extensive coronal pulp dimension. Restorative treatment of crown-root fractures is frequently demanding due to inaccessible subgingival fracture margins. Extrusion of the remaining root is an alternative method to surgical crown lengthening for re-establishing the biological width. This can be carried out either orthodontically (forced eruption), or surgically (intra-alveolar transplantation). Although the treatment of crown-root fractures is one of the most technically sensitive procedures in dental traumatology and is frequently considered as a long-term temporary restoration, tooth conservation up to the age at which implants can be placed may be regarded as a success.