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Case Reports
. 2018 Sep 16:2018:3287965.
doi: 10.1155/2018/3287965. eCollection 2018.

Unexpected Complication Ten Years after Initial Treatment: Long-Term Report and Fate of a Maxillary Premolar Rehabilitation

Davide Augusti  1 , Gabriele Augusti  1
Affiliations
Case Reports

Unexpected Complication Ten Years after Initial Treatment: Long-Term Report and Fate of a Maxillary Premolar Rehabilitation

Davide Augusti et al. Case Rep Dent. .

Abstract

Full-coverage restorations represent a well-known rehabilitation strategy for compromised posterior teeth; in the last years, new ceramic materials like zirconia have been introduced and widely adopted for the prosthetic management of molar and premolar areas. A long-term follow-up of a maxillary premolar rehabilitation using a veneered zirconia crown is presented; after ten years of uneventful clinical service of the tooth-restoration complex, a serious complication-namely, a vertical root fracture (VRF)-occurred. An extended time lapse (9 years) between the end of restorative procedures and development of symptoms due to VRF has been observed. On the other hand, a complete functional and esthetic integrity of the zirconia crown (without chippings or crack development) is documented along the follow-up period. Due to periodontal breakdown and severity of fracture, the premolar was extracted. The illustrations of our late failure, aetiological factors, and available data on the literature regarding VRF are addressed. Patients and clinicians should be aware of potential occurrences of some long-term, serious complications when dealing with previously treated and/or structurally weakened teeth. The development of a VRF might be unexpected and might occur many years after the end of tooth rehabilitation, despite adoption of contemporary restorative protocols and techniques.

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Figures

Figure 1
Figure 1
Preoperative intraoral frontal (a) and lateral (b) views showing the preexisting upper second premolar crown (tooth 1.5).
Figure 2
Figure 2
Periapical radiograph showing previous endodontic and prosthetic treatments on upper second premolar.
Figure 3
Figure 3
Periapical radiograph showing immediate outcome of nonsurgical endodontic retreatment performed at our dental office.
Figure 4
Figure 4
Postoperative intraoral frontal (a) and lateral (b) views showing good integration of the new veneered-zirconia crown on tooth 1.5.
Figure 5
Figure 5
Frontal (a) and lateral (b) views 7 years after crown delivery: an overall dental deterioration is visible associated with soft tissue modifications.
Figure 6
Figure 6
Development of clinical symptoms 9 years after crown delivery: the radiograph revealed a periapical radiolucency, with widening of periodontal ligament/lamina dura modifications.
Figure 7
Figure 7
Apical resection of premolar root showing vertical bone resorption at the cortical vestibular side.
Figure 8
Figure 8
Three (a) and five (b) months after endodontic surgery, the clinical scenario did not improve: a progressive radiolucency involved the distal areas of the tooth and proximal peaks.
Figure 9
Figure 9
Clinical (a) and radiological (b) presentation of the vertical root fracture: splitting of the premolar root into two halves is clearly visible.
Figure 10
Figure 10
Inner (a) and outer (b) views of the two fragments produced by the longitudinal fracture, retrieved after tooth extraction.
Figure 11
Figure 11
Extraoral close readaptation of fragments: the fracture runs for the entire bucco-lingual length of the tooth, as shown by separation on the vestibular (a) and palatal (b) sides. The fracture line was off-centered from the canal when observed on the axial plane (c).
Figure 12
Figure 12
An incomplete cracking line (arrow) involved the coronal area of the small fragment.
See this image and copyright information in PMC

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