Complicated Crown Fracture of Permanent Incisors: A Conservative Treatment Case Report and a Narrative Review

Abstract

Dental trauma may have a severe impact on the social and psychological wellbeing of a patient. Most cases of dental injuries involve anterior teeth, especially the maxillary upper incisors. Crown fractures, with or without pulp exposure, are the most common trauma in permanent dentition. There are many methods of management, in which the initial state of the pulp, the time since the injury, and the presence of an accompanying injury play a key role. This case report aimed at showing a possible conservative treatment after complicated tooth fracture that consisted of partial pulpotomy followed by adhesive reattachment of the tooth fragment using a technique based on heated resin composite. Such a specific procedure represents a conservative approach to traumatic coronal lesions, providing a suitable opportunity to maintain the tooth vitality, aesthetics, and function. Indeed, reattachment of tooth fragment using a composite/adhesive is a simple technique to achieve excellent results in terms of aesthetic and function.

Keywords: adhesive reattachment; tooth fracture; traumatic dental injury.

Figure 1

Intraoral photographs of both cases. (A,C)—buccal view; (B,D)—occlusal view.

Figure 2

The preoperative X-rays.

Figure 3

Fragments of teeth (A) 11 and 21, (B) 11.

Figure 4

PP of teeth 11 and 21 (case #1) and PP of tooth 11 (case #2). (A,E)—clinical situation before pulpotomies; (B,F)—partial pulpotomies; (C,G)—hemostasis with cotton soaked with 1% sodium hypochlorite; (D,H)—capping with MTA.

Figure 5

The reattachment of tooth 11 and 21 (case #1- up). (A)—selective etching of tooth 11; (B)—reattachment of coronal fragment of tooth 11; (C)—selective etching of tooth 21; (D)—buccal view after adhesive reattachment of teeth 11 and 21. The reattachment of tooth 11 (case #2- down). (E)—selective etching of tooth 11; (F)—reattachment of coronal fragment of tooth 11; (G)—buccal view after adhesive reattachment of tooth 11.