Introduction: site of injury. Uncomplicated crown fracture

Introduction: Dentoalveolar fracture isthe most well-known type of head and neck trauma. Dental trauma may happenbecause of a sports mishap, a fall inside of the home, or other causes.

Traumaticinjuries to teeth and their supporting tissues, can occur in any age group, butchildren are most common candidate followed by adolescents. Damage may varyfrom enamel fracture to avulsion, with or without pulpal involvement or bonefracture.Anterior anatomic crown fracturesare a common site of injury. Uncomplicated crown fracture of the permanentteeth has an intense effect not only on the patient’s appearance, but also infunction, speech and physiological behavior.1 The treatment for suchtrauma depends upon the type of injury and whether the injured tooth is aprimary or permanent tooth.

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Definitive treatment is essential for the well-beingof the dentoalveolar fracture. The case report describes aninnovative technique in rehabilitating an uncomplicated fractured maxillary centralincisors tooth in a young patient with composite, which is easily available,economical and requires less operating time with direct technique.Case Report: A 12-year-old traumatized boy was reported tothe Department of Paediatric Dentistry, Pacific Dental College & Hospital,and Udaipur. The patients reported with chief complain correction of brokenupper front teeth. Patient gave history of trauma 6 days back due to fall onground while playing. On extraoral examination revealed no gross facial abnormality.

Intra oral examination revealed Ellis class II (uncomplicated) fracture irt 11and Ellis class I fracture irt 21. The teeth were asymptomatic without anyassociated soft or hard tissue injuries to the supporting tissues and respondedwell to Electric Pulp Tester indicating positive teeth vitality. Intraoralperiapical radiograph confirms the absence of pulpal or periapical pathology. So,it was planned to rehabilitated the fractured segment using compositerestoration with direct technique using template. Primary impression of the maxillaryand mandibular arches were made using alginate(). Studymodels were made in Type III dental stone() andmock build-up of the lost teeth structure with modeling wax() was done.

After build-up of lost segment, the castwas duplicated by using template of putty impression material(). Labial surface of the putty template was removedup to middle third of the crown, to aid in the reconstruction of the lost toothstructure. On labial aspect groves were made and unsupported enamel wasremoved. A clinical try-in of the template was done to ensure adequate fit. Afterappropriate shade selection of the composite material, this crown former wasused to restore the fractured tooth quickly with minimal post-restorationfinishing. Discussion:Trauma with accompanying fracture ofa permanent incisor is a terrible experience for young patient and createspschycological impact on both the parents and children.

2 If the injury involves the loss ofextensive tooth structure, it alters the child’s appearance and makes him thetarget for teasing by peers.Treatment objectives may varydepending on the age of the patient, socioeconomic status of the patient andintraoral status at the time of treatment planning.3 There are various treatmentmodalities for restoration of fractured teeth like composite restoration, fixedprosthesis, reattachment of the fracture fragment (if available) followed bypost and core supported restorations.3-5 Common restorative treatments suchas laminate veneers or full-coverage restoration may be considered aftermultiple fragment rebonding/ composite resin restorations have been done andthis option is no longer functional. They also tend to sacrifice the healthytooth structure and challenge the clinician to match with the adjacent healthyteeth.

Management of patient with anteriortooth fracture provides a great challenge to the clinicians both from a functionaland an esthetic perceptive. The predictable estheticrestoration of broken incisal edge of maxillary incisors is a demanding and techniquesensitive procedure. Its success is dependent on operator’s skills andknowledge and also on adhering to a systematic and problem solving approach.6 A logical method is usedto build-up morphologically correct composite restorations by careful selectionof composite shades, tints and opaquers. In accurate combinations, an illusionof varying translucencies and opacities become visible over natural toothstructure.7 In patients with fractured dentition,satisfactory results were reported with anterior composites offering a costeffective treatment alternative where esthetics is a major concern.

Withfurther improvements in bonding chemistry, the suc­cess rate of composites isspeculated to improve.6 A good polishing system includingpolishing paste, cups and wheels is recommended to achieve appropriate luster. In the present case innovativetechnique which includes both direct and indirect method of restoring wasdesigned by using Polyvinyl Siloxane (PVS) Rubber base impression material(putty) as template. This method is simple quick and economic when compared toother invasive procedures. The usage of the PVS template allowed incrementallayering of the composite material; optimal depth of cure; accuratereproducibility of the anatomic contours and minimal polishing and finishing procedures.8,9Conclusion:Direct composite resin bonding agentssuccessfully deal with esthetic issue of maxillary anterior teeth along with apainless approach providing successful outcome for the dentist and greatersatisfaction for the patients. As restoring a fractured tooth is a complexprocedure, this technique can prove as a simple, effective and appropriatetechnique that will fulfill all the requirements of dental personnels.

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