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Complicated crown fracture - Courtesy ROOTS
From: Marga Ree To: ROOTS Sent: Thursday, August 16, 2007 9:35 PM Subject: [roots] Complicated crown fracture This little 8 yo boy was referred to me because he sustained a trauma last year, at which he had a (un?)complicated crown fracture on tooth 11. His dentist tried to restore the tooth, but as you can see on the first rad, he didn't succeed to make a well sealing restoration, the cervical part of the fracture was not addressed. After a few months, he developed symptoms, a sinus tract appeared, and he was referred for an endo, still with the failing restoration in place. I thought it didn't make sense to refer him back to his dentist to have the resoration replaced (why didn't he do a proper job right from the start), so we decided to do the restoration first, and then do the endo with MTA. After a gingivectomy, I packed a cord, and was able to keep a dry field. A BU was placed, and the tooth was ready for an endo. Ca(OH)2 as interim dressing, next session MTA, and at third session, the case was finished by placing a post. The gingiva looked already better, although it is difficult to clean the site. I used LuxaCore to do the BU, this is not a proper material to serve as a cosmetic restoration for a long time. You can see that it is a bit gray, but for the time being, it does the job. What I sometimes do is make a veneer of a microfill composite in the core material. I decided to wait for the first follow-up to see what it would look like. If necessary, orthodontic extrusion can be executed, and probably he will need a veneer in the future - Marga
Dear Marga A very nice result indeed. Can I just ask: What was the final apical size? Did you use a periapical matrix? How did you condense the mta apically? And finally do you find it easier to veneer at the chairside with microfill rather than have a laboratory veneer made and fitted. Personally I have been using Gradia composite veneers(laboratory constructed)recently an I find it easier to fit the veneer at a further appointment. Admittedly it is an extra visit but I am interested in your technique. - Jan Skrybant
