Page 20 - Dental Practice August 2022
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endodontic section
e n d o d o n t i c s e c t i o n
A NOVEL WAY TO RE-ATTACH
A N O V E L W A Y T O R E - A T T A C H
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FRACTURED INCISAL CROWN WITH FRC
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M A H E S H C H A U H A N
Unlike a salamander or a starfish, humans
with a little help from Fiber Reinforced
U n l i k e a s a l a m a n d e r o r a s t a r f i s h , h u m a n s w i t h a l i t t l e h e l p f r o m F i b e r R e i n f o r c e d available FRC materials are listed below:materials are listed below:
available FRC
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patients do bring their fractured anterior r it as I have some very good follow-ups of f b. Fibre Splint ML, six layers of Fibre e
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a detailed history as to what happened with tioned in my book – “A Visual Guide to“A Visual Guide to c c. F-SPLINT AID and F-SPLINT SLIM
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belief when I say that it can be restored and by Wiley India.” ribbon pre-impregnated with the e
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re-attached back to the main tooth bodye-attached back to the main tooth body Some examples of a few commercially bonding agent
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T a b l e 1 : T R E A T M E N T G U I D E L I N E S F O R T O O T H F R A C T U R E S A N D ALVEOLAR FRACTURES IN THE PERMANENT DENTITION
Table 1: TREATMENT GUIDELINES FOR TOOTH FRACTURES AND ALVEOLAR FRACTURES IN THE PERMANENT DENTITION
CROWN FRACTURE CROWN/ROOT FRACTURE ROOT FRACTURE ALVEOLAR FRACTURE
UNCOMPLICATED COMPLICATED
DEFINITION AND DIAGNOSIS Enamel and dentin fracture Enamel and dentin fracture A fracture involving the root The bone segment containing
without pulp exposure. with pulp exposure. structure. It can be localized at the involved tooth/teeth is
the apical, middle or cervical fractured and mobile.
third.
CLINICAL ASSESMENT AND Sensitivity tests and vitality Sensitivity tests and vitality Sensitivity tests and vitality The coronal fragment is Fracture lines may be located
FINDINGS tests are likely to give positive tests are likely to give positive tests are likely to give positive usually mobile and sometimes at any level, from the marginal
results. results. results. displaced. bone to the root apex.
Normal mobility. Exposed pulp sensitive to Tender to percussion. The apical segment is usually Mobility of the teeth may be
stimuli. not displaced. segmental if the fracture involves
Percussion test: not tender. Coronal fragment is mobile. more than one alveolar socket.
If tenderness is observed, Normal mobility. Tender to percussion.
evaluate the tooth for possible Occlusal interference is often
luxation or root fracture. Percussion test: not tender. Sensitivity tests may be initially present due to misalignment of
If tenderness is observed, negative indicating transient the fractured alveolar segment.
pulpal damage.
evaluate the tooth for possible
luxation or root fracture Displacement of an alveolar
segment.
IMAGING AND RADIOGRAPHIC One occlusal and two periapical One occlusal and two periapical One occlusal and two periapical One occlusal radiograph to In addition to the three
ASSESSMENT AND FINDINGS radiographs from mesial and radiographs from mesial and radiographs from mesial and determine the level of the root angulations and occlusal
distal are recommended in distal are recommended in distal are recommended in fracture at the apical and film, additional views such
order to rule out displacement order to rule out displacement order to rule out displacement middle third. as a panoramic radiograph
or the possible presence of a can be helpful in determining
root fracture. or the possible presence of a or the possible presence of a Two periapical radiographs with the course and position of the
root fracture. root fracture. varying horizontal angles are fracture lines.
Radiograph of lip or cheek Radiograph of lip or cheek CBCT should be considered needed to locate the fractures
lacerations to search for tooth lacerations to search for tooth to reveal the extension and in the cervical third of the root. CBCT may be useful for
fragments or foreign material. fragments or foreign material. direction of the fracture. diagnosis of alveolar fractures,
For a root fracture in the middle especially when they involve the
third, CBCT may rule out or palatal or both cortical plates.
confirm an oblique course
of fracture involving the cervical
third in the labiolingual
dimension.
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Source:The Recommended Guidelines of the American Association of Endodontists for The Treatment of Traumatic Dental Injuries s
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20 Dental Practice // July-August 2022 // Vol 18 No 4
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