Page 21 - Dental Practice August 2022

Table 2: TREATMENT GUIDELINES FOR TOOTH FRACTURES AND ALVEOLAR FRACTURES IN THE PERMANENT DENTITION

CROWN FRACTURE CROWN/ROOT FRACTURE ROOT FRACTURE ALVEOLAR FRACTURE
UNCOMPLICATED COMPLICATED
TREATMENT If a tooth fragment is available, In young patients with open Without pulp exposure: For root fractures where the Reposition any displaced
it can be bonded to the tooth. apices, it is very important to fragment removal with or coronal fragment has been segment and then splint the
Otherwise perform a provisional preserve pulp vitality by pulp without gingivectomy and avulsed out of the socket, involved teeth with a flexible
treatment by covering the capping or partial pulpotomy restore. please use the treatment splint for 4 weeks.
exposed dentin with glass in order to secure further root guidelines for avulsion (Tables
ionomer or a permanent development. With pulpal exposure and 6-8). Otherwise proceed as Suture gingival laceration if
restoration using a bonding immature roots: described below. present.
agent and composite resin. This treatment is also the Perform a partial pulpotomy to
treatment of choice in patients preserve pulp vitality. Rinse exposed root surface with
with closed apices. saline before repositioning.
The definitive treatment for the
Pulp exposure with mature
fractured crown is restoration Calcium hydroxide compounds roots: If displaced, reposition the
with accepted dental and MTA (white) are suitable Perform endodontic treatment coronal segment of the tooth
restorative materials. materials for such procedures. then restore with a post- as soon as possible.
retained crown.
If tooth fragment is available, Check that correct position has
it can be bonded to the tooth. Orthodontic or surgical been reached radiographically.
extrusion of apical fragment
Future treatment for the may be indicated to expose the Stabilize the tooth with a
fractured crown may be margins prior to permanent flexible splint for 4 weeks.
restoration with other accepted restoration. If the root fracture is near
dental restorative materials. the cervical area of the tooth,
Extraction with immediate or stabilization is beneficial for
delayed implant-retained crown a longer period of time (up to
restoration or a conventional 4 months).
bridge.
Monitor healing for at least
Extraction is inevitable in crown 1 year to determine pulpal
root fractures with a severe status.
apical extension, the extreme
being a vertical fracture. If pulp necrosis develops, then
root canal treatment of the
coronal tooth segment to the
fracture line is indicated.
PATIENT INSTRUCTIONS Soft diet, brush teeth with a soft toothbrush after each meal.
Source: The Recommended Guidelines of the American Association of Endodontists for The Treatment of Traumatic Dental Injuries
Note: Pulp necrosis subsequent to trauma should be diagnosed by at least two signs or symptoms. In the noncompliant patient or one with limited access to care,
with a tooth with a mature apex, a lack of response to pulp sensibility testing by 3 months is strongly indicative of pulp necrosis.

Table 3: FOLLOW-UP PROCEDURES FOR FRACTURED PERMANENT TEETH AND ALVEOLAR FRACTURES
TIME CROWN FRACTURE CROWN/ROOT FRACTURE ROOT FRACTURE ALVEOLAR FRACTURE
UNCOMPLICATED COMPLICATED UNCOMPLICATED COMPLICATED
4 WEEKS Splint removal*, clinical & Splint removal*, clinical &
radiographic control radiographic control
6-8 WEEKS Clinical & radiographic Clinical & radiographic Clinical & radiographic Clinical & radiographic Clinical & radiographic control Clinical & radiographic control
control control control control
4 MONTHS Splint removal**, clinical & Clinical & radiographic control
radiographic control
6 MONTHS Clinical & radiographic control Clinical & radiographic control
1 YEAR Clinical & radiographic Clinical & radiographic Clinical & radiographic Clinical & radiographic Clinical & radiographic control Clinical & radiographic control
control control control control
YEARLY FOR 5 YEARS Clinical & radiographic control Clinical & radiographic control
Source: The Recommended Guidelines of the American Association of Endodontists for The Treatment of Traumatic Dental Injuries

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Dental Practice // July-August 2022 // Vol 18 No 4 21