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PEDIATRIC DENTISTRY SECTION

INTERCEPTIONS IN PEDIATRIC DENTISTRY

PART II

POST TRAUMA DENTAL RECONSTRUCTIONS

Ritu Ahal and Rajesh Ahal

INTRODUCTION for achieving relatively long-term results. Recent advancements in
The pediatric dentist plays a crucial role in managing dental trauma composite technology, particularly the development of multi-shaded
in children, particularly during high-risk periods such as the composites, offer substantial evidence-based benefits. These newer
“terrible twos,” adolescence, and as the child matures. Immediate materials enable clinicians to perform biomimetic restorations of
treatment of traumatized deciduous and/or permanent teeth, ideally anterior teeth, providing superior aesthetic outcomes and enhanced
within the first hour—known as the Golden Hour—is critical for durability.
optimizing successful outcomes. Prompt intervention during this Biomimetic reconstruction techniques using these advanced
period significantly enhances the likelihood of successful recovery, composites are more conservative and minimally invasive compared
highlighting the importance of timely awareness and action. to traditional crown placements. They offer increased strength and
In cases of dental trauma, reattachment of fractured tooth fragments longevity, approaching the performance of prosthetic restorations.
is a viable and effective treatment option. This article presents clinical The clinical cases presented herein will demonstrate the efficacy of
cases demonstrating the long-term success of reattached dental biomimetic reconstruction techniques and their durability, which is
fragments. Contrary to the common belief that all traumatized comparable to that of prosthetic alternatives.
teeth necessitate endodontic treatment followed by the placement of
a crown, it is important to recognize that dental pulp, initially in a
state of shock following trauma, often recovers if further trauma is
prevented. Typically, pulp healing occurs within 21 to 28 days. Warm
saline mouth rinses can support this process if initiated after 24 hours
post-trauma. Endodontic intervention, if deemed necessary, should
be deferred for 3-4 weeks to allow for potential pulp recovery, unless
there is a definite pulpal or periapical involvement.
Furthermore, it is advisable to avoid placing crowns on traumatized
teeth until the growth and development of the dentition are complete
and occlusion is stable. In the interim, fractured teeth can be restored
using modern composites, which, when applied according to proper
protocols, provide durable and effective results. Although the use of a
rubber dam is beneficial for isolation, maintaining rigorous isolation
protocols without a rubber dam can still yield satisfactory outcomes.

IMPORTANT POINTS: Fig 1: Anterior view of teeth 11 and 21 following crown placement at
1. Effect of placing crowns on young permanent traumatized/fractured 8 years of age, after trauma and endodontic treatment performed
elsewhere. This photograph was taken 4 years after crown
teeth. cementation.
2. Survivability of re-attached teeth.
3. Step by step reconstruction using multi-shaded nanocluster
composites. I. RE-ATTACHMENT OF FRACTURED CORONAL
FRAGMENT: LONGETIVITY OF SUCH PROCEDURES?
IS IT ADVISABLE TO USE CROWNS FOR TREATING A 12-year-old male patient presented for treatment 6 days following
FRACTURED TEETH IN YOUNG CHILDREN. dental trauma. While playing, he was struck in the anterior tooth by
The early placement of crowns on young permanent teeth often an Amul Kool glass milk bottle, resulting in the fracture of a coronal
necessitates subsequent replacements as the dentition continues to tooth fragment that was re-attached. Two years later, the re-attached
develop. Therefore, it is advisable to defer such dental procedures fragment became detached again due to subsequent trauma while
until the permanent dentition is fully erupted and occlusion is stable. playing. The fragment was re-attached once more.
In the interim, the use of modern composites has proven effective Upon follow-up, 8 years after the initial incident, the patient—

12 Dental Practice I July-August 2024 I Vol 20 No 4