A complex trauma with pulpal exposure: the digital alternative

Digital - Endodontics - Cases
2017-02-22

Traumatic injuries are increasing in the last few years, particularly in young people. When the trauma causes a pulpal exposure, it’s mandatory to avoid pulpal necrosis, particularly in teeth that have an open apex. The pulp capping procedures are quite simple and easy to accomplish but a proper coronal protection by adhesive restoration should be considered as soon as possible.

CAD/CAM indirect restoration are suitable solution for teeth in which a huge part of dentine and enamel tissues were missing.

In the following case a paradigmatic example has been presented.

Fig. 1

Img. 1 – A young boy, aged 10, is checking in for an emergency regarding a traumatic lesion on a front tooth during a fight in the courtyard.

Fig. 2

Img. 2 – The fracture of tooth 2.1 is complicated by a wide pulp exposure. Patient does not refer pain and trauma happened approximately two hours before. The fragment of the injured tooth is missing. No rx signs of horizontal fractures are evident in the X-Ray taken with the long cone technique. The apex of the tooth is not completely matured.

Fig. 3

Img. 3 – Following local anesthesia, we executed a pulpotomy and then a complete sealing of the remaining pulp using a calcium silicate cement (Tech Biosealer Capping- Isasan), a medication indicated for direct pulp capping.

Fig. 4

Img. 4 – During the same visit, after the residual pulp sealing, the endodontic access cavity is closed using a composite resin (SE Bond Kuraray + Tetric Flow Ivoclar Vivadent). Always during the same visit, after a professional cleaning session….

Fig. 5

Img. 5 – …the fractured tooth was prepared using the most conservative method, and an optical impression is taken using Sirona Blue Cam 4.2. This way we receive a proposal of an overlay that is sequentially milled in Lava 3M and immediately cemented using an adhesive technique (SE Bond – Kuraray + Tetric Flow – Ivoclar Vivadent)

Fig. 6

Img. 6 – The clinical steps of the adhesive cementation of the overlay in LAVA 3M. One can appreciate the final trimming, polishing and characterization of the overlay before the luting procedure

Fig. 7

Img. 7 – Radiographic and photographic check after one week followinghte adhesive cementation.

Fig. 8

Img. 8 – Radiographic and photographic check after one week following the adhesive cementation.

Fig. 9

Img. 9 – Radiographic and photographic check after 4 years. The apex of the 2.1 is perfectly closed and the tooth is answering positively to all the pulpal vitality tests. It will be restored using a lithium disilicate onlay.

 

CAD/CAM indirect restoration has been employed to solve these functional and esthetic problems in a young boy who experienced a heavy dental trauma in anterior upper incisors; by an indirect adhesive machined composite veneer the tooth has been reconstructed with a proper shape and a guaranteed durability.