Severe Tooth Fracture Restoration: 13 years clinical report
13 Years Ago, it was a beautiful summer night on a weekend getaway in the mountains Far, Far Away…
It was midnight, everything was so peaceful and quiet, stars shimmering in the blue sky, phone out of network range, no concern about everyday life could affect that magical moment… or, at least, I thought so.
«Please help me, Dr Maciej, you’re my only hope…»
A friend and patient, who considered herself lucky to have my private mobile number, had had an accident. While leaving a party, she tripped and fell down a flight of stairs.
«My upper front teeth are broken and bleeding», she explained with difficulty.
I almost asked myself why I had answered the phone, but the natural curiosity of a dentist beat that thought.
«Collect the tooth pieces and reach me at the office, I’ll be in Kraków in a few hours…»
A few hours later…
…the 29-year-old female patient presented in my dental office immediately after the accident with a trauma of the maxillary central incisors (Imgs. 1, 2).
In the right maxillary central incisor, a heavy subgingival fracture was diagnosed (Img. 3). The patient had, as asked, found the missing tooth fragments and brought them from the place of the accident (Img. 4). Fractured pieces of the right central incisor were cemented adhesively with composite resin (Img. 5) while the subgingivally fractured, part of the tooth (of the palatal side) was removed (Img. 6) and delicate osteotomy with gingivoplasty was performed in order to re-establish the biological width, followed by composite restoration (Img. 7). The left incisor was restored with composite material, as this piece could not be found at the scene of the accident (Img. 5).
Endodontic treatment of the right maxillary central incisor was performed, and few weeks later, necrosis of the left maxillary central incisor was diagnosed and endodontic treatment had to be carried out as well (Img. 8). The clinical examination after eight years showed excellent clinical performance (Img. 9,10) and the check-up X-ray after eight years can be viewed in Img. 11.
12 years after the trauma, the patient showed up in the dental office to ask for the vestibular surfaces to be covered with porcelain (Img. 12). She was influenced by friends showing off their new bleached or veneered smiles, and wanted to know about refreshing her own smile.
The wax-up and mock-up were prepared in order to understand the needs of the patient, and to explore the possibilities of aesthetic treatment (Img. 13). The patient liked the new design of the smile and we decided to perform two porcelain veneers. The teeth were prepared through the resin mock-up in order to reduce the amount of enamel removed (Img. 14). Impressions were taken and feldspathic porcelain laminate veneers were made. After a meticulous try in session, check of the margin adaptation, contact points, and simulating the final colour with glycerin gel, the patient was asked for final approval of the work. Then the veneer was adhesively prepared (10 % HF for 90 s followed by meticulous rinsing, silane and adhesive application), the rubber dam was placed (Img. 15), and the veneers were finally cemented (Img. 16).
The final clinical situation can be viewed in Imgs. 17, 18. The 12-month check-up of porcelain veneer therapy, the clinical result and X ray, 13 years after the tooth fracture can be viewed in Imgs. 19, 22.
Img. 1 – The 29-year-old female patient presented in the dental office immediately after an accident with trauma of the maxillary central incisors
Img. 2 – The close up photo of fractured maxillary central incisors
Img. 3 – The patient had found the missing tooth fragments and brought them from the place of the accident
Img. 4 – The clinical situation after tooth fragment reatachment in 11, and composite restoration in 21
Img. 5 – The subgingivally fractured, part of the tooth (of the palatal side) was removed
Img. 6 – Delicate osteotomy with gingivoplasty was then performed in order to re-establish the biological width followed by composite restoration
Img. 7 – Teeth 11, 21 after endodontic treatment
Img. 8 – 8 years clinical control showed excelent clinical performence
Img. 9 – Teeth 11, 21 eight years after injury
Img. 10 – X-ray control, eight years after injury
Img. 11 – 12 years after the trauma, the patient showed up in the dental office to ask for the vestibular surfaces to be covered with porcelain
Img. 12 – The mock-up was obtained in order to understand the needs of the patient, and to explore the possibilities for aesthetic treatment
Img. 13 – The tooth reduction for porcelain veneers
Img. 14 – Teeth isolation for porcelain veneers cementation
Img. 15 – The clinical situation after porcelain veneer cementation (teeth 11, 21)
Img. 16 – The close up photo of cemented porcelain veneers
Img. 17 – The palatal view of the veneers after cementation
Img. 18 – The 12 months control of porcelain veneers, 13 years after injury
Img. 19 – The close up photo of the teeth 11, 21 restored with porcelain veneers – 13 years after injury
Img. 20 – The X ray of the teeth 11, 21 restored with porcelain veneers, 1 year after veneer cementation and 13 years after injury
Img. 21 – The smile of a happy patient, 13 years after of injury of maxillary central incisors
1. Minimal invasive adhesive dentistry, when appropriately implemented, can be a successful alternative to implant therapy, even in certain cases of severely fractured teeth.
2. Careful interdisciplinary discussion and individual decision-making on a case-by-case basis should always be considered.