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Multidisciplinary Approach in Management of Fractured Incisor....
Sushil K C et al CASE REPORT
Multidisciplinary Approach in Management of Fractured Central

Incisor through Composite Plug Stabilization - A Case Report
Sushil Kumar C1, Amit Rao2, Sheila K3, Hanumanth Reddy G4
1Reader, Department of Conservative and Endodontics, Dr.H.S.R.S.M Dental College Hingoli, Maharashtra, India; 2Professor ,Department of
Oral and Maxillofacial Surgery, Dr.H.S.R.S.M Dental College Hingoli, Maharashtra, India; 3Senior lecturer, Department of Pediatric and
Preventive dentistry, Dr.H.S.R.S.M Dental College Hingoli, Maharashtra, India; 4MDS, Professor, Department of Orthodontics, Chhattisgarh
Dental College & Research Institute, Rajnandgaon, Chhattisgarh, India.
ABSTRACT
Crown fracture is the most frequent type of traumatic injury in permanent dentition. Traumatized anterior teeth
requires quick functional and esthetic repair. Traditionally such injuries have been restored with conventional
post-core and crown techniques after endodontic treatment. This article presents an innovative technique of
managing a complicate crown fracture of anterior tooth where plain orthodontic band was used for stabilization
and post endodontic restoration was done with adhesively luted fiber reinforced composite post through fragment
and composite plug stabilization.
Key words: Traumatic injuries, Crown fracture, Composite plug.
How to cite this article: Sushil K C, Rao A, Sheila K, Hanumanth R G. Multidisciplinary Approach in Management
of Fractured Central Incisor through Composite Plug Stabilization - A Case Report. J Int Oral Health 2013; 5(1):79-
82.
Source of Support: Nil Conflict of Interest: None Declared

Received: 11th November 2012 Reviewed: 12th December 2012 Accepted: 10th January 2013
Address for Correspondence: Dr. Sushil Kumar C, Access Dental Hospital, # 5, & 6 Satya complex, Golnaka
Alwal, Secunderabad-10. Email: 16.sushil@gmail.com. Contact no.: 9704171797
Introduction: Complicated crown fracture in a mature anterior

Traumatic injuries to the teeth and the supporting tooth should be immediately treated with method
structures are one of the few areas in dentistry of isolation and restoration becomes difficult.
that should be considered as an emergency. Restoration of esthetics is one of the main
Crown fracture is the most frequent injury in concerns in such teeth2. This article presents an
permanent dentition. Apart from loss of hard innovative technique of managing a complicate
tissue, this injury represents hazard to pulp. crown fracture of anterior tooth where plain
Traumatized anterior teeth requires quick orthodontic band was used for stabilization and
functional and esthetic repair. Traditionally such post endodontic restoration was done with
injuries have been restored with conventional adhesively luted fiber reinforced composite post .
post-core and crown techniques after endodontic
Case Report:
treatment. Several factors influences the
management of coronal tooth fractures including A 17 years old female patient walked into
extent of fracture, pattern of fracture and the department of Conservative dentistry and
restorability of the tooth, presence or absence of Endodontics Dr.H.S.R.S.M Dental College at
the fractured tooth fragment, occlusion and Hingoli, Maharashtra, sustaining a complicated
esthetics1. crown fracture to her left upper central incisor.
The patient’s history for allergy or systemic
[ 79 ] Journal of International Oral Health. Jan-Feb 2013; 5(1):79-82

Multidisciplinary Approach in Management of Fractured Incisor....Sushil K C et al CASE REPORT
problems was non-contributory. Externally mild endodontically following conventional methods.

swelling of the lip was observed. Intraoral clinical The major concern in this case was giving a
examination revealed laceration in the alveolar proper definitive restoration. After a week of root
sulcus in relation to upper incisors. There was no canal treatment post space was prepared by
evidence of alveolar fracture. Clinically the upper removing gutta-percha from the root canal space
left central incisor presented with fracture lines using a no.2 Pezzo drill, leaving the apical third
running across the crown where the conventional intact. Later a fiber reinforced composite (FRC)
technique of placement of rubber dam clamp and post (size 2) was selected. The post space was
Fig. 1: Pre-operative Photograph of the Fractured 21 Fig. 2: Stabilization Done with Orthodontic Band
achieving access was not possible. Stabilization etched for 15secs using 35% phosphoric acid,
and approximation of the fragments was achieved washed thoroughly and air-dried. Then the post
by using pre-formed orthodontic band, which space was painted with bonding agent and light
was cemented to the tooth by zinc phosphate cured for 20secs. The post space was filled with
cement. dual curing composite resin cement with the FRC
Root canal therapy was performed after proper post in place and light cured at an angle of 450 for
stabilization with the orthodontic band. 40secs at three levels. In this case, bonding of
Stabilization with the band helped in achieving composite resin luting cement to the FRC post is
better access and standard isolation with the help both chemical and mechanical bonding because of
of rubber dam. The tooth was treated
Fig. 4: Post-operative Radiograph Fractured

Fig. 3: Pre-operative Radiograph
the isoelastic properties of the resin cement, post week’s follow-up the tooth was restored with a
and dentin. provisional crown.
Fig. 6: Grooves prepared along Fracture Lines.

Fig. 5: Placement of FRC Post
In this case, the composite core build-up was Discussion:

replaced by the fragment strengthening of the The aim of endodontic and restorative treatment
fractured crown to prevent the natural tooth is to restore the function, form and esthetics.
structure and provide better esthetics. Fragment Esthetics has an impact on psychology of an
strengthening of the fractured crown was adolescent patient when it comes to anterior teeth.
performed by preparing 3mm of deep grooves of Traditionally cast posts have been used for
0.8mm width along the fracture lines leaving the restoration of endodontically treated teeth with
incisal edges. Later composite cement was used complicated crown fracture. Recent advancements
along the grooves and light cured. From the post in adhesive dentistry lead to the usage of ﬁber-
space to the fragment stabilisation resin cement reinforced resin-based composite posts with resin
Fig. 7: After Fragment Strengthening

Fig. 8: Provisional Crown.
and composite material was used for establishing composite build-ups especially with teeth in the
a plug for better integration and bond strength. esthetic zone are considered such as maxillary
This technique of composite plug stabilization anterior teeth6.
exhibits better bond strength between the luting Usage of FRC post along with resin cement helps
materials, root dentin and FRC posts5. After a in distribution of stresses along the tooth structure

uniformly thus decreasing the chances of post References:

endodontic failure. Because of the isoelastic 1. Macdeo GV, Diaz PI, De O Fernandes CA.
properties and similar modulus of elasticity of the Reattachment of Anterior Teeth Fragments: A
FRC post, resin cement and dentin increases the Conservative Approach. J Esthet Restor Dent;
retention and provides monoblock effect5. 2008;20:5-20.
In this case stabilization of the fractured 2. Andreason FM, Andreasen JO. Crown root
fragments was achieved by orthodontic band fractures: Textbook and colour atlas of
which helped in retention of natural tooth traumatic injuries to the teeth, 3rd edition.
structure and establishment of esthetics. This Copenhagen, Munksgaard, 1994;219-56.
technique employed was an excellent means of 3. Ingle J, Bakland LF. Endodontic
stabilization of the fractured teeth and prevented considerations in dental trauma. Endodontics,
its demise during the root canal treatment7. 5th edition. Elsivier.2002;795.
Fragment strengthening of the fractured crown 4. ZJohn SR. Advanced endodontics. Clinical
was possible in this case as there was absolutely Retreatment and Surgery, 2nd edition. New
no loss of the crown structure apart from the York, 2006;17.
fracture lines running across the tooth. As the 5. Tay FR, Pashley DH. Monobloks in root
original contour was intact, the natural tooth canals: A hypothetical or a Tangible Goal.
structure acted as biological contour for better J.Endod 2007;33:391-8.
resistance. 6. Reis A, Kraul A. Reattachment of fractured
teeth, A review of literature regarding
Conclusion:
techniques and materials. Oper Dent.
In a traumatic injury to the tooth, the success of
2004;29(2):226-33.
the endodontic treatment depends on the
7. Reis A, Kraul A. Francei C. Reattachment of
remaining tooth structure. Though a FRC post
anterior fractured teeth. Fracture strength
was used for support maximum effort was put to
using different materials. Oper Dent.
save the natural tooth structure for better esthetics
2008;27:621–7.
and function. The current case report illustrates a
viable and conservative technique by which the
fractured tooth can be stabilized without any
fragment loss through which both function and
esthetics were established.

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Multidisciplinary Approach in Management of Fractured Incisor....

Sushil K C et al CASE REPORT

Multidisciplinary Approach in Management of Fractured Central

Source of Support: Nil Conflict of Interest: None Declared

Introduction: Complicated crown fracture in a mature anterior

[ 79 ] Journal of International Oral Health. Jan-Feb 2013; 5(1):79-82

problems was non-contributory. Externally mild endodontically following conventional methods.

Fig. 4: Post-operative Radiograph Fractured

Fig. 6: Grooves prepared along Fracture Lines.

In this case, the composite core build-up was Discussion:

Fig. 7: After Fragment Strengthening

[ 81 ] Journal of International Oral Health. Jan-Feb 2013; 5(1):79-82

uniformly thus decreasing the chances of post References:

[ 82 ] Journal of International Oral Health. Jan-Feb 2013; 5(1):79-82

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