Introduction: the maxillary and mandibular arches were made using

Introduction:

Dentoalveolar fracture is
the most well-known type of head and neck trauma. Dental trauma may happen
because of a sports mishap, a fall inside of the home, or other causes. Traumatic
injuries to teeth and their supporting tissues, can occur in any age group, but
children are most common candidate followed by adolescents. Damage may vary
from enamel fracture to avulsion, with or without pulpal involvement or bone
fracture.

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Anterior anatomic crown fractures
are a common site of injury. Uncomplicated crown fracture of the permanent
teeth has an intense effect not only on the patient’s appearance, but also in
function, speech and physiological behavior.1 The treatment for such
trauma depends upon the type of injury and whether the injured tooth is a
primary or permanent tooth. Definitive treatment is essential for the well-being
of the dentoalveolar fracture.

The case report describes an
innovative technique in rehabilitating an uncomplicated fractured maxillary central
incisors tooth in a young patient with composite, which is easily available,
economical and requires less operating time with direct technique.

Case Report:

 A 12-year-old traumatized boy was reported to
the Department of Paediatric Dentistry, Pacific Dental College & Hospital,
and Udaipur. The patients reported with chief complain correction of broken
upper front teeth. Patient gave history of trauma 6 days back due to fall on
ground while playing. On extraoral examination revealed no gross facial abnormality.
Intra oral examination revealed Ellis class II (uncomplicated) fracture irt 11
and Ellis class I fracture irt 21. The teeth were asymptomatic without any
associated soft or hard tissue injuries to the supporting tissues and responded
well to Electric Pulp Tester indicating positive teeth vitality. Intraoral
periapical radiograph confirms the absence of pulpal or periapical pathology. So,
it was planned to rehabilitated the fractured segment using composite
restoration with direct technique using template.

Primary impression of the maxillary
and mandibular arches were made using alginate(). Study
models were made in Type III dental stone() and
mock build-up of the lost teeth structure with modeling wax() was done. After build-up of lost segment, the cast
was duplicated by using template of putty impression material(). Labial surface of the putty template was removed
up to middle third of the crown, to aid in the reconstruction of the lost tooth
structure. On labial aspect groves were made and unsupported enamel was
removed. A clinical try-in of the template was done to ensure adequate fit. After
appropriate shade selection of the composite material, this crown former was
used to restore the fractured tooth quickly with minimal post-restoration
finishing.

Discussion:

Trauma with accompanying fracture of
a permanent incisor is a terrible experience for young patient and creates
pschycological impact on both the parents and children.2 If the injury involves the loss of
extensive tooth structure, it alters the child’s appearance and makes him the
target for teasing by peers.

Treatment objectives may vary
depending on the age of the patient, socioeconomic status of the patient and
intraoral status at the time of treatment planning.3 There are various treatment
modalities for restoration of fractured teeth like composite restoration, fixed
prosthesis, reattachment of the fracture fragment (if available) followed by
post and core supported restorations.3-5 Common restorative treatments such
as laminate veneers or full-coverage restoration may be considered after
multiple fragment rebonding/ composite resin restorations have been done and
this option is no longer functional. They also tend to sacrifice the healthy
tooth structure and challenge the clinician to match with the adjacent healthy
teeth.

Management of patient with anterior
tooth fracture provides a great challenge to the clinicians both from a functional
and an esthetic perceptive. The predictable esthetic
restoration of broken incisal edge of maxillary incisors is a demanding and technique
sensitive procedure. Its success is dependent on operator’s skills and
knowledge and also on adhering to a systematic and problem solving approach.6 A logical method is used
to build-up morphologically correct composite restorations by careful selection
of composite shades, tints and opaquers. In accurate combinations, an illusion
of varying translucencies and opacities become visible over natural tooth
structure.7

 In patients with fractured dentition,
satisfactory results were reported with anterior composites offering a cost
effective treatment alternative where esthetics is a major concern. With
further improvements in bonding chemistry, the suc­cess rate of composites is
speculated to improve.6 A good polishing system including
polishing paste, cups and wheels is recommended to achieve appropriate luster.

In the present case innovative
technique which includes both direct and indirect method of restoring was
designed by using Polyvinyl Siloxane (PVS) Rubber base impression material
(putty) as template. This method is simple quick and economic when compared to
other invasive procedures. The usage of the PVS template allowed incremental
layering of the composite material; optimal depth of cure; accurate
reproducibility of the anatomic contours and minimal polishing and finishing procedures.8,9

Conclusion:

Direct composite resin bonding agents
successfully deal with esthetic issue of maxillary anterior teeth along with a
painless approach providing successful outcome for the dentist and greater
satisfaction for the patients. As restoring a fractured tooth is a complex
procedure, this technique can prove as a simple, effective and appropriate
technique that will fulfill all the requirements of dental personnels.

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