August 2008

Repositioning of fracture tooth fragment

R.Sathyanarayanan

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This patient reported with a fracture of the right central incisor, immediately after the injury. The fracture fragment that was implanted in the upper lip was removed and sutured. This case tells us the importance of soft tissue examination especially in tooth fracture cases to rule out the presence of fractured fragments in the soft tissue.

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Removed fractured fragment was refixed with composite and as the patient was from different city, was advised for regular follow up for pulpal status. Patient came for follow up after three years with discomfort in relation to the same tooth. Radiograph revealed improper obturation in relation to the same tooth.

 

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Retreatment was advised and the same was successfully carried out. Post operative radiograph revealed satisfactory apical seal and lateral seal.

 

 

 

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Patient reported three years after completion of retreatment and was symptomatic.Radiograph revealed good formation of bone tissue at periapex.

 

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Clinical examination revealed wearing away of the intervening composite used to bone the fracture fragment. There is mild discoloration and the treatment is scheduled for full ceramic crown. Repositioning of fracture tooth fragment may be interim treatment option for emergency esthetic management. The success of such reposition will depend upon the approximation of fragment and the extend of fracture line. Fracture fragment in communication with gingival tissue/ extending sub gingival will not be an ideal candidate for such therapy. In fact it may cause sub gingival caries and may pave way for extraction of tooth in long term.

 

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This case shows a fractured buccal cusp of the premolar which already had an amalgam restoration. Since the fragment had a good apposition to the tooth, it is used for restoring the fracture along with composite material.

 

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Another case that shows a fractured fragment from the second molar, the palatal cusp, which was intact and used for restoring along with composites. Since these patients did not report back ,the longevity of these restorations is not sure.