The Conservative Restoration In Critical Areas
A young patient presented to the Author with a traumatic coronal fracture of tooth 21, localized at cervical level at about 1 mm from the cementum-enamel junction.
A standardized periapical radiograph was taken and a careful treatment plan was designed. A multidisciplinary approach was chosen, based on endodontic treatment, temporary conservative restoration, orthodontic treatment and prosthetic rehabilitation of the tooth.
After the clinical examination, an oblique coronal-apical fracture moving buccally to palatally was evidenced; such fracture extended below the palatal gingival margin causing the complete detachment of the crown.
The operatory field was isolated by means of rubber and liquid dam and the tooth was subjected to endodontic treatment and three-dimensional obturation of the root canals.
Then, a glass fiber post was luted using a resin cement.
After rinse and disinfection of the crown, the fragment was bonded to the root by menas of adhesive techniques, paying careful attetntion to the isolation and inspection of the gingival margin.
Then, the restored tooth was subjected to orthodontic treatment. A controlled extrusion was performed, progressively reducing the length of the crown at the incisal margin, in order not to create any occlusal interference and keeping a good simmetry of the front teeth.
The orthodontic extrusion caused a coronal migration of both the marginal and deep periodontal tissues.
Subsequently, the clinical crown was lengthened by means of periodontal surgery, so as to match the gingival parabola to that of the adjacent tooth.
The patient was not satisfied by the esthetics of tooth 11 beacuse of a sever milky characterization of the incisal third. Consequently, the appearance of the tooth was corrected with a minimally invasive conservative treatment.
After healing of the periodontal tissues, the tooth 21 was prepared for a prosthetic restoration and the marginal tissues were conditioned with a temporary resin restoration.
Finally, the tooth was restored with an all-ceramic single crown.
The Author would like to thank Dr. Aldo Crescini (Brescia, Italy) for the orthodontic support.
Odontoiatria estetica adesiva. Didattica Multimediale
A. Cerutti, F. Mangani A. Putignano
Quintessenz Verlags-GmbH, Berlin