How to rescue a broken central Incisor?



Occasionally a patient comes in with a broken central incisor after some trauma. One day slightly over a month ago, one of my patients came in and was really upset since he had just broken his maxillary central and needed something done. As are many of my Manhattan patients, he was extremely busy and  had an "important meeting" the following day.  When I inspected the damage,my heart sank. To me it didn't look like there was sufficient tooth structure for me attach a reliable restoration. Yes I could fix it, but it might break the first time he bit into a sandwich. "Doc You have to do something!" he said... and then he added "I can't leave here without a tooth! "

Now time was of the essence since I had another patient due in less than an hour so I had to work fast. What should I do in that window of time. Starting a root canal wasn't my best option, since the pulp wasn't exposed and I really didn't have the time to start a root canal and make a temporary post and crown in the next 50 minutes.

What I did seemed to work out for him. Luckily he had brought in the part of the tooth that broke off with him and I put some crazy glue on it and put it back in his mouth. Then I took a fast silicone impression of the reconstituted tooth and put it aside. I removed snapped off the broken tooth again and cleaned the stump and bonded a tooth colored composite core onto what remained of his tooth.

Then I packed a zero Ultradent cord around the tooth to retract the gingiva slightly and prepped the tooth and core with a narrow diameter chamfer bur (.75mm at tip). The chamfer was not too deep and luckily for my patient he had some recession on the lingual of his tooth and I was able to prep more than three mm of ferrule on the inside of his tooth. I figured this would help retain his restoration.

I filled my silicone impression with A-1 Protemp composite material and reinserted it into his mouth and Voila... sixty seconds later removed it from his mouth while it still was in the gel state. Four minutes later it was set and I trimmed it so it had nice margins, polished it with an enhanced point and used Nexus luting cement to bond his new overly white temporary onto his prepared tooth. I asked him to stay away from stiff baguettes and asked him to return in thirty days if his temp was still in place.

Its been over thirty days since he left happy with his temporary crown, but I haven't heard anything back from him. I was completely unsure on how well my temporary my fix would work,  but given the circumstances, it was the best I could do. I look at the temporary as a "proof of concept" if it stays put for six months or more, I might even consider replacing it with a permanent bonded crown. His alternative options are to have, crown lengthening and a new crown  (he will likely need crown lengthening of multiple teeth for it too look good)  a root canal post and crown, a three unit bridge or an extraction and a single tooth implant restoration. None of these alternative options are extremely appealing but maybe needed if my temporary doesn't stand the test of time.










from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/03/how-to-rescue-broken-central-incisor.html - http://lspindelnycdds.blogspot.com/

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