The bane of the baby boomer: coronal fracture syndrome.
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Coloring Agents↗
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Incisal edge reattachment: literature review and treatment perspectives.
Anterior crown fractures in children and adolescents are a common form of injury, affecting approximately 25% of that population. Common restorative treatments such as composite bonding, laminate veneers, or full-coverage restorations tend to sacrifice healthy tooth structure and challenge dentists to match the adjacent unrestored dentition. Incisal edge fragment reattachment, including the use of current bonding techniques, is a restorative treatment option that offers the advantages of simplicity, immediate esthetics, and conservatism in cases of dental trauma. This article presents a comprehensive literature review on this restorative technique. It also provides diagnostic and treatment algorithms to simplify and clarify the recommended diagnostic and clinical regimens.
Child↗
Reattachment and orthodontic extrusion in the management of an incisor crown-root fracture: a case report.
This article describes the management of a case of oblique crown root fracture of a central incisor where the fractured fragment was used as a temporary replacement crown in order to maintain esthetics during the period of orthodontic extrusion of the remaining root. Placement of the final restoration after orthodontic extrusion resulted in good esthetics and periodontal health postoperatively. The merits and demerits of this treatment modality are discussed.
Adolescent↗
Influence of margin design and taper abutment angle on a restored crown of a first premolar using finite element analysis.
PURPOSE: The purpose of this study was to determine the influence of margin design and taper abutment angle on the stresses developed in all-ceramic first premolar crowns. MATERIALS AND METHODS: Four margin designs and three taper abutment angles were independently incorporated into models examined by finite element analysis. A 600-N force was applied vertically downward. RESULTS: The taper abutment angle had a significant influence on the greatest peak tensile maximum principal stresses (sigma11) in the coping (16.8% change in stress for an 8-degree variation in taper angle). The margin design had significant influence on the highest peak tensile sigma11 in the dentin (60% difference in stress between designs) and lesser significance in the cement (30%). All calculated values of the highest peak tensile sigma11 were considerably lower than the fracture strengths of the respective materials in which the stresses resided. CONCLUSION: A smaller taper abutment angle and a larger chamfer radius (equivalent to the modified light chamfer) are recommended to reduce the magnitude of the greatest peak tensile sigma11 based on the finite element modeling conducted.
Bicuspid↗
Disturbed root development of permanent teeth after pediatric stem cell transplantation. Dental root development after SCT.
BACKGROUND: Deficient dental root development has been reported after conventional pediatric anticancer therapy, but less information is available on stem cell transplantation (SCT) recipients. METHODS: Root-crown (R/C) ratios of fully developed permanent teeth were assessed from panoramic radiographs of 52 SCT recipients, who were treated when they were age < 10 years. Using standard deviation scores (SDSs), the authors compared the R/C ratios to the corresponding tooth and gender-specific values in a healthy population. The percentage of affected R/C ratios per individual was examined in a subgroup of 39 (SG39) patients with advanced tooth development. The effects of total body irradiation (TBI) and SCT age on the R/C ratios were studied in TBI and high-dose chemotherapy (HDC = non-TBI) groups and in 3 age groups (< or = 3.0 years, 3.1-5.0 years, > or = 5.1 years). RESULTS: Per individual, 77% of the fully developed permanent teeth were affected in SG39. At the tooth level, in 77% of the 945 teeth studied (52 patients), the R/C ratios were outside +/-2 SDSs. More teeth were affected in the TBI (85%) than in the non-TBI (55%) group (P < 0.001). The teeth of the patients who were ages 3.1-5.0 years old at SCT presented with the most severe aberrations of the R/C ratio (mean SDS = -4.4) whereas the teeth of the youngest (age < or = 3.0 years) and the oldest (age > or = 5.1 years) patients were equally affected (mean SDSs = -3.1 and -3.0, respectively). CONCLUSIONS: Disturbances of dental root growth always followed pediatric SCT. HDC alone intensely harmed root growth but TBI further increased the adverse effects that were most extensive in the patients 3.1-5.0 years at SCT. These sequelae should be taken into account during the lifelong dental follow-up to minimize the clinical consequences of dental injuries.
Adolescent↗
A biological conservative approach to complex traumatic dento-alveolar lesions.
Of all the kinds of traumatic dental injury, luxation injuries associated with crown-root fractures deserve special attention due to the particular need for complex multidisciplinary treatment. Clinical experience has demonstrated the need for repositioning of luxated teeth and treatment of crown-root fractures by orthodontic or surgical extrusion and completed with periodontal plastic surgery (gingivoplasty). In many cases the outcome is good conservation and excellent esthetic results. This approach cannot however, always be recommended, for example because of the age of the patient. For this reason, a different protocol is proposed that involves, in addition to orthodontic repositioning of the luxated teeth, (as is required to return teeth to the physiological position), the extrusion, restoration and subsequent re-intrusion to the natural position (without the need for further surgery) of those teeth involved with associated crown-root fractures. Two cases illustrate the use of this proposed technique.
Adolescent↗
Displacement and pulpal involvement of a maxillary incisor associated with a talon cusp: report of a case.
The talon cusp is a relatively uncommon dental anomaly manifested as an accessory cusp-like structure on the crown of anterior teeth. The presence of a talon cusp can cause clinical problems. This article reports the case of a patient presenting a talon cusp affecting the permanent maxillary right central incisor causing clinical problems related to caries, displacement of the tooth, occlusal position and tendency to dental traumatism. The management of this tooth included caries removal and reduction of the cusp. Pulp-capping with calcium hydroxide was required because of the presence of pulp horn extensions in the talon cusp.
Child↗
Changes in tooth length on radiographs after crown therapy.
Altogether 155 crowned teeth--incisors, canines, premolars and molars in both jaws--have been studied by means of radiographs regarding tooth length before and after crown therapy. The results show that the correlation in tooth length is good. The mean differences, however, vary between -0.52 mm for the upper molars and 0.44 mm for the upper incisors. The best correlation in tooth length was found for the upper premolars and the lower incisors.
Crowns↗
Human and mouse cementum proteins immunologically related to enamel proteins.
SDS-polyacrylamide gel electrophoresis, immunoblot and amino acid composition analyses were applied to human and mouse acellular cementum proteins immunologically related to enamelins and amelogenins. In this analysis, anti-mouse amelogenin, anti-human enamelin and synthetic peptide (e.g., -LPPHPGHPGYIC-) antibodies were shown to cross-react with tooth crown-derived enamelin with a molecular mass of 72,000 Da (72 kDa), amelogenins (26 kDa), and also to four human cementum proteins (72, 58, 50 and 26 kDa) and two mouse cementum proteins (72 and 26 kDa). Each of the antibodies recognized tooth root-derived cementum polypeptides which share one or more epitopes with tooth crown-derived enamel proteins. The molecular mass and isoelectric points for crown-derived and root-derived enamel-related proteins were similar. Analysis of human and mouse cementum proteins revealed a characteristic amino acid composition enriched in glutamyl, serine, glycine, alanine, proline, valine and leucine residues; compared to the major enamel protein amelogenin, cementum proteins were low in proline, histidine and methionine. The human and mouse putative intermediate cementum proteins appear to represent a distinct class of enamel-related proteins. Moreover, these results support the hypothesis that epithelial root sheath epithelia express several cementum proteins immunologically related to canonical enamel proteins.
Amelogenin↗
Analysis of the crown fractures and crown-root fractures due to dental trauma assisted by the Integrated Clinic from 1992 to 2002.
The purpose of this study was to analyze crown fractures and crown-root fractures due to dentoalveolar trauma, treated in the Integrated Clinic comprehensive dental care at Aracatuba School of Dentistry (UNESP), from January 1992 to July 2002. The data were obtained from files of trauma cases. On the analysis period, 293 patients had crown fractures or crown-root fractures, in 605 teeth. Sixty-nine percent were males and 31% were females. Adolescents between 11 and 18 years old were the most prevalent group (41.6%) and the maxillary arch was the most commonly traumatized (83%). The most commonly affected tooth was the maxillary central incisor (58.3%). The most frequent causes were falls from bicycles (30.8%). It was concluded that the reality of the local service is similar to the published data.
Accidental Falls↗
Management of traumatic injuries in the anterior region.
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Bicycling↗
Otodental syndrome: a case report.
The purpose of this article is to describe the clinical features of otodental syndrome. A 9-year-old boy presented with dental abnormalities that have been described for otodental syndrome. The characteristic findings included large bulbous crowns in canine and molar teeth of both dentitions, deep vertical enamel fissures separating the cusps of affected molars, and hypoplastic yellow areas on the labial surfaces of the canines. Radiographs revealed the abnormal molars to possibly be the product of fusion of multiple tooth buds. The pulp chambers appeared to be duplicated, and possibly a supernumerary tooth or complex odontoma is present.
Child↗
Comparison of the contact surface pattern between virtual and milled Cerec 3D full-ceramic crowns.
PURPOSE: The objective of this study was to compare resulting contact point patterns in the context of crown production with the Cerec 3D system. The contact surface patterns of full-ceramic crowns milled with the Cerec 3D system were examined for agreement with the corresponding virtually produced crowns. MATERIALS AND METHODS: The agreement was determined with regard to the parameters number, size, position, and shape. Twenty-eight models were mounted centrally in a mechanical articulator. In these model cases, at least one second premolar and one first molar in the maxilla and mandible had to be prepared for crown production (preparation). A total of 50 teeth was prepared. Crowns were then designed with the aid of the Cerec 3D system. The crown designs were milled and integrated in the model. Silicone bite registrations, the contact point patterns of which were compared with the virtually designed crowns, were produced in static occlusion in the region of the crowns. Different evaluation methods were used for the comparison. RESULTS: There was an agreement of 78% with regard to number, 76% in terms of localization, 65% regarding size, and 65% in terms of shape. CONCLUSION: It was thus confirmed that very good, highly reproducible results can be achieved with the Cerec 3D system.
Bicuspid↗
Effect of treatment delay upon pulp and periodontal healing of traumatic dental injuries -- a review article.
Based on an analysis of the literature concerning parameters influencing the prognosis of traumatic dental injuries, few studies were found to have examined possible relationships between treatment delay and pulpal and periodontal ligament healing complications. It has been commonly accepted that all injuries should be treated on an emergency basis, for the comfort of the patient and also to reduce wound healing complications. For practical and especially economic reasons, various approaches can be selected to fulfill such a demand, such as acute treatment (i.e. within a few hours), subacute (i.e. within the first 24 h), and delayed (i.e. after the first 24 h). In this survey the consequences of treatment delay on pulpal and periodontal healing have been analyzed for the various dental trauma groups. Applying such a treatment approach to the various types of injuries, the following treatment guidelines can be recommended, based on our present rather limited knowledge of the effect of treatment delay upon wound healing. Crown and crown/root fractures: Subacute or delayed approach. Root fractures: Acute or subacute approach. Alveolar fractures: Acute approach (evidence however questionable). Concussion and subluxation: Subacute approach. Extrusion and lateral luxation: Acute or subacute approach (evidence however questionable). Intrusion: Subacute approach (evidence however questionable). Avulsion: If the tooth is not replanted at the time of injury, acute approach; otherwise subacute. Primary tooth injury: Subacute approach, unless the primary tooth is displaced into the follicle of the permanent tooth or occlusal problems are present; in the latter instances, an acute approach should be chosen. These treatment guidelines are based on very limited evidence from the literature and should be revised as soon as more evidence about the effect of treatment delay becomes available.
Alveolar Process↗
Vital pulp therapy with mineral trioxide aggregate.
The present case report describes the treatment of complicated crown fractures using mineral trioxide aggregate (MTA). MTA was used as pulp-capping material after partial pulpotomy to preserve the vitality of the pulpal tissues in two cases. Follow-up examinations revealed that the treatment was successful in preserving pulpal vitality and continued development of the tooth.
Aluminum Compounds↗
Restoration modalities of severely injured anterior teeth--gingival integration, papillae support, and predictable imperfections.
This article presents 4 cases, each describing a different dental trauma and a different treatment modality. Because of various limitations, none of the results presented is esthetically perfect, but the outcomes were acceptable to both the operators and the patients. Such limitations should be predicted and discussed with patients before beginning treatment and should be regarded as acceptable compromises, unless other less conservative treatments are to be used.
Adult↗
A calculation of stress distribution in metal-porcelain crowns by using three-dimensional finite element method.
The objective of this study was to calculate stress distribution in a maxillary second premolar tooth which occurred by the mastication force. The tooth model was crowned with Au-Pd alloy, Ni-Cr alloy and porcelain. A load of 450 N, at an angle of 45 degrees to the longitudinal axis was applied on the occlusal margin of the crown tooth. The tooth was assumed isotropic, homogenous, elastic and unsymmetrical. This numerical study was carried out using three-dimensional finite element models and calculation programs were prepared by the authors using FORTRAN 77. The distribution of compressive, tensile and shear stress were plotted for the dentine, dentine-metal and metal-porcelain interfaces. The highest stress values were observed when Ni-Cr alloy and porcelain was used.
Bicuspid↗
Vertical root fracture in endodontically treated teeth: a review of 25 cases.
OBJECTIVE: We sought to examine the clinical conditions under which 25 endodontically treated teeth underwent vertical root fracture (VRF) and to relate this condition to the time elapsed from endodontic treatment to fracture. STUDY DESIGN: This was a retrospective study in which we reviewed 25 case histories of patients with postendodontic VRF and studied the effect of various pretreatment and posttreatment factors as they related to VRF. RESULTS AND CONCLUSIONS: The mean time to VRF was 54 months; this was not significantly influenced by the presence or absence of prior restoration or by the presence or absence of a crown fitting. The use of a prefabricated, cylindrical, cemented intraradicular retainer increased the time between endodontics and VRF. Teeth restored with conventional amalgam took significantly longer to undergo VRF than those restored with composite or bonded amalgam. In contrast, amalgam-restored teeth suffered more coronal fractures before VRF than did teeth in the other 2 groups.
Cementation↗