2. CLINICAL PEDIATRIC DENTISTRY I DSV 441 CHAPTER 21 MANAGEMENT OF TRAUMA TO THE TEETH AND SUPPORTING TISSUES II EMERGENCY TREATMENT AND TEMPORARY (pages 461-465) 17 Tuesday 10\2\2015 1:00 pm-2:00 pm OTHMAN AL-AJLOUNI 1

3. Lecture outline EMERGENCY TREATMENT AND TEMPORARY RESTORATION OF FRACTURED TEETH WITHOUT PULP EXPOSURE FF ragment Restoration (Reattachment of Tooth Fragment) TT emporary Bonded Resin Restoration OO rthodontic Band SS tainless Steel Crown 2

4. EMERGENCY TREATMENT AND TEMPORARY RESTORATION OF FRACTURED TEETH WITHOUT PULP EXPOSURE The emergency treatment of minor injuries in which only the enamel is fractured may consist of no more than smoothing the rough, jagged tooth structure. The patient should be reexamined: -a-at 2 weeks -a-at 1 month after the injury. If the tooth appears to have recovered at that time, -c-continued observation at patient's regular recall appointments. 3

5. Extensive loss of tooth structure and exposed dentin require an IMMEDIATE temporary restoration or protective covering, in addition to complete diagnostic procedure. Initial pulpal hyperemia and possibility of further trauma to pulp by PRESSURE or by THERMAL or CHEMICAL irritants must be reduced. In addition, if NORMAL CONTACT with adjacent or opposing teeth has been lost, temporary restoration or protective covering to maintain integrity of arch. Several restorations that will satisfy these requirements can easily be fabricated. 4

6. FRAGMENT RESTORATION (REATTACHMENT OF TOOTH FRAGMENT) Occasionally the dentist may have the opportunity to reattach the fragment of a fractured tooth using resin and bonding techniques. 5

7. FRAGMENT RESTORATION (REATTACHMENT OF TOOTH FRAGMENT) For cases in which considerable dentin is exposed or a direct pulp cap is indicated, some controversy currently. Some believe that the meticulous USE OF BONDING AGENTS AND MATERIALS TO DIRECTLY cap the exposed dentin and the pulp (if exposed) is best, whereas others believe that CALCIUM HYDROXIDE should be applied to the exposed dentin and pulp before completing the bonding procedure. The former method has been called the total- etch technique. 6

8. FRAGMENT RESTORATION (REATTACHMENT OF TOOTH FRAGMENT Studies Croll has reported successfully using light-hardened GLASS IONOMER material for reattaching fragments. Kanca reported reattachment of a fragment that successfully capped the pulp using the TOTAL-ETCH TECHNIQUE. Ludlow and LaTurno have reported the success of a fragment restoration for a 13-year-old patient in which essentially the ENTIRE CLINICAL CROWN of a maxillary incisor was fractured away (Class IV fracture).The remaining tooth was first treated with a root canal filling, and then the pulp canal of the tooth and the enlarged pulp chamber in the fragment crown were used as retentive internal cavities to strengthen the reattached crown. 7

9. FRAGMENT RESTORATION (REATTACHMENT OF TOOTH FRAGMENT) TREATMENT STRTEGY Fragments can be reattachment WITHOUT HAZARD to pulpal vitality at time of injury. Advantages of immediate fragment reattachment: SHORT treatment time, immediate hermetic SEAL of dentinal tubules, immediate restoration of FUNCTION and ESTHETIC. Using calcium hydroxide as a liner lower the strength of bonding. Fragment should kept in moist. Direct bonding of the fragment performed after pulpotomy. Newer dental adhesives which bond to a moist dentin surface. Expanded area of application in treatment of fractures close to gingival crevice. 8

10. FRAGMENTAL RESTORATION CLINICAL APPROACH Enhance fragment retention - Cleaning - Testing the fitting - Fragment handling - Preparation of both fractured surfaces - Enamel etching - Dentin etching (Conditioning) - Bonding of the fragment - Fragment repositioning - Photo-polymerization

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18. TEMPORARY BONDED RESIN RESTORATION The excellent MARGINAL SEAL and RETENTION. These bonding techniques are highly successful and versatile. Not be advisable to restore an extensive crown fracture with a finished esthetic resin restoration ON DAY OF INJURY, -N-NOT TO MANIPULATE tooth. -U-UNSCHEDULED appointments. A temporary restorative resin restoration can be placed in an efficient manner and is treatment of choice. As a protective covering at fracture site As a short-term temporary restoration, it requires little or no finishing and does not need to restore tooth to normal contour. After an adequate recovery period, an esthetic resin restoration may be completed, without removing all temporary resin material. 17

19. ORTHODONTIC BAND Serve as a RETAINER or a THERAPEUTIC DRESSING on exposed dentin and MAINTAIN CONTACT with adjacent teeth. It does not meet esthetic requirements and should be replaced. It may be temporary restoration of choice immediately after an injury if tooth cannot be easily isolated for a bonding procedure. If EXTENSIVE loss of tooth structure or tooth MOBILITY makes this procedure difficult, band can be adapted to a corresponding intact tooth. Advantage of EASILY, QUICKLY and clinical crown is sufficiently exposed to make PERIODIC PULP TESTS. The band is allowed to remain undisturbed for 4 to 6 weeks or until initial recovery of dental pulp is reasonably evident. 18

20. STAINLESS STEEL CROWN One of most STABLE restorations for temporary protection of a fractured tooth. If coronal fracture is EXTENSIVE WITH A VITAL PULP EXPOSURE (especially class IV), this crown be temporary restoration of choice to provide PROTECTION and SPACE MAINTENANCE. Also indicated when patient is AWAY from dental service in BED and COMPLETELY IMMOBILIZED, until patient is in a better position. Disadvantages its UNAESTHETIC appearance and INABILITY TO ACCURATELY EVALUATE PULPAL RESPONSES. 19

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