Cases reported "Tooth Fractures"

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21/206. Cutaneous sinus tract from remaining tooth fragment of edentulous maxilla.

    Cutaneous sinus tract of dental origin usually arises from chronic dental infections. These tracts usually appear as suppurative lesions of the chin or neck. Because many patients with this lesion do not have any complaints of oral symptoms, these lesions are often diagnosed incorrectly and overlooked, and are also treated ineffectively. A case of an unusual presentation of a chronic suppurative granuloma on nasolabial fold, which originated from the remaining tooth fragment of edentulous maxilla, is reported. Treatment with removal of the tooth fragment as well as the sinus tract resulted in complete healing of the lesion. This report emphasizes the importance of awareness of the possible dental origin of facial sinuses, despite their unusual location.
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22/206. Hard and soft tissue management for the restoration of traumatized anterior teeth.

    The restoration of coronally fractured anterior teeth without surgical invasion is contingent upon several factors. Specifically, the biologic width of the tooth should not be violated by the apical extent of the fracture, and the residual root structure must possess an adequate ferrule. In patients with these conditions, it is possible to prosthetically restore the tooth following orthodontic extrusion. This article describes a technique in which orthodontic extrusion is utilized to provide adequate tooth structure for the prosthetic restoration of patients who presented with fractured anterior teeth.
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23/206. tongue piercing: a restorative perspective.

    The implication of a traumatic injury to a permanent molar tooth as a complication by tongue piercing with ornamental jewelry is reported. An appropriate restorative management of the fractured tooth is described. The dentist's role in prevention and treatment of unfavorable complications is outlined. The rationales for selection of specific treatment modalities, in view of the degree of damage to hard dental tissues, are discussed. The range of hard tissue injuries resulting from tongue jewelry varies from a simple crack propagating into the enamel to a fractured tooth. A variety of factors must be considered before employing the available restorative methods.
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24/206. Extraction as a treatment alternative follows repeated trauma in a severely handicapped patient.

    Handicapped patients with protruding maxillary incisors are prone to repeated dental trauma. A 13-year-old girl with cerebral palsy, severe mental retardation and seizure disorder was referred to our department for restoring the traumatized anterior teeth. Despite drug combination, the frequency of seizure attack was around 10 times a month. The oral examination showed multiple caries, gingival hyperplasia, class II malocclusion with 14 mm overjet and deep overbite. During the first 3 years of a 7-year follow-up period, six episodes of anterior tooth trauma due to seizure attack occurred. The trauma-related treatment performed included endodontic therapy, multiple composite restorations, apical repositional flap, and finally extraction of all four upper incisors with fabrication of a semi-fixed band-retained denture. The denture restored normal overbite and overjet with improved esthetics. For 4 years following the fabrication of denture, no trauma occurred to the anterior teeth in later seizure attacks. Considering inadequate control of seizure disorder, little ability of the patient to receive comprehensive orthodontic treatment, poor prognosis of restorations, and possible future injuries, the removal of non-functional, nonesthetic, trauma-susceptible incisor teeth can be justified as an alternative to tooth preservation.
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25/206. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract.

    A necrotic immature mandibular second premolar with periapical involvement in a 13-year-old patient was treated. Instead of the standard root canal treatment protocol and apexification, antimicrobial agents were used in the canal, after which the canal was left empty. Radiographic examination showed the start of apical closure 5 months after the completion of the antimicrobial protocol. Thickening of the canal wall and complete apical closure was confirmed 30 months after the treatment, indicating the revascularization potential of a young permanent tooth pulp into a bacteria-free root canal space.
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26/206. A case report of a fractured healthytooth during use of Guedel oropharyngeal airway.

    A young Chinese male with healthy dentition was admitted for haemorrhoidectomy. General anaesthesia was administered using facemask and a Guedel oropharyngeal airway with patient breathing spontaneously on nitrous oxide, oxygen, desflurane. Except for a brief episode of laryngospasm, no adverse events were noted intraoperatively. Postoperatively however patient was found to have a fractured upper incisor. Mechanism of possible events that caused the fracture are postulated. Problems associated with the use of Guedel airway are discussed and alternatives proposed.
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27/206. A case report of reattachment of fractured root fragment and resin-composite reinforcement in a compromised endodontically treated root.

    The composite reinforcement technique has been used clinically to salvage damaged root-filled teeth compromised by caries, trauma, developmental abnormalities, internal resorption and iatrogenic causes. This clinical case report describes the use of the technique to reattach a fractured fragment in a compromised endodontically treated root besides reinforcing it for continued function in the mouth. Factors of clinical importance related to this additional application; including reattachment of tooth fragments, post crown retention, coronal microleakage and fracture resistance and strength, are also briefly discussed.
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28/206. Vertical root fracture treated by bonding fragments and rotational replantation.

    These case reports describe a new treatment method for complete vertical root fractures. This method is composed of two steps. First, the fractured tooth is intentionally extracted atraumatically, and then the separated fragments are bonded with an adhesive resin cement. The restored tooth is replanted by rotating approximately 180 degrees into the original socket and fixing with an orthodontic wire. For both cases reported here, bone regeneration was observed at the 3-year follow-up. Since this modality adopts the respective advantages of both intentional replantation and adhesive treatment, it might be the treatment of choice in cases of vertical root fracture.
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29/206. Enhanced resilience and esthetics in a Class IV restoration.

    The purpose of this article is to give the reader a better understanding of the complex restorative challenge in achieving true harmonization of the primary parameters in esthetics (i.e., color, shape, and texture) represented by the replacement of a single anterior tooth. The case presented demonstrates the restoration of a Class IV fracture taking esthetic consideration of the anatomic variations of the adjacent teeth to produce a direct composite resin in harmony with the surrounding dentition. The basic procedure includes tooth preparation, development of the body layer, internal characterization with tints, development of the artificial enamel layers, shaping and contouring, and polishing. In understanding the total morphology of a tooth and using natural teeth as the basis for morphological thinking, the clinician possesses the knowledge to create restorations with a more natural appearance. Use of a recently developed optimized-particle composite and this morphological thinking allowed the author to achieve a restoration in harmony with the surrounding dentition. Continuing technological breakthroughs allow the clinician to implement and maximize new products to attain more predictable and esthetic results as demonstrated by this methodological protocol of incremental application of composite resins and modifiers to transform the Class IV fracture into a final restoration that mimics nature.
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30/206. Reattachment of an autogenous tooth fragment in a fracture with biologic width violation: a case report.

    An 11-year-old patient that fractured her maxillary left central incisor is presented. The fracture involved two thirds of the crown, compromising the pulp, and extended subgingivally on the palatal aspect, invading the biologic width. The procedure used to repair the fracture included flap surgery with a slight ostectomy and endodontic treatment. The reattachment of the tooth fragment and the restoration were performed with a bonding system and a resin composite. Examination 6 months after treatment revealed periodontal health, good esthetics, and normal function.
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