Bike Accident Dental Trauma
Amsterdam is a great city. With its beautiful houses along the canals. And with a lot of cyclists. This patient came to our practice after visiting the emergency room. She was unfortunately involved in a bike accident and had undergone trauma. She got two crown fractures of the two central incisors without pulp involvement. Both teeth were slightly moving compared than the neighboring teeth. The exposed dentin was sealed with a glass-ionomer cement and x-rays were taken. Tooth #11 displayed a pulp shining through giving the dentin a dash of pink color. The two involved incisors were slightly more sensitive but not limiting the patient in her daily life. The patient wanted the two incisors to be restored: invisibly and naturally. The treatment of choice was a direct layering composite. In cases like these – involving relatively young patient trauma – we may encounter two extra challenges besides trying to create exact replicas of the fractured teeth. Because of the widespread use of an orthodontic fixed retainer on the palatal the possibility to correctly place a rubber dam is limited as well as the access for treatment. So usually removal of the retainer is indicated. Replacement is necessary to prevent any unwanted tooth movements after restoring. This means fabricating a new fixed retainer because of distortion occurring while removing it. Second is the issue of time after trauma. The patient often demands direct restoration. But for a long term satisfying result the use of a silicone index based on a wax-up increases your chances of achieving that long term goal. That means taking impressions for models, photography and referring to the lab for a wax-up. Delay of direct treatment is unavoidable. This case shows how we handled the challenges on the road and how the final outcome destination was reached within the estimated time of arrival
Cases that involve anterior teeth fractures compromise the patients appearance in a massive way. The first emotion is to make restorations instantly to help the patient. And that is as well what the patient asks you urgently do. But underneath that question is the actual demand: restore my teeth back to what they were before they were fractured. To achieve that goal mostly more time is required in preparation. In color and shape analysis, lab work for the models and wax-up and adjusting the schedule book to offer your patient your full attention. Good communication with the patient is of great importance; explaining that waiting a few days can prevent re-treatments in the future because of aesthetic failure.
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