Immediate temporary crown for tooth fracture

Among the diverse emergencies we receive at a dental practice, tooth fracture is kind of common.
Before taking action, we have to decide what we can do for the patient in the first place. Does the case require emergency treatment? Or maybe just some medication? Do we have enough time in our schedule to face that emergency?
This 40 years old male patient came to the office complaining about a fracture on tooth 16. The situation is quite clear to understand: a root canal treated first molar, with a big composite restoration and no cusp coverage had a fracture of the palatal wall. The fracture line was deep under the gingival margin. No particular pain or complaining referred by the patient. So, cases like this can be scheduled with no hurry. We just had some little “logistic” problems in having the patient available for the treatment, so we tried to do everything in the first appointment.

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Fig.1
In the pre-operative picture we can see that the fracture line is under the gingival margin, so a surgical crown lengthening is needed.

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Fig.2
Some composite resin without adhesive was used to make a sort of direct wax-up of the tooth, in order to take a small silicone impression to use for fabricating the provisional crown.

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Fig.3
The silicone key.

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Fig.4
After the surgical crown lengthening we could easily isolate with rubber dam.

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Fig.5
After root canal retreatment, the dowel space was prepared on the palatal root, and a fiber post (DMG LuxaPost) of the correct size was chosen and tried. We have to remember that we only need to remove gutta-percha and sealant, without cutting sound tissue. Removing structure will only have the consequence of weakening the tooth. We don’t adapt the canal to the shape of the post, we must choose the proper post for the shape of the canal we are working on.

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Fig.6
After placing a circumferential matrix, total etch dual-cure adhesion was performed (DMG Luxabond-Total Etch).
Just one material, a dual-cure composite with zirconia inside (DMG LuxaCore Z Dual) was used in one shot to cement the post and simultaneously build-up the tooth. Light curing allowed us to immediately block the material, then we just waited a little bit for the complete dual-curing procedure.

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Fig.7
The exceeding part of the post was immediately cut, then rubber dam removed.

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Fig.8
The tooth was immediately prepared for a complete crown. The material used for building up the tooth has a consistency very similar to dentin, so during the preparation we feel no difference between dentin and composite.

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Fig.9
A semi-permanent crown was easily made injecting the material (DMG LuxaCrown) in the silicone key. The abutment was isolated with glycerine and the key was settled.
The silicone was then removed and the crown was finished and polished.

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Fig.10
The margins were left short, in order to allow appropriate space for gum healing. Instructions for cleaning and disinfection were given to the patient.

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Fig.11
After occlusal adjustment the semi-permanent crown was cemented.

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Fig.12
After 10 days sutures were removed.

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Fig.13
Tissues are still in the middle of the healing process, we need to wait to let them completely heal. During this time, we have no worries thanks to the immediate semi-permanent crown, that guarantees resistance and strength.

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Fig.14
After 2 months tissues look healthier. The patient asked to postpone the final impression for “logistic” reasons. With this kind of temporary crown we are pretty sure everything will be fine. The patient only needs to clean properly and come to the office for checking up regularly.

Fig.14
After 2 months tissues look healthier. The patient asked to postpone the final impression for “logistic” reasons. With this kind of temporary crown we are pretty sure everything will be fine. The patient only needs to clean properly and come to the office for checking up regularly.

Conclusions

Thanks to the workflow and the use of new and reliable materials, we can easily handle this kind of situation, even if we don’t have the chance to schedule them in our agenda. In just one appointment we can secure the situation and make our patient happy.

Bibliography

1. Grandini S, et al. Fatigue resistance and structural integrity of different types of fiber posts.Dent Mater J. 2008.
2. Ferrari M, et al. J Dent Res. 2007. Post placement affects survival of endodontically treated premolars.Randomized controlled trial
3. Juloski J, et al. Dent Mater. 2014. The effect of ferrule height on stress distribution within a tooth restored with fibre posts and ceramic crown: a finite element analysis.
4. Juloski J, et al. J Dent Res. 2014.Four-year Survival of Endodontically Treated Premolars Restored with Fiber Posts.Randomized controlled trial

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