A 22-year-old male patient came to the clinic for having suffered a trauma in the oral region.
Part 11 had a horizontal fracture at the coronal middle third with pulp exposure and tooth 21 with an oblique fracture extending from the vestibular middle third to the palatal cervical with pulp exposure and invasion of biological space.
1.
The patient carried two dental fragments and a third fragment was obtained from the palatal portion of the fracture in tooth 21, which was subject only to blade tissue.
The fragments were washed and immersed in physiological solution.
Bone, periodontal and occlusal conditions were verified in order to rule out any additional alteration.
The root canal treatment was performed in both jaws in a session and acrylic prosthesis was made.
In the following session, glass fiber posts were placed in each.
The restorative treatment was then programmed.
1.
Collage piece 11
Teeth were cleaned with pumice stone and water.
The fragment was adapted to the remaining tooth, taking care not too worn the inner part of the fragment or the remaining tooth and thus not to compromise the resistance or aesthetic result.
Absolute isolation of the anterosuperior area was performed.
Then, the dental fragment washed and the remaining tooth washed with 37% acidic acid for 30 seconds, with air-water spray for 15 to 20 seconds, and dried with air.
A layer of adhesive Helio Bond (Ivoclar Vivadent) was applied to the attached structures, taking care not to alter the final adaptation, and then to photoactivate for 20 seconds.
Finally, the palatal resin and fluid fixation in Flow (3M ESPE) were used. The parts were confronted verifying that the margins fit correctly, with a micro-bow the excesses were removed and then the mouths were turned 60
It proceeded with the finishing and polishing, also, the occlusion control was carried out, eliminating harmful contacts.
Collage.
mucoperiticosteroid tape piece 21
He had two fragments of fracture: one coronal and the other cervical; the latter extended below the palatal gingival margin.
Just like tooth 11, both fragments were adapted out of mouth, only coronal.
Then the patient was prepared to perform a mucoperitic flap at full thickness at the level of teeth 11, 21 and 22 palatal.
Since the height of the interproximal and marginal bone crest at palatal level of tooth 21 was 1.5 mm to the fracture line, osteotomy was performed to return the biological space to that piece.
Then, the area with a rubber tip was was washed thoroughly with saline solution, the joints were adapted and the first fragments were isolated in the same way.
The parts were carefully confronted, the gross excesses were eliminated and photoactivized on each face of the tooth for 60 seconds.
Care was taken to slowly remove excess margins, to polish especially the cervical junction area, and the flap was closed.
In addition, occlusion control was performed in order to eliminate harmful contacts.
1.
During the one-week and successive follow-up, good healing and progressive mimicking of the fragment with its respective teeth were observed.
The continuity of restorations was verified radiographically.
In the second week, it was decided to treat the vestibular interface in tooth 21, to hide the junction line and improve the aesthetic result.
The color and type of resin to be used (A2 Esmalte Brilliant - Coltene Whaledent) was verified, and with the help of a diamond burr round surface, a groove was made.
Finally the patient came to control after 3 years.
