10-yr-old fractured his front teeth in apparent fall accident. The patient presented for emergency evaluation of his front teeth. The coronal portion of the tooth fractured in half, but, did not break into the pulp chamber. The teeth were fully erupted and a typical central incisor is 11mm long. His teeth were broken off at an oblique angle leaving only 2mm of tooth remaining on #8 near the midline and 1.5mm of tooth remaining on #9 near the midline.
At some point in the future, we may elect to place all-ceramic restorations, e.g. an Obsidian-type crown (lithium silicate,) but, since the patient is young and still very active with sports and athletic recreation, we have elected to place composites on these teeth for now. This method allows us more flexibility for a few reasons. The patient could foreseeably fracture the front teeth again, and replacing a composite costs less than if the patient were to fracture a crown and need that replaced. Also, this allows the patient’s other teeth to come in and find their normal levels. If I need to adjust these teeth, we can complete the more permanent crowns after the other teeth have come in and moved into the right place.
These fillings were completed using a small amount of local anesthetic (Articaine 4%, with epi 1:100,000) since the pulp chambers were sensitive. The restorative composite was placed using Scotchbond Universal, and a blend of 2 composite colors mixed together to create a chameleon effect (Filtek Supreme Ultra A1B, Filtek Supreme Ultra B1B.)
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