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Avulsed Natural Crown as a Temporary Crown: Report of Case
Avulsed natural crown as a temporary crown: report of case H. Wayne Todd, DDS, Orlando, Fla The natural crown of a fractured m axillary right lat eral incisor was returned to the dentition of a 12year-old boy as a temporary measure. Six weeks af ter the in itia l procedure, the crown was removed. The gingival tissues were found to be clin ica lly normal and, after additional procedures were per formed, the crown was replaced. After six months, the crown was c lin ic a lly firm and the gingiva ap peared to be normal. The patient had experienced no additional discomfort.
in terms o f root callus formation and physiologic joining o f the fragments, but it may be possible to maintain the crown and root in the mouth as a tem porary m easure until the tooth and gingiva have m atured enough so that an artificial crown can be constructed. A m ethod is described by which a natural crown that has been fractured below the lingual crest o f bone can be retained in the mouth until a m ore conventional crown can be constructed.
R e p o rt of a c a s e
Traumatic injuries to the mouth and teeth can cause problems at any age, but fracture of a crown in an adolescent can result in more difficult prob lems from the standpoint o f treatment planning. In a very young child, severe traum a to a tooth usual ly results in luxation or complete avulsion, but in an older child both the crown and the root may be fractured. The dentist must then attempt to m ain tain the health o f the periodontium; the space in the developing dentition; and an esthetic condi tion until a more acceptable, permanent treatment can be accomplished. Fracture in the coronal third o f a tooth usually results in loss of the tooth.1 This is true if we speak
A 12-year-old boy was referred to m e by a pedodontist. T he patient had been accidentally struck in the mouth earlier that day with a baseball bat. Injuries included two fractured teeth, and contu sions and lacerations o f the lower lip. The m andib ular right lateral incisor was fractured through the enamel and dentin, but no pulp exposure was evi dent. T he pedodontist had treated this tooth with an application o f calcium hydroxide and varnish. The maxillary right lateral incisor was fractured through the pulp; the fracture line extended lingually below the alveolar bone (Fig 1 left, middle, right). Normally, a crown that has been fractured com
Fig 1 ■ Preoperative condition of gingiva and alveolus (left); avulsedcrown with fracture linethat ex tended well below cingulum (middle); radiograph showing root of tooth in alveolus (right). 1398 ■ JADA, Vol. 82, June 1971
Fig 2 ■ Completed endodontic procedure. An Endopostwas used to condense gutta-percha. Double-bow cervical clamp was placed to retain rubber dam.
Fig 4 ■ Crown was cemented to Endopost and root with zinc oxide-eugenol cement.
pletely above the alveolar bone would be re stored with pins or a dowel crown; but in this in stance, such treatment would necessitate a gingi val flap and removal o f bone to expose the finish line o f the root. In view of the subalveolar frac ture, the unrestored crown, and the patient’s age, it was decided to return the natural crown to the tooth as a temporary crown until a more lasting re sult could be obtained. Given time, the alveolar bone might be expected to recontour itself to the level of the fracture line. Local anesthesia was obtained and a rubber
dam was placed with use o f a double-bow cervical clamp. The lingual beak of the clamp was set into the palatal gingiva for retention. T he field was further isolated with an astringent cord and a tem porary filling material (Cavit*) to control the gin-
Fig 3 ■ Avulsed crown fitted over Endopost.
Fig 5 ■ Radiograph taken six months postoperatively. Todd: AVULSED CROWN AS TEMPORARY CROWN ■ 1399
Fig 6 ■ Esthetic condition of tooth six months postopera tive! y.
Fig 7 ■ Clinically normal appearance of lingual gingiva six months after operation.
gival seepage. The remaining pulp was extirpated and routine mechanical preparation was accom plished. The canal was then dried and a root canal sealer was introduced with a spiral filling instru ment mounted in a slow-running contra-angle. The canal was obturated by vertical condensation of gutta-percha; an Endopostt was used as the con densing instrument (Fig 2). The coronal portion of the fractured tooth was removed from a saline storage solution and the lingual surface was opened into the pulp chamber. The crown was fitted over the Endopost and ad justed so the fragments were closely aligned. The crown and Endopost were then removed (Fig 3). A m ixture of zinc oxide-eugenol cement was intro duced into the pulp canal and around the crown and Endopost. The three segments were realigned and the cement allowed to set. The excess cement was removed from the fragments and the Endopost was cut flush with the lingual surface of the crown with a high-speed diamond instrument (Fig 4). The patient was then dismissed. When the patient returned after six weeks, the crown and Endopost were removed and the gingi val tissues were found to be clinically normal. The remnants of the zinc oxide-eugenol cement were removed from the canal, crown, and the Endopost. The three segments were realigned and cemented with zinc oxyphosphate cement. The coronal por tion of the Endopost was shortened and the lingual opening in the crown was filled with a dental com posite restorative material (Adaptici). The patient returned after six months and the
crown was found to be clinically firm. The gingiva appeared normal and the patient said he had ex perienced no discomfort after the original traum a (Fig 5, 6, 7).
1400 ■ JADA, Vol. 82, June 1971
Su m m a ry
The natural crown o f a tooth was returned to the dentition o f a 12-year-old boy after injuries that included a fracture of the maxillary right lateral in cisor. The procedure was used as a temporary m ea sure to allow time for the alveolar bone to recon tour itself to the level of the fracture line at which time a permanent crown could be constructed. The treatment was successful for eight months at which time the crown was subluxated in an accident that involved a football. Attempts by another dentist to stabilize the crown were said to be futile and a dowel crown was placed. The initial replacement of the crown was successful enough as a temporary measure to indicate that further study should be considered.
Doctor Todd’s address is 10043 EColonial Dr, Orlando, Fla 32807. * Premier Dental Products Co., Philadelphia, t Kerr Manufacturing Co., Detroit. $ Johnson and Johnson, New Brunswick, NJ. 1. 583.
Ingle, J. Endodontics. Philadelphia, Lea & Febiger, p
in terms o f root callus formation and physiologic joining o f the fragments, but it may be possible to maintain the crown and root in the mouth as a tem porary m easure until the tooth and gingiva have m atured enough so that an artificial crown can be constructed. A m ethod is described by which a natural crown that has been fractured below the lingual crest o f bone can be retained in the mouth until a m ore conventional crown can be constructed.
R e p o rt of a c a s e
Traumatic injuries to the mouth and teeth can cause problems at any age, but fracture of a crown in an adolescent can result in more difficult prob lems from the standpoint o f treatment planning. In a very young child, severe traum a to a tooth usual ly results in luxation or complete avulsion, but in an older child both the crown and the root may be fractured. The dentist must then attempt to m ain tain the health o f the periodontium; the space in the developing dentition; and an esthetic condi tion until a more acceptable, permanent treatment can be accomplished. Fracture in the coronal third o f a tooth usually results in loss of the tooth.1 This is true if we speak
A 12-year-old boy was referred to m e by a pedodontist. T he patient had been accidentally struck in the mouth earlier that day with a baseball bat. Injuries included two fractured teeth, and contu sions and lacerations o f the lower lip. The m andib ular right lateral incisor was fractured through the enamel and dentin, but no pulp exposure was evi dent. T he pedodontist had treated this tooth with an application o f calcium hydroxide and varnish. The maxillary right lateral incisor was fractured through the pulp; the fracture line extended lingually below the alveolar bone (Fig 1 left, middle, right). Normally, a crown that has been fractured com
Fig 1 ■ Preoperative condition of gingiva and alveolus (left); avulsedcrown with fracture linethat ex tended well below cingulum (middle); radiograph showing root of tooth in alveolus (right). 1398 ■ JADA, Vol. 82, June 1971
Fig 2 ■ Completed endodontic procedure. An Endopostwas used to condense gutta-percha. Double-bow cervical clamp was placed to retain rubber dam.
Fig 4 ■ Crown was cemented to Endopost and root with zinc oxide-eugenol cement.
pletely above the alveolar bone would be re stored with pins or a dowel crown; but in this in stance, such treatment would necessitate a gingi val flap and removal o f bone to expose the finish line o f the root. In view of the subalveolar frac ture, the unrestored crown, and the patient’s age, it was decided to return the natural crown to the tooth as a temporary crown until a more lasting re sult could be obtained. Given time, the alveolar bone might be expected to recontour itself to the level of the fracture line. Local anesthesia was obtained and a rubber
dam was placed with use o f a double-bow cervical clamp. The lingual beak of the clamp was set into the palatal gingiva for retention. T he field was further isolated with an astringent cord and a tem porary filling material (Cavit*) to control the gin-
Fig 3 ■ Avulsed crown fitted over Endopost.
Fig 5 ■ Radiograph taken six months postoperatively. Todd: AVULSED CROWN AS TEMPORARY CROWN ■ 1399
Fig 6 ■ Esthetic condition of tooth six months postopera tive! y.
Fig 7 ■ Clinically normal appearance of lingual gingiva six months after operation.
gival seepage. The remaining pulp was extirpated and routine mechanical preparation was accom plished. The canal was then dried and a root canal sealer was introduced with a spiral filling instru ment mounted in a slow-running contra-angle. The canal was obturated by vertical condensation of gutta-percha; an Endopostt was used as the con densing instrument (Fig 2). The coronal portion of the fractured tooth was removed from a saline storage solution and the lingual surface was opened into the pulp chamber. The crown was fitted over the Endopost and ad justed so the fragments were closely aligned. The crown and Endopost were then removed (Fig 3). A m ixture of zinc oxide-eugenol cement was intro duced into the pulp canal and around the crown and Endopost. The three segments were realigned and the cement allowed to set. The excess cement was removed from the fragments and the Endopost was cut flush with the lingual surface of the crown with a high-speed diamond instrument (Fig 4). The patient was then dismissed. When the patient returned after six weeks, the crown and Endopost were removed and the gingi val tissues were found to be clinically normal. The remnants of the zinc oxide-eugenol cement were removed from the canal, crown, and the Endopost. The three segments were realigned and cemented with zinc oxyphosphate cement. The coronal por tion of the Endopost was shortened and the lingual opening in the crown was filled with a dental com posite restorative material (Adaptici). The patient returned after six months and the
crown was found to be clinically firm. The gingiva appeared normal and the patient said he had ex perienced no discomfort after the original traum a (Fig 5, 6, 7).
1400 ■ JADA, Vol. 82, June 1971
Su m m a ry
The natural crown o f a tooth was returned to the dentition o f a 12-year-old boy after injuries that included a fracture of the maxillary right lateral in cisor. The procedure was used as a temporary m ea sure to allow time for the alveolar bone to recon tour itself to the level of the fracture line at which time a permanent crown could be constructed. The treatment was successful for eight months at which time the crown was subluxated in an accident that involved a football. Attempts by another dentist to stabilize the crown were said to be futile and a dowel crown was placed. The initial replacement of the crown was successful enough as a temporary measure to indicate that further study should be considered.
Doctor Todd’s address is 10043 EColonial Dr, Orlando, Fla 32807. * Premier Dental Products Co., Philadelphia, t Kerr Manufacturing Co., Detroit. $ Johnson and Johnson, New Brunswick, NJ. 1. 583.
Ingle, J. Endodontics. Philadelphia, Lea & Febiger, p