PMC4396651_01
Frontal view of fractured mandibular teeth.
imcrj-8-087Fig1.jpg
PMC4396651_01_imcrj-8-087Fig1.jpg
f1-imcrj-8-087
An 8-year-old female patient came to the clinic with her parent having fractured her mandibular left incisors (teeth number 31 and 32) the previous day (Figure 1). Clinical examination revealed that both teeth had an Ellis fracture class II, which meant that there was an extended crown fracture with dentin involvement but without pulp exposure (Figure 1).
Occlusal view of fractured teeth. Glass Ionomer Cement is covering the fractured teeth.
imcrj-8-087Fig2.jpg
PMC4396651_01_imcrj-8-087Fig2.jpg
f2-imcrj-8-087
Both teeth were already covered with glass ionomer cement temporary fillings which were placed within 2 hours after the trauma by a general dentist who advised them to keep the fractured fragments and present them to a specialist to reattach them (Figure 2).
Fractured fragments after cleaning.
imcrj-8-087Fig3.jpg
PMC4396651_01_imcrj-8-087Fig3.jpg
f3-imcrj-8-087
Both fractured fragments were cleaned with prophylactic paste and kept aside (Figure 3).
Circumferential enamel bevel placed on both fractured teeth.
imcrj-8-087Fig4.jpg
PMC4396651_01_imcrj-8-087Fig4.jpg
f4-imcrj-8-087
Both fractured teeth received a circumferential bevel which encompassed the whole fractured tooth and it was 1.5 mm wide and 0.5 mm in depth (Figure 4).
Fractured fragments received a circumferential enamel bevel.
imcrj-8-087Fig5.jpg
PMC4396651_01_imcrj-8-087Fig5.jpg
f5-imcrj-8-087
Both fragments also received a similar circumferential bevel which encompassed the whole fractured piece and it was 3 mm in width and 0.5 in depth (Figure 5).
Frontal view showing excellent esthetics of attached fragments.
imcrj-8-087Fig6.jpg
PMC4396651_01_imcrj-8-087Fig6.jpg
f6-imcrj-8-087
Filtek Z350 XT Universal Restorative was placed labially and lingually to cover the fractured lines and the bevels surrounding them. After light curing both, the placed composite was finished and polished using an Astropol  finishing and polishing kit (Ivoclar Vivadent, Schaan, Liechtenstein) (Figure 6). Finally, a solid gold chain retainer (Ortho FlexTech Dental Retention System; Reliance Orthodontic Products, Inc., Itasca, IL, USA) was bonded to the lingual aspect of teeth number 32, 31, and 41 for extra means of retention.
Frontal view of teeth after 8 month recall.
imcrj-8-087Fig7.jpg
PMC4396651_01_imcrj-8-087Fig7.jpg
f7-imcrj-8-087
Clinical examination revealed excellent composite restorations covering the fracture lines (Figure 7).
Lingual view showing the retainer in place. Some plaque accumulation noticed.
imcrj-8-087Fig8.jpg
PMC4396651_01_imcrj-8-087Fig8.jpg
f8-imcrj-8-087
Some plaque accumulation was noticed against the palatal surfaces of bonded teeth with mild gingival inflammation (Figure 8).
Periapical radiograph of mandibular incisors showing healthy pulp and periodontal tissues.
imcrj-8-087Fig9.jpg
PMC4396651_01_imcrj-8-087Fig9.jpg
f9-imcrj-8-087
Radiographic examination of periapical X-rays revealed normal and unremarkable bone tissue surrounding both teeth (Figure 9).