PMC3295587_01
Oblique fracture of distofacial cusp with 16 with loss of mesiopalatal cusp with 16.
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After a thorough evaluation of the periodontal, endodontic, coronal, and occlusal (PECO) status of the teeth, a diagnosis of oblique fractures with 16 (Figure 1), 26, 25 (Figure 2), and vertical fracture with 24 extending subcrestally (Figure 3) was made.
Oblique fracture of distofacial cusp with 26, loss of buccal cusp with 25.
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fig2
After a thorough evaluation of the periodontal, endodontic, coronal, and occlusal (PECO) status of the teeth, a diagnosis of oblique fractures with 16 (Figure 1), 26, 25 (Figure 2), and vertical fracture with 24 extending subcrestally (Figure 3) was made.
Mesiodistal fracture in the vertical direction with 24 extending subcrestally.
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fig3
After a thorough evaluation of the periodontal, endodontic, coronal, and occlusal (PECO) status of the teeth, a diagnosis of oblique fractures with 16 (Figure 1), 26, 25 (Figure 2), and vertical fracture with 24 extending subcrestally (Figure 3) was made.
Occlusal view of vertical fracture mesiodistally with 36 and oblique fracture of the mesiolingual cusp with 46.
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fig4
With respect to the mandibular molars, oblique fracture with 46 involving mesiolingual cusp (Figure 4) and vertical fracture with 36 extending mesiodistally (Figure 4) were diagnosed.
Preoperative radiograph revealing oblique fracture involving distal aspect of the tooth 16.
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The clinical diagnosis was confirmed radiographically (Figures 5, 6, 7, and 8), which also suggested the presence of transverse fracture at the level of coronal and middle third of the root with respect to 24 (Figure 6).
Preoperative radiograph revealing oblique root fracture with 24, loss of buccal cusp with 25, and oblique fracture of distobuccal cusp with 26.
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The clinical diagnosis was confirmed radiographically (Figures 5, 6, 7, and 8), which also suggested the presence of transverse fracture at the level of coronal and middle third of the root with respect to 24 (Figure 6).
Preoperative periapical radiograph with 36 showing the radiolucent fracture line in the coronal area and passing through the pulp chamber.
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fig7
The clinical diagnosis was confirmed radiographically (Figures 5, 6, 7, and 8), which also suggested the presence of transverse fracture at the level of coronal and middle third of the root with respect to 24 (Figure 6).
Preoperative periapical radiograph with 46 revealing radiolucent fracture line in the coronal aspect of the tooth.
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fig8
The clinical diagnosis was confirmed radiographically (Figures 5, 6, 7, and 8), which also suggested the presence of transverse fracture at the level of coronal and middle third of the root with respect to 24 (Figure 6).
Preoperative view of 36, prior to placing surgical incisions for a full thickness mucoperiosteal flap on lingual aspect.
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fig9
Surgical treatment was initiated with 36 (Figure 9).
Lingual view of 36, revealing frank pulp exposure after removal of the partially attached dental fragments and surface disinfection with 0.12% chlorhexidine. Surgical site reveals the relationship of fracture to the osseous crest.
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fig10
The fracture had occurred in the mesiodistal dimension, dividing the lingual aspect of the tooth into mesial and distal halves and a pin point pulp exposure (Figure 10).
Buccal view of dental fragments of fractured 36, after surface disinfection with 0.12% chlorhexidine and application of dentin bonding adhesive.
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fig11
The two fractured fragments that were partially attached with the help of gingival fibres were separated and were maintained in normal saline (Figure 11).
Completed immediate repair with 36 and sutures in place.
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fig12
The surgical site was closed, and interrupted sutures were placed (Figure 12).
Lingual view of reflected full thickness mucoperiosteal flap and surgical correction of biologic width with 46.
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Although the invasion of biologic width was small in extent and magnitude, a similar surgical approach was executed so as to reattach the fractured mesiolingual fragment (Figures 13, and 14).
Clinical view after the fragment attachment has been performed, and flaps have been sutured.
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fig14
Although the invasion of biologic width was small in extent and magnitude, a similar surgical approach was executed so as to reattach the fractured mesiolingual fragment (Figures 13, and 14).
Buccal view of obliquely fractured 26 and 25, after reflection of the full thickness mucoperiosteal flap on the facial aspect. Relationship of fracture to remaining gingival tissues.
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fig15
With respect to the left quadrant of the upper arch, a full thickness mucoperiosteal flap was reflected in the region of 24, 25, and 26 (Figure 15), and the procedure for reattachment with the obliquely fractured distofacial cusp of 26 was performed as is described previously (Figures 16 and 17).
PMC3295587_02