PMC5634575_01
(a) Initial orthopantomography. (b) Preoperative clinical view. (c) Tooth fragment.
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A 17-year-old male patient presented to Egas Moniz University Clinic (Egas Moniz, Health Sciences Institute) for an urgent consult thirty days after craniofacial trauma (Figure 1(b)). The upper left central incisor (2.1) had a complicated crown-root fracture with palatal involvement of the biologic width and the fragment (Figure 1(c)) was attached to the junctional epithelium and connective tissue. The radiographic examination revealed full root development and absence of root fracture of both teeth (Figure 1(a)).
(a) Final periapical radiograph after pulpectomy. (b) Clinical aspect during the exploratory surgery showing the extension of the complicated crow-root fracture, invading the biological width in the palatal aspect. (c) After gingival flap and osteotomy, a rubber dam was placed. (d) Final aspect after fragment reattachment and polishing.
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Obturation was done with gutta-percha (Dentsply Maillefer, Ballaigues, Switzerland) and root canal sealer (AH Plus, Dentsply, Konstanz, Germany) using lateral condensation technique (Figure 2(a)). It was necessary to perform an intrasulcular incision followed by a gingival flap (Figure 2(b)) to allow rubber dam isolation. Rubber dam isolation was performed using a #212 retraction clamp (Hu-Friedy, Chicago, USA) in order to expose the fracture margin and to keep the area clean and dry, providing favorable conditions for the restorative treatment (Figure 2(c)). Before reattaching the fragment, gutta-percha was covered with resin-modified glass ionomer (Vitrebond, 3M ESPE, USA) (Figure 2(d)).
(a) Buccal aspect of the sutures. (b) Palatal aspect of the sutures.
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After rubber dam removal, the gingival flap was repositioned and the papillae were sutured with 4.0 silk braided nonabsorbable suture material (SMI, Belgium) (Figures 3(a) and 3(b)).
(a) Veneer surface conditioning. (b) Preparation for veneer adhesive procedure on tooth 1.1. (c) After adhesion palatal veneer in 1.1. (d) Clinical aspect of buccal view after rehabilitation of 2.1 and 1.1.
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We made the palatal veneer/onlay using a hybrid composite (Filtek Supreme XTE, Auckland, New Zealand) (Figure 4(a)). With rubber dam placed (Figure 4(b)), we performed the palatal veneer adhesion, described in Table 2 (Figure 4(c)). After removing the glycerine gel, we finished with diamond burs and polishing discs (Sof-Lex, 3M, USA) and checked for occlusal adjustments (Figure 4(d)).
(a) Clinical aspect of buccal view after 1-year follow-up. (b) Clinical aspect of palatal view after 1-year follow-up. (c) The periapical radiograph after 1-year follow-up.
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Furthermore, clinical (Figures 5(a) and 5(b)) and radiographic (Figure 5(c)) findings of both teeth presented restorations with good adaptation and no color change, absence of radiographic signs of root resorption, no mobility, no pocket formation or gingival recession and absence of painful symptomatology, and tenderness to percussion.