Management of enamel/dentine fractures

Question 1

Enamel infraction

Answer 1

incomplete fracture of enamel without loss of tooth substance
treated via monitoring and occasionally etch and seal

Question 2

Enamel fractures

Answer 2

Minimal fracture results in loss of tooth substance confined to enamel
treated via composite restorations
periodic review with radiographs

Question 3

Enamel-dentine fractures

Answer 3

Loss of tooth substance confined to enamel and dentine and not involving the pulp
treated through pulp protection and restoration of the crown
emergency tx:
1. dress exposed dentine with GI
2. reattachment of fragment. if fracture is close to pulp, use indirect pulp cap such as CaOH lining

Question 4

Pulp cap

Answer 4

Indicated in cases of pin point exposures
layer of CaOH2 placed directly over the exposed pulp bandage/GI or composite
the aim is to preserve vital pulp, bridge of reparative dentine
radiographs to exclude resorption

Question 5

Pulpotomy

Answer 5

Incomplete apex/complete apex
small exposure
vital pulp - not infected
allow continued root growth:
1. apexogenesis: allow continued root growth
2. apexification: avoid need for open apex RCT
96% successful

Question 6

Pulpectomy

Answer 6

Gross exposure/extrusion of pulp
complex crown/root fracture
necrotic pulp in open apex
RCT- closed apex
Apexification - open apex

Question 7

Root fractures

Answer 7

Classified: apical/middle/coronal 1/3
may require 2 views radiographically to position and displacement
tx:
- immediate repositioning
- splint 4 weeks
- soft diet
- chlorhexidine mouthwash
- review vitality of coronal fragment
- treat complications

Question 8

Splint

Answer 8

to immobilise tooth in correct anatomical position preventing further trauma and allowing healing
functional splint
root fracture – 4 wks with functional splint