Conservative Management 


of Dental Fracture 


Taofik Hidayat
December 14th 2018
One Day Seminar
Oral & Maxillofacial Surgery Dept,
Faculty of Dentistry UNPAD
 Dentistry
• Conservative dentistry; the healing arts concerned with
the teeth and associated structures of the oral cavity,
including prevention, diagnosis and treatment of diseases
of the teeth involved with the preservation of natural
teeth.
• Dentistry, operative; concerned with operations to restore
or reform the hard dental tissues (e.g., operations
necessitated by caries, trauma, and impaired function, and
for improvement of appearance).
• Endodontic; specializes in the diagnosis and treatment of
diseases of the dental pulp, tooth root, and surrounding
tissues and in the associated practice of root canal therapy
?????

3 mo 8 mo
Conservative Dentistry Main Objective:

SavingThe Irreplaceabe Teeth...
• Conserve Vs Extract
• Prothetic
• Implant

• Tooth Germ Transplant

In Endodontic
• Stem Cell Therapy
• Traumatic dental injuries ussually are
unanticipated events that, if not managed
properly, can have serious consequences for the
patient.
• The management of dental trauma should be part
of practice for every dentists
• Unfortunately the knowledge of dental
traumatology is not universal among dental
professionals neither in regards to acute care nor
long term treatment.
• Since treatment of many traumatic injuries require
both immediate as well as subsequent attention,
• It is useful to look at the effects of trauma on
the tissues that determine the success or
failure following injury:
• The tooth structure, tooth pulp and the PDL
(including cementum and lamina dura).
 Goal of the treatment

• To return the teeth to acceptable function and

appearance.
• Normal function requires repositioning of the
teeth, and acceptable appearance requires repair
of possible dental fractures and proper
positioning of peridental soft tissues.
Guidelines of treatment priorities

• Acute treatment:. treatment within a few hours

can significantly affect the outcome tooth
avulsions, alveolar fractures, extrusive and
lateral luxations, and possibly root fractures.
• Early repositioning and stabilization will
promote the best PDL repair
Guidelines of treatment priorities

• Subacute treatment: :
– concussion, subluxations, and intrusive luxation,
and crown fractures with pulpal exposure.
• Treatment within 24 h after injury allow the
fore mentioned injuries proper care
• Pulpal and PDL responses do not seem to be
adversely affected by a delay of 24 h
Guidelines of treatment priorities

• Delayed treatment:
– Crown fractures without pulpal exposure appear
to have the same prognosis whether treatment is
performed within a few or several hours
 Summary of

Current Treatment Planning
Recommendations
 Uncomplicated crown fractures:

• In mature teeth, esthetic and functional

restoration will provide good prognosis.
• In developing teeth, timely care includes
disinfection of the dentin and capping material
covered with a restoration to allow continued
root formation
• Or a restoration bonded directly to the broken
tooth surface,
 Complicated crown fractures

• ︎Fully developed teeth will require a prosthetic

crown, that require root canal treatment done
prior to the restoration.
• Or choose a bonded restoration is to be used,
to protect the exposed pulp with capping
material
 Crown-root fractures:

• ︎ Often involve pulpal exposure,

• In developing teeth, pulpal protection is
essential if the tooth is going to continue to
develop.
• Because the fractures extend to the roots to
varying depths, treatment options depend on
the level of fracture.
 Crown-root fractures:
• ︎After the removal of the loose tooth fragment,
allow the gingiva to adapt to the exposed
dentin by formation of long junctional
epithelium,
• or surgically expose the fracture site, or
extrude the tooth orthodontically or surgically
• In fully developed teeth, all of these procedures
are likely to be associated with root canal
therapy
 Root fractures:
• ︎ This type of injury involves the pulp, dentin,
cementum, and the PDL.
• The treatment should be semi-rigid stabilization for
a few weeks (3–4 weeks) to allow re-establishment
of the damaged PDL
• The pulp has a favorable prognosis; less than 20%
develop necrosis RCT needs only to be applied to
the coronal segment as the apical segment
invariably remains vital even when the coronal pulp
tissue is necrotic.
 Root fractures:

• ︎ If infection developed on the apical segment

of the root, surgically remove the root
fracture and put intracoronal stabilization/
endodontic implant
 Luxation injuries:

• ︎ Minor involvement such as concussion and

subluxation, requires mostly symptomatic
treatment: soft diet and possibly occlusal
adjustment to minimize discomfort on biting
contact
• All traumatized teeth must be monitored for
delayed pulpal necrosis; endodontic
intervention is indicated in such cases
 Extrusive and lateral luxations,

• Repositioning and stabilization for 2–4 weeks

and long-term consideration. . (eval. pulp
vitality)
• In luxated teeth with pulp necrosis, root canal
therapy is indicated.
 Extrusive and lateral luxations,

• Developing teeth with open apices (40.5mm

diameter) have the potential for revascularization,
which will facilitate continued root development
• If necrosis occure, current evidence indicates
that a short-term (o1 month) use of CH for its
disinfecting property, followed by MTA
placement in the apical segment of the root canal
 Intrusion
• The most serious type of luxation injury
• Damage occurs to the cementum and the PDL,
and the neurovascular pulp supply is crushed.
• Current treatment approaches include
surgical repositioning, orthodontic extrusion,
and a combination of both (5, 40, 43). It is not
yet evident which approach is most reliable. In
any case, root canal treatment is a must
(except in very immature teeth)
 Avulsions:

• ︎ All current evidence indicates that immediate

replantation favors a successful outcome
• Keep avulsed tooth in suitable media, Keeping
the tooth in saliva is also an option. Plain
water or dry storage will result in a quick
death of the PDL and its cells.
 Avulsions:
• ︎ With the exception of immature, incompletely
devel- oped teeth, root canal treatment is an
essential component of the treatment strategy
• Failure to remove the necrotic pulp will result
in infection-related resorption
• Failure to replant the avulsed tooth before
PDL death will likely lead to ankylosis- related
resorption.
Clinical Cases
Enamel Fracture
Enamel Dentine Fracture
Enamel Dentine Pulp Involved
Fracture
Root Fracture
Avulsed Tooth
Avulsed Tooth- Adult
Compound Fracture
1 mo.
10 years
 Conclusion 


• Dental traumatology has progressed in recent

years.
• Efforts to raise public awareness about dental
trauma
• Research explores new for pulpal evaluation and
materials
• . The future has promise for even more successful
management of traumatic dental injuries.
 Conclussion
¨ Crown fractured teeth present a challenging problems
to be restored aesthetically.
¨ With proper treatment protocol such a challenge can
be addressed predictably
• Hatur nuhun