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Technique Tips

From Volume 47, Issue 2, February 2020 | Pages 172-173

Authors

Maya Amlani

BDS

Dental Core Trainee, Eastman Dental Hospital, 47-49 Huntley Street, London WC1E 6DG, UK

Articles by Maya Amlani

Ayesha Patel

BDS, MFDS RCS(Ed), PGcert DentalEd, MPaedDent

(King's College Hospital)

Articles by Ayesha Patel

Suzanne Dunkley

BDS, MFDS, MClinDent(PaedDent), MPaedDent, FDS RCS(PaedDent)

Consultant Paediatric Dentistry, Eastman Dental Hospital, 256 Gray's Inn Road, London WC1X 8LD, UK

Articles by Suzanne Dunkley

Abstract

Management of Enamel-Dentine Fractures with Clear Crowns in a Young Patient

Article

Enamel dentine fractures are common forms of dental trauma in children (Figures 1 and 2). Restoration of the fracture is important for aesthetic reasons but also to ensure a good prognosis for pulp. Managing a young patient presenting as an emergency with an enamel dentine fracture can often be challenging due to pain and anxiety. Using clear crown forms is a technique which is quick, simple and an effective method for restoring these teeth. The technique is widely accepted by young patients and produces an aesthetic result (Figures 3 and 4).

Figure 1. Enamel dentine fracture UR1.
Figure 2. Enamel dentine fracture UR1 palatal view.
Figure 3. Enamel dentine fractures UR1, UL1.
Figure 4. Enamel dentine fractures UR1, UL1 restored using crown forms.

Technique

It is essential to carry out a full trauma assessment prior to restoring the teeth, including sensibility testing, radiographs and clinical photographs.

1. Local anaesthesia

A buccal infiltration with lidocaine is normally sufficient.

2. Isolation

Isolate the affected teeth using a dri-dam or rubber dam. A split dam technique can be used as it is important to see the adjacent teeth when selecting your crown. Using a dri-dam or rubber dam ensures adequate moisture control, protects the patient’s soft tissue and provides airway protection. Dri-dams or rubber dams can be secured with clamps or wedges, the latter often being more readily acceptable for paediatric patients (Figure 5).

Figure 5. Dri-dam isolation.

3. Preparation of the tooth

Bevel the margin of the fracture to improve retention and avoid a butt joint.

4. Selection of a crown form

Clear crown form kits provide a range of tooth forms in a variety of sizes. A few sizes may need to be tried before deciding which crown form most closely fits the natural shape and form of the tooth you are restoring. Size selection can be aided by placing the incisal edge of the crown form against the adjacent tooth to choose the correct width (Figure 6).

Figure 6. Size selection by placing incisal edge of the crown form against an adjacent tooth.

5. Modification of chosen crown form

Trim the crown form using scissors, cut the crown form so it resembles the shape of the lost fragment of tooth you are trying to restore. Curved Bee Bee scissors are ideal for this.

Check the margin of the crown form sits just beyond the fracture line to increase retention (Figure 7). In severe fractures or in a case with several failed restorations it is worth considering full coronal coverage with the composite margin at the gingival margin.

Figure 7. Checking seating of crown form prior to placement.

Small vents should be cut into the incisal edge to allow for excess composite removal as the crown is seated.

6. Composite preparation

Prepare the tooth for a composite restoration using etch (usually 35% phosphoric acid) and a bonding agent.

7. Composite restoration

Fill the crown form with composite, taking care to ensure sufficient composite is placed in the crown (Figure 8). Position the crown form ensuring that it is orientated correctly and seat using light pressure to avoid air bubbles (Figures 9 and 10). It can be helpful to examine the crown form positioning from different views to ensure correct angulation and projection. Remove the excess composite material and light cure while the crown form is still in place. Carefully remove the crown form using an excavator or probe and assess the restoration (Figure 11).

Figure 8. Crown form with composite restoration in situ.
Figure 9. Light presssure on crown form.
Figure 10. Crown form in position.
Figure 11. Composite restoration in place following removal of crown form.

8. Polishing

Polish the composite restoration as normal ensuring smooth adaptations of the margins.