Reattachment is an effective, economical, and conservative procedure to restore the natural shape, contour, translucency, surface texture, occlusal alignment, and color of the fractured tooth that results in positive emotional and social response in a patient. This case report details the multidisciplinary management of a fractured central incisor with fracture line extending subgingivally in the palatal region. Access opening was done through the fractured segment of 21 and it was detached and stored in saline. After completion of endodontic therapy, crown lengthening procedure was done. Fiber post was placed for added reinforcement and the fragment reattached. A new trauma occurred after 4 months, but the reattached fragment did not get detached.
There are several reasons for a root canal therapy to be unsuccessful. One of the causes for endodontic failure is instrument separation. As a consequence of fracture, access to the apical portion of the root canal is obstructed, leading to improper disinfection. The retrieval of separated instrument followed by obturation to the working length is the treatment option. Many factors can make retrieval difficult. In such cases, management can be done even by bypassing the separated instrument. Another factor for endodontic failure is underobturation. It may be due to block or ledge in the apical third of the canal. Proper instrumentation with frequent confirmation of apical patency during instrumentation can prevent formation of ledge. The inability to treat all the canals is the other cause leading to endodontic failure. Bacteria residing in these canals lead to the persistence of symptoms. Proper evaluation of the radiograph with proper deroofing can prevent chances for missed canals. Combination of all these factors can make retreatment difficult. This case report discusses two endodontic failure cases. In the first case, a premolar tooth with separated instrument and incomplete obturation was treated by retrieval of separated instrument and the obturation of both canals to working length was done. The second one was a molar tooth which had a missed canal, a separated instrument, and an incomplete obturation. Missed canal was negotiated and the fractured instrument was bypassed and root canal was obturated.
Coronal fractures of the anterior teeth are a common form of dental trauma affecting mainly children and adolescents. Trauma with accompanying fracture of anterior teeth is an agonizing experience for a young individual, which requires immediate attention, not only because of the physical disfigurement but also because of the psychological impact on the patient. Coronal fractures may be vertical or horizontal. Vertical crown fracture with pulpal involvement usually presents mild symptoms and pain. Pain is mainly due to the mobility of the fractured segment during function. This study describes the single-visit management of a complicated vertical coronal fracture in a maxillary central incisor. Esthetic management of the fracture line was done by resin composite by preparing grooves and followed by joining the fragments together. After esthetic management, endodontic treatment was done for the tooth. Crown was given at a later stage to prevent the extension of fracture line and for the longevity of tooth.
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