Traumatic crown fractures in permanent incisors with immature roots: a follow-up study

Resident: Adam J. Bottrill
Date: 28AUG09
Region: Providence
Author(s): Cavalleri G., Zerman N.
Journal: Endodontics and Dental Traumatology
Volume #; Number; Page #s: Volume 11 pp: 294-296
Year: 1995

Major topic: Immature permanent incisor fracture
Minor topic(s): None
Type of Article: Topic review and summary
Main Purpose: Analyze the long term effect of treatment of crown fractures in permanent incisors with incomplete root formation in regard to pulp survival and aesthetics.
Overview of method of research: Prospective case comparison
Findings: What? Spoil the surprise????!!!

Key points in the article discussion: The most common dental injury at age 6-13 is crown fracture. This injury often involves immature teeth.

A. Clinical Materials and Methods:
1. 55 injured Pt’s (age 6-12) with 84 crown fractures in permanent teeth with incomplete root formation.
2. Follow-up over 5-yr period at Dental Clinic of the University of Verona Italy.
3. Crown fractures divided into 3 categories:
a. Fracture of enamel
b. Fracture of enamel and dentin with no pulpal involvement
c. Fracture of enamel and dentin WITH pulpal involvement.
4. Recorded data: personal data, med Hx, exam, trauma Hx, photos, lesions, occlusion, injured teeth, type of injury, color of teeth, mobility, general oral health, subjective symptoms, vitality tests, radiographs, Tx.
5. Various Tx:
a. Enamel fx: smoothing, composite
b. Enamel/Dentin fx: comp, CaOH pulp cap, bonding of frag
c. Enamel/Dentin with Pulp fx: pulp cap, pulpot
6. Follow-up:
a. E, E/D: 1,2,4 wk, 6 mo, 1yr, annually
b. E/D w/Pulp: 1,2 wk, 1,2,3,4,5,6 mo, 1 yr annually

B. Results:






























Endodontic & Dental Traumatology
1995: 11: 294-296

1. Most injuries occurred in 8-y.o. children
2. Boys 3.6:1 over girls
3. 95% maxillary centrals
4. 40% occurred with maxillary overjets of >3mm
5. Note: 6 of the 8 teeth that experienced pulpal necrosis werer treated >24 hrs later.
6. 36 restored teeth considered aesthetically satisfactory
7. 34 restored teeth needed retreatment due to new trauma.

C. Extra Discussion:
1. The high percentage of retreatment because of new trauma emphasized importance of preventative measures (mouthgaurds from Dr. Brian etc…)
2. Bonding of tooth fragment seemed to have better long term prognosis than composite restorations.

Assessment of article: Applicable and well organized.