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

Resident’s Name: Jessica Wilson

Program: Lutheran Medical Center - Providence

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

Author(s): Cavalleri & Zerman.

Journal: Edodontics & Dental Traumatology

Year. Volume (number). Page #’s: 1995. 11: 294-296.

Major topic: Dental Trauma

Overview of method of research: Follow-up Study

Purpose:
Analyze the long term esthetic effects and pulpal vitality of treatment of crown fractures of incisors with incomplete roots.

Methods:
55 patients between the ages of 8 and 12 years old with 84 injured incisors with incomplete root formation were followed and studied for 5 years at the University of Verona, Italy. Patients with any injury other than crown fracture were excluded from the study and the injuries were treated according to trauma protocol.
Patients with enamel fracture only were treated by either smoothing affected enamel or with the addition of composite resin. Patients with fracture involving enamel and dentin only were treated with CaOH covering dentin and then either bonding the fractured fragment back on or a composite restoration. These uncomplicated crown fractures were followed up with radiographic and clinical exam including thermal testing at 1, 2 and 4 weeks, 6 months, 1 year and every year after for 5 years.
Incisors with crown fractures involving the pulp were treated with either pulp capping or partial or coronal pulpotomy with CaOH followed by a composite restoration or bonding of crown fragment and followed up at 1 and 2 weeks, every month for 6 months, 1 year and then annually for 5 years.

Findings:
80% of the injuries were crown fractures involving enamel and dentin and 95% of the injured teeth were maxillary central incisors.
51% of the patients also experienced some sort of soft tissue lesion and 40% of the patients had overjets of over 3mm.
Only 12% were treated by bonding the coronal crown fragment.
After 5 year none of the injured incisors with enamel fracture only experienced pulpal necrosis whereas 6% of injured involving enamel and dentin were found to have pulpal necrosis and 1.5% or 1 tooth experienced pulpal obliteration.
8 of 14 or 57% of the incisors with fractures involving the pulp showed pulpal necrosis.
After 5 years only 43% of the restorations were found to be esthetically satisfactory. 40% had to be re-treated due to new trauma, 17% of the composite restorations experienced incisal wear only 1 of the 10 fragments that were bonded had to be re-bonded at some point.

Key points/Summary:
In general, results established in this study were consistent with previous studies.
Bonding of crown fragments seemed to have better prognosis than composite resins.

Assessment of Article: This was a study with a small sample size which seems to demonstrate what we already know to be true, but a decent article that still reminds us the importance of mouth guards and or ortho treatment for patients with excessive overjets and patients with a history of incisor injury.