Year :
2007
| Month :
February
| Volume :
1
| Issue :
1
| Page :
17 - 21
Full Version
Functional Crown Lengthening On A Fractured Tooth In A Medically Compromised Patient
Published: February 1, 2007 | DOI: https://doi.org/10.7860/JCDR/2007/.48
GOPAL Y,MULLABADI R
Gopal Dental Care Clinic, Barnala,India
Correspondence Address :
Dr Yamir Gopal, Email:harshita_bnl@yahoo.com
Abstract
A fractured tooth is one of the most challenging cases in a dental office; more so when the tooth is fractured at the level of the gums. Treatment options in such cases are extremely limited. More often than not, extraction of the tooth is preferred. However in medically compromised patients extraction is not feasible and hence other treatment options have to be explored. Functional crown lengthening is one such procedure that allows a dentist to preserve the fractured tooth as well as restore it to its aesthetic and functional stability. Described below is a case involving a tooth fractured at the gum level. The patient was medically compromised, thus ruling out extraction. Functional crown lengthening was the preferred treatment.
Keywords
Functional Crown Lengthening, Dental, Fractured tooth
Case Report
A medically compromised patient,who was suffering from labile hypertension and asthmatic bronchitis, who presented with a fractured lower right first premolar (tooth no 34) was treated by this procedure.(Table/Fig 1)
The gingiva and the bone followed a definite pattern inter-proximally, facially and palatally or lingually. In the given case, the patient came to us with a horizontal fracture of the right lower 1st premolar tooth crown at the gum margin. On clinical examination, it was found that the remaining part of the tooth was non-vital. An X-ray to assess the underlying bone patterns and support was taken. After a thorough assessment of the radiograph, it was decided to save the remaining part of the tooth.
Procedure
An intra-alveolar nerve block was first administered along with a sulcular block. Thereafter a circumferential incision for gingivectomy was made around the neck of the root.(Table/Fig 2) Then circumferential bone gutter was made using a round bur in the gingival sulcus(Table/Fig 3). The available root length was calculated from an RVG X-ray(Table/Fig 4). It was found to be 14 mm, which is quite adequate for the purpose.
We filled 10 mm of the root canal with gutta percha and selected an 8 mm post for root. We put 4 mm of the post inside the root and 4 mm of post was left outside the root(Table/Fig 5)(Table/Fig 6). Then, using posterior composite material, we built a core for the crown. Tt was ready for impression making(Table/Fig 7)(Table/Fig 8).
Final crown placement:
There are two important points which are normally taken care of:
• Ferrule effect is taken care of,
• The PFM crown must rest on the finishing line made at the root part – prepared after guttering inside the gingival sulcus around the fractured root part of the tooth. The Crown must not rest on the post or composite alone.
A medically compromised patient presented with a fractured lower first premolar at the gum margin, he would have been a problem case for extraction, but has been successfully managed by the Functional Crown Lengthening procedure with good results.
Discussion
The Functional crown lengthening is a means of facilitating restorative procedures and preventing extraction of those teeth that can be theoretically be spared. There is extensive literature to back the feasibility of this procedure in cases like the one mentioned above.
A few of the indications for crown lengthening are - caries beneath the gingival margin, fractured teeth with insufficient clinical crown exposure, and teeth with excessive occlusal or incisal wear.(1)
In recent times, crown-lengthening procedures have been necessitated more by aesthetic than biologic requirements.(2) Basically the crown lengthening procedure allows the dentist to recreate the dento-gingival junction at a more apical level on the root, so that the junctional epithelium and the connective tissue attachment can be safely relocated.
There are many instances of using functional crown lengthening as a means to save a tooth cited in dental literature. In a survey conducted in 2004, Wyatt G, Grey N, and Deery C found that specialists in periodontics were more likely to perform crown lengthening procedures as opposed to other specialties.(3)
Conclusion
Functional Crown Lengthening procedure is a viable procedure that enables dentists to restore teeth having a short clinical crown, extensive sub-gingival caries, sub gingival tooth fractures as well as fractures at the dento-gingival junction. When performed in ideal clinical settings, functional crown lengthening gives satisfactory results both from a functional as well as an aesthetic viewpoint.
Acknowledgement
JCDR services were used in research and write up of this article.
Reference
| 1. | Becker W, Ochsenbein C, Becker BE. Crown lengthening: the periodontal-restorative connection. Compend Contin Educ Dent 1998;19:239–40, 242, 244–6 passim; quiz 256.
| 2. | Lee EA. Aesthetic crown lengthening: classification, biologic rationale, and treatment planning considerations. Pract Proced Aesthet Dent 2004;16:769–78; quiz 780.
| 3. | Wyatt G, Grey N, Deery C. A cross-sectional survey of clinicians performing periodontal surgical crown lengthening. Eur J Prosthodont Restor Dent 2004;12:109–14.
| 4. | Lanning SK, Waldrop TC, Gunsolley JC, Maynard JG. Surgical crown lengthening: evaluation of the biological width. J Periodontol 2003 Apr;74(4):468–74.
| 5. | Pontoriero R, Carnevale G. Surgical crown lengthening: a 12-month clinical wound healing study. J Periodontol 2001 Jul;72(7):841–8.
| 6. | Gegauff AG. Effect of crown lengthening and ferrule placement on static load failure of cemented cast post-cores and crowns. J Prosthet Dent 2000 Aug;84(2):169–79.
| 7. | Brägger U, Lauchenauer D, Lang NP. Surgical lengthening of the clinical crown. J Clin Periodontol 1992;19:58–63.
| 8. | Parashis A, Tripodakis A. Crown lengthening and restorative treatment in mutilated molars. Quintessence Int 1994;25:167–72.
| 9. | Deas DE, Moritz AJ, McDonnell HT, Powell CA, Mealey BL. Osseous surgery for crown lengthening: a 6-month clinical study. J Periodontol 2004 Sep;75(9):1288–94.
| 10. | Sonick M. Esthetic crown lengthening for maxillary anterior teeth. Compend Contin Educ Dent 1997 Aug;18(8):807–12, 814–6, 818–9; quiz 820.
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