- Permanent:
(a) apexogenesis/apexification;
(b) root filling + root extrusion;
(c) + gingival and alveolar collar modification;
(d) semi or permanent coronal restoration.
Trauma cases require painstaking follow up to identify any complications and
institute the correct treatment. The 'trauma stamp' is invaluable in this. In the review
period the following schedule is a guide: 1 week; 1, 3, 6, and 12 months; and then
annually for 4-5 years.
12.7.1 Injuries to the hard dental tissues and the pulp
Enamel infraction
These incomplete fractures without loss of tooth substance and without proper
illumination are easily overlooked. Review is necessary as above as the energy of the
blow may have been transmitted to the periodontal tissues or the pulp.
Enamel fracture
No restoration is needed and treatment is limited to smoothing of any rough edges and
splinting if there is associated mobility. Periodic review as above.
Enamel-dentine (uncomplicated) fracture
Immediate treatment is necessary and the pulp requires protection against thermal
osmotic irritation and from bacteria via the dentinal tubules. Restoration of crown
morphology also stabilizes the position of the tooth in the arch.
Emergency protection of the exposed dentine can be achieved by:
- A composite resin (acid etched) or Compomer bandage
- Glass ionomer cement within an orthodontic band or incisal end of a stainless-steel
crown if there is insufficient enamel available for acid-etch technique.
Intermediate restoration of most enamel-dentine fractures can be achieved by:
- Acid-etched composite either applied freehand or utilizing a celluloid crown
former. The majority of these restorations can be regarded as semi-permanent/
permanent. Larger fractures can utilize more available enamel surface area for
bonding by employing a complete celluloid crown former to construct a 'direct'
composite crown. At a later age this could be reduced to form the core of a full or
partial coverage porcelain crown preparation. - Reattachment of crown fragment. Few long-term studies have been reported and
the longevity of this type of restoration is uncertain. In addition, there is a tendency