Restoration, filling and replacement of the incisal edge of an incisor having suffered traumatic fracture using Asteria composite filling (Case presentation) (53)

Traumatic dental injuries triggered by falling, impact, altercations are frequent during childhood. 5% of childhood injuries are composed of dental injuries and over 25% of school children are affected by a dental trauma of some sort. Injuries have various levels:

• A mild blow may cause the tooth to become loose and sore, which soreness resolves over time and no treatment becomes necessary. Soft, pulpy foods and avoidance of strong bite on the injured tooth are recommended.
• A stronger blow may cause pieces of the tooth to chip off, and injury to veins and nerves nurturing the tooth. Occasionally a small bump may appear on the gums over the tooth, which may at times excrete pus. This calls for root canal treatment without delay to prevent infection.
• On a severe blow the tooth may break out of the tooth socket. If this happens, place the tooth in a moist place (milk, saliva, physiological saline solution) in a clean textile cloth and a box and report to the dentist as soon as possible, since with immediate root canal treatment the tooth may be salvaged and re-implanted. Do not wipe off fibres and epithelial tissue remaining on the tooth surface. Teeth re-installed in such a way may be firmly secured for years in the jaw.

The timely assessment of the extent of the injury and setting up a diagnosis by the dentist are crucial in preserving the teeth. Therefore, in the event of an injury, the parent should take their child to the dentist without delay. Tending to fractured teeth is all-important as they can be rather disturbing in aesthetic terms for the developing child, with the broken teeth greatly impairing bite, chewing and, in time, the development of occlusion, in other words, the mutual position of the lower and upper teeth on bite. At this age the teeth can easily migrate from their original position causing subsequent crowding or gaps (diastema) between the teeth. Often the fracture also affects the dental pulp chamber, causing the tooth to bleed right after the fracture. Such cases call for root canal treatment and root canal filling. With children it is particularly important to block the way of infections into the body or the tooth germ of the prospective permanent tooth as soon as possible. Occasionally, the fault line may lie deep underneath the gums in which case the removal of remaining root canal pieces may become necessary.

Figure 1 – the anatomy of the molar

Figure 2 – in the event of enamel fracture no root canal treatment is necessary

Figure 3 – Fractures affecting the dental pulp chamber indicate root canal treatment

Case presentation A female patient aged 11 suffered a dental trauma, chipping off the incisal edge of her upper left central incisor. The tooth remained vital and presented no complaints, and with the fault line being remote from the dental pulp chamber the case called for no root canal treatment. The fracture belonged with the category of dentin fractures.

Upper left central incisor with fractured incisal edge following dental trauma, prior to incisal edge restoration

If the tooth is fractured in a sharp line and the chipped-off part is available, the tooth can be restored by gluing the chipped-off part back on. In such cases, however, the chipped-off part may get discoloured as it loses some of its moisture content with its erstwhile connection to the tooth being impaired. In the present case the chipped-off part was not available, which is why our choice fell on incisal edge restoration. Restoration with filling also has the benefit that it allows for the preservation of the most dental material. The restoration of the chipped-off part was performed in one sitting using Tokuyama Astreria and Estelite without anaesthesia. The premium quality material used complies with the highest aesthetic standards, which makes it the fittest choice of filling material in the front region.

The upper left central incisor following restoration of the incisal edge

The patient left thoroughly satisfied. There is no over-emphasising the importance of appropriate oral hygiene in preserving the function and aesthetics of the filling. The patient will report for a follow-up examination in 6 months’ time. The life expectancy of the filling is 8 to 10 years, but subject to the discoloration of the teeth it may need to be replaced earlier. The tooth tends to get discoloured earlier than the filling, so once a colour discrepancy arises it is advisable to prepare a new a filling. The edges of the filling need to be re-polished at the follow-up sessions to ensure the highest aesthetic and functional standards. Cleaning the filling and the neighbouring teeth is best performed with a combination of the tooth brush (electric or manual), tooth floss, interdental brush, single tufted tooth brush and mouth rinses.

Before/After

Keywords: incisal edge restoration, filling of front teeth, Asteria filling material, aesthetic filling, re-implantation