Temporary and Permanent Restorations for Fractured Permanent Teeth with Immature Apices: A Clinical Study
PURPOSE: A Comparative evaluation of two techniques for treating Ellis Class I, II or III fractures of permanent teeth with Physiologically incomplete apices.
MATERIALS & METHODS: Human Study with 56 pts. (53.6% Male and 46.3 % female) ages 7–11. All had at least 1 permanent Incisor with an Ellis Class I, II or III fracture with a physiologically incomplete apex. The following clinical steps were followed with all subjects:
1-Isolating the tooth, using lip retractor and cotton rolls, 2-Cleaning the affected area with a physiological salt solution, 3- Cleaning the tooth with a rubber cup and a mixture of pumice stone and water, 4-Washing, Irrigating and protecting the dentin-pulp with calcium hydroxide. As well as A) Half the pts. were restored using the conventional technique: A metal band cemented with ZOE cement and B) Half the pts. were restored with Photopolymerizable G.I. (Vitrebond) and a Polymerizable resin (Silux).
RESULTS: All pts. were clinically examined 3, 6 and 12 months. Pulp vitality was determined using mechanical and electrical tests. A radiograph evaluation was also made to determine the state of apical growth using apical convergence as the criterion. A) It was found that of 44 teeth reconstructed with the band technique 91% maintained their vitality, in the 1st and successive evaluations.B) Also, of the teeth constructed with the crowns, 97.5% maintained their vitality in the 1st and successive evaluations. C) Physiologic completion of the apices of the roots occurred after 3 months in 17% of the crown cases and 9% of the band cases. D) At 6 months, 48.7% of the crown cases and 43.1% of the band cases. E) At 12 months, 73.1% of the crown cases and 54.5% of the band cases.
DISCUSSION: There is no significant relationship between the type of restorative technique used and the preservation of pulp vitality. No significant relationship between the type of restoration and the time at which the physiological completion of the apices occurred. The results of the study corroborate the hypothesis that immediate restoration of a fractured Incisor does not affect the vitality of its pulp and the growth of its apex.
SUMMARY/COMMENTS: There was a predominance of injuries amongmales and a greater frequency among school-aged children as well as a greater incidence in the maxillary teeth. Falls were seen to precede most fractures and the greatest % of injuries is found in pts. with pronounced overjets. It may be concluded that both the band and crown restoration technique allow preservation of pulp vitality and the physiological completion of apical growth in fractured permanent teeth with immature apices.
Viada, Rivera, Nava Et Al; JDC; Nov-Dec; 414–416; 1997.
Originally published at alfredkhallouf.com.