John Pasicznyk Anyone ever have that nightmare where you break a tooth, or bite into something and your tooth comes out? Maybe I'm just weird, but that's one of my worst nightmares. So it always pains me when I hear about someone breaking a front tooth. I had a nice normal day going and see a message come across Eaglesoft stating we added an emergency patient to the schedule. 19 yo kid, stated to treatment coordinator on the phone that he "thinks he chipped his front two teeth". I'm not really concerned, figure he at worse busted off part of the incisal edge. To my horror, this is what I walk into when I see him later in the day. We really need to work on his communication skills
Turns out he was in significant pain, had a busted lip, bleeding, the whole bit. He was "roughhousing" with a friend in their dorm room, and he got the short end of the stick. #8 had a bleeding exposure, #9 had some significant cracks through the facial aspect. #9 tested normal to cold. Neither tooth exhibited any clinical mobility. Due to the exposure of #8, recommend endo. Decided to build both teeth up with resin to stabilize and then determine what long term restoration they need, most likely crowns due to the fractures present.
In this case, I knew it would be far easier to place an indirect resin hybrid on #8 than to sculpt it by hand and attempt to make it look reasonable. Instead of direct placement, I decided to prep a slight bevel on the facial aspect, smooth out the roughened enamel surfaces and fabricate an indirect hybrid resin. After consent was obtained, financial arrangements were made, and we got set up, the appointment went like this:
Anesthesia
Smooth prep and esthetic bevel #8, bevel and smooth #9
Image, design, start fabrication Cerasmart #8 MIFL
While the block was in the miller, I started endo on #8 with a conservative access. Instrumented to a Waveone Gold size large. Obturation took place using Wave One Gold gutta percha point, backfilled with Obtura warm gutta percha. I sealed off the chamber with core build up material, intentionally leaving the build up short of the prep surface to not interfere with the seating of the restoration.
Try in the restoration, prepare for bonding. Selective etch process was used on the tooth, followed by Prime and Bond Active and Calibra Ceram adhesive resin cement to bond the restoration in place.
Leaving the rubber dam in place, #9 was restored with TPH spectra resin
Removed rubber dam, polished finish line of #8 and polished resin #9 using 3M Soflex discs
Checked occlusion, removing any excursive interferences.
All in all, not displeased with the result. #8 lost translucency in its edge due to the bulk of Cerasmart. Material selection for final crowns will need to accommodate for this. Mom and patient left very happy with results and service. 12 and 24h follow up calls reported no pain from procedure, just some residual soreness of where he cut his lower lip and chin.
One fun caveat to this case, I'll bill medical insurance for the entire procedure and due to this being a trauma case, I anticipate reimbursement. I'll be sure to post once the claim is processed and (hopefully) paid.
