Trauma and Provisionals for #8 and #9
I live in a college town so I see a lot of college students who end up having a bit too much fun on a Friday night and experience dental trauma. This patient presented with crown fractures of #8 and #9 with the pulp of #8 evident but not obviously exposed and #9 pinpoint pulp exposure.
Of course, she is about to head home for summer break so I won't be able to do any follow up for the next ~3 months.
I used a bioceramic for a pulp cap of #9 and then I prepared the teeth for crowns as conservatively as possible (especially on the lingual leaving the cingulum intact) and milled crowns out of Empress Multi to be used as provisionals. My rationale for cementing these as provisionals rather than definitively is in case either of the teeth become discolored or need RCT.
I plan to see her back in the Fall to evaluate and proceed with the final restorations.
Would anyone do this differently if they were in my shoes?
Did you use a provisional cement? With her being gone for 3 months I would have definitively bonded these. Very nice result either way.
I used a provisional cement. With a handmade bisacryl temporary I wouldn't trust the seal for 3 months but with milled provisionals it seems like the fit is so accurate that leakage is not a major concern. I've done a handful of cases with milled provisionals for 1-3 months and never had issue with leakage under the provisionals.
Say she comes back after 3 months and #9 is necrotic and grey and needs RCT. Would you just do the RCT through the bonded crown or make a new crown?
Fantastic outcome for sure. The problem with any glass would be accessing through the lingual and not having some sort of fracture. I would plan to redo the crown had they been bonded. Because these are on with tempish cement you may be able to remove, RCT and re-temp cement or bond depending on your concern with the tooth turning grey. Lots of unknowns with trauma but what she came in with and left with is night and day, she was lucky to have you.
Very nice temps. Due to her young age, I may have placed composite build up on the fractured corner of the 8. BUT I am just going by the photo I see.
