Treatment of patients with fracture of the tooth

03-09-2009
Treatment of patients with fracture of the tooth
 Treatment of patients with fracture of the crown of the tooth is aimed at restoring the lost crown of the tooth tissue. In the case of fracture of the tooth at the cervical orthopedic methods of reconstructing the lost crown a more promising, if the fracture line passes over extragingival attachment (making pins tooth crowns Stump). Sometimes to implement the plan of orthopedic treatment appropriate excision of the edges of the mucous membrane. In the literature there are indications of the effectiveness of orthodontic preparation for orthopedic treatment. It consists in placing the stump of the root of the alveoli in the side edge of the gum with the orthodontic apparatus. If you can not orthopedic treatment showed removal of the root. 

At the turn of the lengthwise crown and root of the tooth (crown-root fracture) in the literature there are few reports on the effectiveness of artificial crowns or rings fixed on the neck of the tooth after the treatment and the introduction of a channel steel pins on the phosphate cement. Specified positive experience concerns the fracture in the frontal plane when the fracture line runs from the vestibular surface of the crown of the tooth near the edge of the gum and is distributed by standing in an oblique direction [Chuprynina NM et al, 1993]. Most of his teeth with such a fracture is removed. Treatment of patients with fractures of the root of the tooth is determined by the localization of the fracture, the degree of displacement of bone fragments, the state of the pulp of the tooth. Clinical experience shows that when the turn of the pulp remains viable more than dislocation. At the turn of the root of the tooth pulp with a break at the line of fracture last perishing fragments only in the crown, but the crown remains alive. This should be borne in mind by defining the tactics of treatment of such patients. Transverse fracture of the neck near the root of the tooth is the least favorable for effective treatment. Immobilization of the coronal fragments even when living in the root pulp, the department usually does not lead concretionary fragments. Positive results are possible with the introduction of the metal pin in the tooth canal after extirpation of the pulp, including living through trepanations in its crown. Pin sufficient thickness fixed phosphate cement. Such observations are scarce. Often broke off part of the crown with a part of the root is removed and restored it bolted tooth or Pin tab. 

At the turn of the root in the middle third of the method of treatment will be determined by the state of the dental pulp, the degree of displacement of bone fragments. Established that the fracture without displacement of the root pulp is injured slightly and remain viable for 75-80% of patients. Infection it does not happen, because the periodontium intact extragingival protected compound and a circular band. If rupture of the pulp has not happened and there is no displacement of bone fragments, should produce immobilization of the tooth bus Kappa plastic not less than 4 weeks. You can use a smooth tire-bracket with the inclusion of 2.3 of healthy teeth on each side, but it better not to fix the metal ligatures, and composite materials. The metal alloy, having around the neck of the tooth, with its twisting makes otlomok of the alveoli and increases the gap between the fragments of the root. In the case of displacement of crown fragment should it reponirovat immobilization and implement the described method. Radiological fracture line may be determined within a few years. However, most often arises in the death of the pulp coronal fragment. A negative result for a single elektroodontometrii is not yet absolute proof of necrosis of the pulp. If necrosis of the pulp happens, crown loses its characteristic luster and becomes grayish, grayish-yellowish brown tint. In this clinical situation shown endodontic treatment the tooth by the rules adopted in preventive dentistry. 

Often at the turn of the root in the middle third of its fragments with offset justified the tactics of introducing a metal pin in the fragments after extirpation of the deceased and viable pulp. This prerequisite is a thorough comparison of the fragments of the root, driven them to each other, so that phosphate cement did not get between the fragments, which will lead to an adverse outcome – the development of chronic inflammation in periodontitis. For bonding tooth fragments selected by the maximum diameter of the channel thick metal pin is introduced into the canal coronal fragments and promoted in the apex. If the fragments are displaced and the pin is not included in the apical otlomok begin, shaking his crown piece, to change its position in the hole, gently pressing on the pin. Tied channel pin slips into the canal apical fragments. After this manipulation remember the position of crown fragments and the pin is extracted. Channel dried, pin brush with phosphate cement and injected into the channel of the two fragments of the tooth as described above. After the hardening of cement are being withdrawn from the tooth occlusion. If the line is a fracture in the apical third of the root and the pulp is lost, it can be removed from the coronal part of the root canal stop a phosphate cement to the line of fracture, and tooth fix with the help of a tire if it is mobile. Apical otlomok with living pulp remain, if it does not cause inflammation. In the event of such – the tip of the root is removed, an operation type of resection of the root after relieving acute inflammatory phenomena. Feature is its need trepanirovaniya vestibular wall of the hole within otlomlennogo apical root fragment. There is another solution in this clinical situation. You can remove the pulp from the coronal and apical fragments and seal both fragments with a steel pin, as described above. Sometimes fragments of the root is removed, connect the pin out of the mouth, after which the tooth replantiruyut. The costs of this method of treatment does not differ from those after replantation of the tooth at all. If you can not compare the fragments of the root in the right position or there is a comminuted fracture of his, as well as in the case broke off a wall of the alveoli, the tooth to be removed. 

Clinical and experimental studies have established [Konstantinov, AM, Sedykh VA, 1989] that in the absence of displacement of fragments of the root or non-existent it when the pulp is viable and maintained a compact disc hole tooth root fragments combined tsementoidnoy cloth. If the fragments are displaced more than 2 mm and there was a fracture of the alveoli walls broken tooth, tooth root fragments combined with fibrous (scar) and tsementoidnoy or only fibrous tissue. Pulp fragments while fused with the formation of the scar, which is dominated by collagen fibers with a large number of cells fibroblasts statistically series. When the displacement of bone fragments and damaged compact disc hole tooth clearly defined hyperostosis compact disc. In the line already had a root fracture teeth is a gradual replacement of periodontal compact coarse-fibered osseous tissue, the growth of opposition which starts from the walls of the alveoli. Root fragments combined, stitched lines formed around the fracture of the bone collar. This process takes about 5 months. Thus, depending on the state of periodontal tissues and dental pulp connect fragments of the roots of teeth can occur with bone couplings, tsementoidnoy actually connective (fibrous) tissue, or a combination thereof.
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