Restoring a Child’s Smile: The Case of the Broken Incisor and Pulp Vitality Preservation

In a remarkable case of dental repair, a simple yet innovative approach was taken to preserve the vitality of a young patient’s tooth after a fracture exposed the pulp. This case involved an 11-year-old patient with a cleanly broken incisor, presenting a unique challenge and opportunity for dental professionals.

Reasons for Cementing the Fragment:

  • Simple Restoration: The reattachment of the broken fragment was deemed the most straightforward method to restore both the tooth’s aesthetics and functionality. This is particularly crucial for children, where achieving a color match can be complex.
  • Durability: The bond strength obtained through this method is robust, making it more likely that any future trauma would result in a fracture at a new site, rather than a debonding of the repaired fragment.
  • Biological Potential Preservation: Compared to alternatives such as endodontic treatments, cementing the fragment maintains the tooth’s biological integrity. Other treatments may be considered if this initial attempt fails.

Preserving Tooth Vitality Despite Risks:

  • Young Age Consideration: The decision to prioritize pulp vitality was based on the patient’s age, considering the high potential for recovery and vitality maintenance at a young age. Regular follow-ups are planned to monitor the tooth’s condition, with root canal treatment as a contingency.
  • Ideal Fit Preservation: By avoiding a root canal initially, the perfect fit between the tooth and its fragment is maintained, something that might not be achievable post-endodontic treatment.
  • Future Treatment Options: Should pulp necrosis occur, root canal treatment is a viable next step.

Protocol for Direct Pulp Capping:

  • Isolation and Cleaning: The area is isolated with a rubber dam, and the exposed pulp is cleaned using sodium hypochlorite for its antimicrobial properties, with alternatives like saline solution and chlorhexidine also considered for their respective benefits.
  • Hemostasis and Drying: Achieving hemostasis and gentle drying are crucial steps before applying the capping material, ensuring the area is prepared without overdrying.
  • Direct Pulp Capping: If the pulp is viable, direct pulp capping is performed using a bioceramic material, chosen for its compatibility and effectiveness.

Covering the Bioceramic Material:

  • Restoration Options: The choice between glass ionomer cement and an adhesive protocol is made based on the need for protection and aesthetics. The adhesive protocol, despite its challenges, is selected for its strong bond strength and aesthetic results.
  • Space Creation: A small portion of the fragment’s inner surface is removed to accommodate the biomaterial, ensuring a proper fit during reattachment.

Practical Application:

  • Cementation Process: The tooth and fragment are prepared with a total etch IV generation adhesive, not immediately polymerized. A preheated sculptable composite is then applied, excess removed, and the assembly is light-cured, following the manufacturer’s instructions meticulously.

This case exemplifies how a blend of traditional techniques and innovative materials can result in successful dental outcomes, particularly in preserving the natural vitality and functionality of young patients’ teeth.

Restoring a Child's Smile: The Case of the Broken Incisor and Pulp Vitality Preservation
Restoring a Child's Smile: The Case of the Broken Incisor and Pulp Vitality Preservation
Restoring a Child's Smile: The Case of the Broken Incisor and Pulp Vitality Preservation
Restoring a Child's Smile: The Case of the Broken Incisor and Pulp Vitality Preservation
Restoring a Child's Smile: The Case of the Broken Incisor and Pulp Vitality Preservation
Restoring a Child's Smile: The Case of the Broken Incisor and Pulp Vitality Preservation
Restoring a Child's Smile: The Case of the Broken Incisor and Pulp Vitality Preservation
Restoring a Child's Smile: The Case of the Broken Incisor and Pulp Vitality Preservation