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14 February 2021

Crown fracture in aesthetic area: biological-functional management with chair-side system

Authors: Franco Brenna, Lidia Tordiglione, Adriana Brenna, Sergio Porro

Objectives: The aim of this case report is to present the management of vital anterior tooth with a complex crown fracture with pulp exposure caused by traumatic injury. The case describes the adhesive rehabilitation with chair-side system maintaining the tooth vitality in a young tooth patient with a 6 years follow-up. In the first emergency phase, the conservation of vitality pulp was reached with an application of bio-active materials. In the second phase, a provisional crown was realized to monitor the dental vitality and to create a dental functional aspect by using adhesive system. In the last phase, a definitive crown in ceramic material was performed to give an aesthetic result and a long term restoration.

Materials and Methods: In the emergency phase, a partial pulpotomy and a direct pulp capping were performed to protect the pulp vitality using calcium silicate paste based on Portland cement (Tech Biosealer Capping; Isasan) and sealed with adhesive system and flowable resin composite (Optibond FL, Kerr and Tetric Evoflow, Ivoclar Vivadent). A provisional crown was realized by using Bluecam Cerec (Dentsply-Sirona): an intraoral digital impression was acquired, the restoration was projected with Cerec Software (Software Cerec 4.3, Dentsply-Sirona) and it was milled from a resin nano-ceramic block (Lava Ultimate, 3M ESPE). The provisional crown was luted with adhesive system in the same clinical appointment. After 4 years of clinical and radiographic follow up, a more functional and aesthetic crown was obtained in lithium disilicate (IPS e.max CAD, Ivoclar-Vivadent). In this last phase, a digital impression of the provisional crown was acquired with Cerec Bluecam intraoral scanner in the biogeneric copy mode to keep the same morphology of the present restoration.

Results: After the first 4 years of clinical and radiographic follow up, the tooth demonstrated to conserve the pulp vitality during the provisional phase. This result conducted to the definitive prosthetic phase. The lithium disilicate crown improved the aesthetic requirement of an anterior area and increased the restoration survival rate.

Conclusions: When pulp exposure occurs in less than 1 mm of thickness, the vital pulp can manage with partial pulpotomy and pulp capping material. The management of a dental injury depends on the immediate therapy, on a correct diagnosis and on a specific follow-up. Cad-Cam chair-side system are able to obtain good and predictable result. 

Clinical significance: The case report propose a biological and functional solution in the presence of compromise dental structure in a young patient. The application of bio-active material on the exposed pulp and the use of adhesive system allow to conserve as dental structure as possible. The new generation materials ensure restorations with a long term survival. In this overview, Cad-Cam chair-side system propose an alternative and saving time solution with a good aesthetic result as the traditional one. 

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