In uncomplicated crown fractures there is loss of
tooth structure without an exposure of the pulp. These
injuries can involve the loss of enamel only or loss of
enamel and dentine. Pulpal complications rarely occur
in teeth with enamel fractures only (0–1 per cent),
unless there is an associated luxation injury (8.5 per
cent).
In the absence of concomitant luxation injury,
complications resulting from injuries involving both the
enamel and the dentine are also infrequent (0–6 per
cent).
An increased incidence of pulpal necrosis in
teeth with combined fracture and luxation injuries has
been clearly established (25 per cent).
In the absence
of simultaneous luxation injuries, complications are
also believed to develop from bacterial penetration into
open dentinal tubules. Dentine coverage is indicated for
all these fractured teeth. Relevant determinants of
prognosis are: the type and site of fracture; the presence
of luxation injury; the type of treatment undertaken
and the timing of treatment. Pulp necrosis occurs more
often in deep angular fractures and in deep fractures
that are left untreated for more than 24 hours. Lost
tooth structure can be restored by restorative
materials or by re-attachment of the fragment.
The prognosis for re-attached crown fragments is
good and continues to improve with the increasing
bond strengths achievable with dentine bonding
agents.
Thus, patients should be advised to search for
and bring any tooth fragments with them when
presenting for treatment. Reinforcing the fragment
margins with composite resin does not appear to
have any significant effect on the retention rate of the
fragment.
Placement of an internal groove within the
dentine of the fragment to improve retention by
increasing the surface area available for bonding has
been suggested.
Composite restoration with fibre
reinforcement has a higher load-bearing capacity than
conventional composite restoration.
Porcelain
laminate veneers are a predictable, effective and
relatively conservative way of reinforcing the strength
of a re-attached fragment.