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Enamel (E) or Enamel-Dentine (E/D)
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Enamel fracture or Enamel-dentin fracture
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Same as E/D fracture, with pulp exposure.
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The coronal fragment is attached to the gingiva and mobile. The pulp may or may not be exposed. Minimal to moderate tooth displacement
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Tooth is usually mobile and sometimes displaced
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The bone segment containing the involved tooth/teeth is mobile
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Clinical -Radiographic assessment and findings
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Take one radiograph (2)
Evaluate size of pulp chamber and stage of root development.
Sensibility test
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Take one radiograph (2)
Evaluate size of pulp chamber and stage of root development.
Sensibility test
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Take one radiograph (2)
The oblique fracture line is usually perpendicular to the central x-ray beam.
And therefore usually not visible
Sensibility test
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Take four radiographs (1-4)
Extra radiographs taken with different angulations can be useful.
Sensibility test
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Take four radiographs (1-4)
Extra radiographs taken with different angulations can be useful.
Sensibility test
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If dentin is exposed provide a temporary glass ionomer cement bandage or a permanent restoration using a dentin bonding agent and composite (x).
If an intact fragment exists, a bonding procedure may be carried out (xx)
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Perform pulp capping or partial pulpotomy with calcium hydroxide (x)
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In an emergency, stabilize the coronal fragment with an acid etch/resin splint to adjacent teeth.
Alternatively:
Expose subgingival fracture site by:
a) Gingivectomy (x)
b) Orthodontic or surgical extrusion (x)
If root formation is complete, root canal treatment with gutta-pecha/sealer indicated. Otherwise pulp capping or pulpotomy and wait for completion of root formation
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Reposition the coronal fragment. Check position radiographically. Immobilize the tooth with a splint for three weeks. (xx)
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Reposition the fragment. Splint the fragment to adjacent teeth with a splint(xx)
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Soft diet
Brush teeth with a soft toothbrush after each meal
Use chlorhexidine mouthrinse (0.1%) twice a day for 7 days
Follow up (see Table)
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