Trauma to the mouth is most frequently seen in the pediatric population. Fractured anterior teeth present a challenge to both the dentist and patient. The most common type of fracture involves the enamel and dentin, with no exposure of pulpal tissues. The challenge is how best to protect the traumatized tooth and allow healing of the young pulpal tissue before restoration is done at a later date. Immediate restoration of the fracture, although tempting, could aggravate an already inflamed pulp.1
Commonly accepted treatment for fractured anterior teeth involving dentin but no pulp consists of placing a resin bandage over the dentin to protect the tooth until it is restored at a follow-up appointment. Most practitioners place calcium hydroxide under conventional acid-etched composite. The procedure can be difficult to perform, however, especially in the presence of saliva, blood, dirt and debris. The patient usually is in distress. In addition, the tooth may be very sensitive to cold temperatures. Local anesthetic may be needed, but it can add to the trauma for the already distressed patient. An alternative method exists that involves use of a bandage to protect a fractured anterior tooth without the need for anesthetic, etching, rinsing or blow-drying. In fact, a wet field is desirable.
TECHNIQUE
Isolation usually is not necessary. The clinician should gently wipe the fractured tooth with a warm, wet gauze pad until all traces of blood and debris have been removed. The tooth should be left slightly wet; no blow-drying is needed. Mix the powder and liquid of the light-cured resin-reinforced glass ionomer cement (Fuji Ortho LC, GC America Inc.) according to the manufacturer’s directions. Place a layer of the mixture over the exposed dentin and on the fractured edges of enamel without interfering with the patent’s occlusion. Light-cure for 20 to 40 seconds. In addition, it is essential that the dentist reassure and comfort the patient and his or her parents.
The challenge is how best to protect the traumatized tooth and allow healing of the young pulpal tissue before restoration is done at a later date.
Wait two to four weeks for the pulp to heal, then restore the tooth with the acid-etch technique. A layer of the glass ionomer resin bandage can be left on the dentin when restoring the tooth. The clinician can often restore the tooth without administering a local anesthetic because the pulp is no longer inflamed and the patient is more calm and comfortable.
CONCLUSION
I have presented a fast, easy and effective technique to protect a traumatized tooth. The reinforced glass ionomer bonds well in a wet field, without the need for etching, rinsing or blow-drying. In my practice, I have not encountered any postoperative problems associated with this technique.
