Volume 2 - Issue 3 (May-Jul)

Case Report
the length of time that has passed between the accident
and treatment. 12 Treatment may also depend on the
ability of the child to co-operate with the treatment
and number of teeth involved. 6 The increased incidence
of traumatic injuries to anterior teeth is a consequence
of modern leisure activities and the most common
injuries are crown fractures. 11
The following cases were reported in the literature
wherein the fractured teeth were extracted owing
to either a delay in the treatment instituted or the
inability to provide a secure post-endodontic restoration
and only two cases were reported for preserving
the teeth. 8
Figure 9. Postoperative IOPA.
examination wound dressing in the chin region was
observed, no gross asymmetry; no deviation and
no extraoral swelling were observed. On intraoral
examination revealed a vertical fracture of 74, fracture
line extending mesiodistaly and occluso-gingivally
towards the lingual side in 74 (Fig. 2).
Extraoral examination showed a healing laceration on
the chin. Mouth opening was normal and there was
no pain on examination of temporomandibular joints.
Orthopantomogram (OPG) (Fig. 3) and intraoral
periapical (IOPA) (Fig. 4) confirmed the fracture line
extension to pulpal region in 74. Extraction is usually
the treatment of choice. But, the child being be too
young to lose her teeth, an attempt was made to save
the tooth 74 by attaching fragment with glass ionomer
cement (GIC) type 1X (Fig. 5) followed by pulpectomy
using metapex (Figs. 6 and 7), with placement of
stainless steel crown (Figs. 8 and 9).
Discussion
Crown root fractures of primary molars are extremely
rare and usually occur as a result of trauma to the
chin, as occurred in this case. Although anterior teeth
are more prone to trauma than the posterior teeth, it
is essential that the posterior teeth are also carefully
examined to ensure an accurate diagnosis, especially
when there has been an injury to the chin. 9
Treatment of the fractured tooth or teeth depends on
the severity and position of the fracture line as well as
The literature reports several different treatments
for this kind of problem, ranging from the
maintenance and use of the tooth fragment either as
a temporary or permanent crown, definitive crown
after an orthodontic or surgical extrusion or a crown
lengthening to an extraction of the residual tooth
followed by an immediate or delayed implant surgery,
or fixed partial denture. 13 There have been reports of
fractured primary molars being successfully treated by
pulp therapy and restoration with preformed metal
crowns but in many cases extraction will be the
necessary treatment. 4
The need for a multidisciplinary approach in the
treatment of routine dental problems has been
recognized for some time, especially for dental traumas
that require comprehensive treatment and an accurate
diagnosis and treatment plan, respecting the biological,
functional and esthetic aspects as well as the patient’s
will. 5
In the present case report, we have attempted to save
the teeth by pulpectomy with placement of stainless
steel crown in order to maintain the masticatory
function and thereby prevented the complicated
clinical problems that may arise after extraction of the
primary molars in such a very young patient.
Conclusion
Treatment of the dental trauma is complex and requires
a comprehensive and accurate diagnosis and suitable
treatment plan. It is also important to consider the
biological, functional, esthetic and economic aspects
as well as the patient’s desire.
524
Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 3, May-July 2012