CDE0111

06 I I clinical technique _ fractured maxillary central incisors _Acute dental trauma of anterior teeth is a common occurrence in children under the age of 12. The most frequently fractured teeth are the maxillary incisors, involving solely enamel, enamel and dentine or, in extreme cases, pulpal exposure, very often without root fractures. Unlike the relatively slow tooth loss due to den- tal caries or tooth wear, acute dental trauma is animmediate,oftenpainfullossofnaturaltooth substrate. Furthermore, involvement of the pulp complicates initial and long-term treatment, placing the affected teeth in jeopardy and re- quiring periodic monitoring. The sequential treatment strategy for acute dental trauma is restoring health (H), followed by function (F) and lastly, achieving acceptable aesthetics(A;theHFAtriad).Contemporaryden- tal composites and direct adhesive techniques allow replication of the tooth morphology, as well as optical (colour, translucency, opales- cence, fluorescence) and mechanical properties. The advantage of a direct approach is that it is minimally invasive, not requiring additional removal of tooth substrate; however, it is tech- nique sensitive, requiring patience and meticu- lous execution. _Clinical case A ten-year-old boy was involved in a sporting accident that resulted in acute dental trauma to the maxillary central incisors. The fractured fragment of the left central incisor was lost, while that on the right central incisor was lo- cated. The patient was treated at the accident and emergency department of a local hospital, where tetanus inoculation was verified and composite resin used to reattach the right cen- tral incisor fragment and to build-up the left central incisor (Figs. 1–3). The patient presented to my practice a few weeks later, complaining of poor aesthetics and cosmeticdentistry 1_2011 Reattachment and build-up of fractured maxillary central incisors Author_ Dr Irfan Ahmad, UK Fig. 1_Dento-facial view, showing immediate treatment of the two maxillary central incisors, following a sporting accident. Fig. 2_Pre-op status, showing extensive plaque deposits, acute gingivitis, reattachment of the coronal fragment on the right central incisor and a defective composite build-up on the left central incisor. Fig. 3_Incisal pre-op view, showing the reattached right fragment on the right central incisor and an over-contoured composite build-up on the left central incisor. Fig. 4_Peri-apical radiograph, showing large defects between the composite resin fillings and remaining tooth substrate, with large pulp chambers and immature, open apices. Figs. 5–7_Post-scaling and polishing, showing improvement of gingival Fig. 6 Fig. 7Fig. 5 Fig. 2 Fig. 3 Fig. 4Fig. 1