This is one technique you will be glad you have

Uncomplicated crown fractures Enamel hypocalcification Enamel hypoplasia Coronal abrasion; if discontinue behavior Coronal attrition; if correct malocclusion Adjunct to restorations of composite

restoratives

Post light cured, bonded sealant application

Pre-operative uncomplicated crown fracture

Reduce sensitivity of exposed dentin Block infection immediately Allow improved production of tertiary dentin OK, the teeth do look better. Improve

aesthetics Coronoplasty or smoothing of crown prevents

rapid plaque and calculus accumulation common in uncomplicated fractures

Pre-operative photo of right upper fourth premolar tooth

Pre-operative photo upper right fourth premolar tooth

Pre-operative photo upper left fourth premolar tooth

Pre-operative radiograph upper left fourth premolar tooth

• Slow speed handpiece• Contra angle• Sanding discs• 37-40% phosphoric acid etchant• Dentinal adhesive• Applicators• Light curing gun• Unfilled resin

Sanding discs with mandrel

These do not have metal inserts limiting damage to enamel

Dentinal adhesive

Approximately $500-600 Can treat approximately 50 teeth for this Ongoing costs approximately◦ $2 per tooth ◦ Technician time; ($24.00/hr); $2.40◦ Doctor time; ($75.00/hr); $7.00◦ Total costs; $11.40 per tooth◦ Usual fee; $35-60 per tooth

Approximately 95% in only study looking at success

• Smooth unsupported enamel• Smooth exposed dentin• Acid etch exposed dentin and enamel • Rinse, flush, gently dry crown• Apply dentinal adhesive• Light cure • Apply unfilled resin• Light cure

• If uncomplicated fracture is noted on oral charting, use non-fluoride polish to minimize interference with restorative process – PUMICE

• If significant unsupported enamel, smooth with white stone or coarse taper diamond bur on high speed handpiece

• Be careful using high speed, it is very easy to expose pulp tissue when first starting this, necessitating endodontia

• Control saliva at site of uncomplicated crown; suction etc.

Slow speed handpiece Contra angle applied

Latch type contra angle Mandrel applied

• Apply to slow speed handpiece• Be gentle especially with initial, rougher discs

as these can expose pulp• Progressively finer grit denoted by color• Black; most aggressive; use first• Purple• Green• Red; most fine

Apply black sanding disc Be gentle!

You should be able to visualize smoothing

At this point you should see marked smoothing

• Apply gel to prepared area of crown• Will slightly demineralize exposed dentinal

tubules• Increases cross sectional area available for

restoration• Allow 10-30 seconds contact time• Wipe gel from crown• Thorough rinse with air/water syringe• Gently dry; do not desiccate crown• Some mild dullness of enamel may be noted

Gel form allows accurate application Remove gross volume

Rinse phosphoric acid Fine clouding shows etched enamel

• Use microapplicator or fine brush to apply• Options;

– One solution; such as ONE Step from Bisco Inc.– Primer and bonding agent separate such as Scotch

Bond Multipurpose from 3M Products1. Apply thin layer2. Gently thin using air syringe3. Allow 10 seconds contact time4. Light cure according to manufacturer’s

directions; usually 10-20 secondsVIEW LIGHT CURING THROUGH PROTECTIVE LENSES ONLY TO PREVENT RETINAL DAMAGE

Apply dentinal adhesive Light cure; usually 10-20 seconds

• Unfilled resin such as Fortify from Bisco Inc.• Apply using microapplicator or fine brush• Apply to fractured area and remainder of

crown• Attempt to avoid gingival margin• Light cure according to manufacturer’s

recommendation; usually 15-30 seconds

Unfilled resin Light cure; usually 20-30 seconds

• If no other procedures performed only require NSAIDs for 1-2 days

• Recommend follow-up anesthesia and radiographs in 6 months – most common follow-up schedule is 12 months at

routine cleaning, scaling and polishing

• Bacteria may have entered dentinal tubules prior to restoration procedure causing subsequent non-vitality of tooth

• Abrasion from coronoplasty causes heat• In inexperienced hands, aggressive

preparation of crown can cause irreversible pulpitis

• Either of these are more likely if near pulpal exposure is encountered