A 19 year old male approached our dental hospital, seeking for correction of his broken upper front teeth. Patient gives a history of traumatic fall 10 days ago, which has broken a part of the tooth structure in the upper front teeth. Patient complained of severe sensitivity of the teeth at the relative site. Even the contact of slightest air on the teeth induced sensitivity. The patient had tried using de-sensitizing toothpaste for a week and stated that it didn’t make his condition any better. Moreover, he felt that the broken anterior teeth looked aesthetically unpleasant. He felt insecure to speak confidently and smile for photos.
On clinical examination, there was no pain on palpation. There was no sign of mobility or discolouration of the broken teeth. The gum tissue surrounding the relative teeth had no abnormality.
On radiological examination, it was evident that a portion of the front teeth were broken exposing the structure called Dentin (yellowish structure which lies beneath the enamel of the tooth). No crack line was seen on the root of the tooth. No pathological findings in the surrounding bone structure.
“Dentin consists of a sensitive layer of tissue that communicates with the nerve of your teeth. When dentin becomes exposed, things that never hurt your teeth before may also feel very painful”.
First choice of treatment of restoration of the broken upper anteriors with tooth coloured filling material was suggested to the patient with its pros and cons. Patient was asked not to bite anything with the front teeth after the treatment, as the restoration is more likely to chip off. This concerned the patient. As he was young and aesthetically concerned, he demanded for an alternative option.
Considering the patients age and demand and in order to treat hypersensitivity, our highly skilled Endodontist ( dentist specialized in restoration and root canal treatment of the teeth), under the guidance of Dr.S.M.Balaji, planned to perform root canal treatment of the affected anterior teeth under local anesthesia followed by placement of a fixed ceramic/ Zirconia bridge. The dental procedure was clearly explained to the patient. Patient opted for Zirconia as it provides more natural appearance and durability. Consent was obtained.
Root canal is a treatment to repair and save a badly damaged or infected tooth instead of removing it. The procedure involves removing the nerve tissue of the affected tooth (the pulp), cleaning and disinfecting it, then filling and sealing it.
In the first visit, under local anesthesia, root canal procedure was carried out for the broken upper anteriors. An access hole was drilled at the back of the teeth. The nerve tissue (pulp) of the teeth is taken out followed by cleaning and disinfecting of the root canals. Saline medium is used periodically to flush away the debris. Thorough cleaning and shaping of the root canal was achieved. The exterior hole in the tooth was sealed with a temporary material to keep out contaminants like saliva and food between appointments. The patient was asked to report after 3 days. In the second visit, temporary restoration was removed. Finally the root canals are filled with a permanent restorative material called “guttapercha” and sealed with a medicated paste. Followed by root canal treatment, crown preparation of the anterior teeth was done.
Restoring teeth to good form and function requires preparation of the teeth for placement of the dental restorations (crown or bridge). The process of preparation usually involves grinding of the teeth with special dental burs, until the desired shape and size is achieved, to make space for the ceramic bridge. Then the impression of the teeth in the upper and lower jaw are taken, so the permanent crown can be made accordingly. The patient was given a new temporary dental bridge that protects the tooth until the final crown is ready to be permanently placed.
After a couple of days, the temporary bridge was removed. Aesthetically pleasant looking fixed ceramic bridge was positioned and fixed on to the teeth with special adhesive cement. The dental bridge looked real and matched the natural colour of his teeth. Patient was very pleased with the outcome and he walked out with a dazzling smile confidently.