Re-treatment of a Central Incisor With Vertical Root Fracture
Effects of infection necessitate systematic grafting to restore the papilla and create an esthetic emergence profile for the implant-retained crown
Hanno Venter, BDS
As time progresses, there are many factors that can affect the integrity of the teeth. These factors can be intrinsic or extrinsic, such as tooth wear from abrasion, abfraction, or erosion related to an acidic environment created by diet or stomach acids in reflux. These changes affect the way that the upper and lower teeth occlude during function and can lead to isolated or widespread areas of increased deterioration. How the mandible is postured in order to create maximal intercuspation, which can be affected by the loss of teeth or skeletal discrepancies in the mandible when compared with the maxilla, will also have an impact on both the function and esthetics.
In the case described here, a healthy 38-year-old female patient presented to the practice with soft-tissue swelling overlying the distal papilla of tooth No. 9. The swelling was resulting from an undetected vertical root fracture that had caused internal damage from the presence of chronic granulomatous tissue. By the time the fracture was detected and acted upon, the osseous and gingival architecture had remodeled to such an extent that, after healing, there was a complete loss of the distal papilla. Subsequently, this led to a cascade of restorative and reconstructive challenges in order to restore the patient's smile.
In addition to this hard- and soft-tissue dilemma, there were flaws inherent in the existing smile that had been previously created with bonded porcelain crowns and veneers. The smile had to be assessed in order to identify these flaws and determine how they could best be corrected. Therefore, a systematic approach was undertaken to evaluate the existing smile, its inherent flaws, and the changes that needed to be made to restore it to its former glory.
About the Author
Hanno Venter, BDS
International Congress of Oral Implantologists
Orange Moose Dental