Clinicians preserved a patient’s split tooth using a nonsurgical technique that included widening and sealing the fracture gap with mineral trioxide aggregate (MTA) and composite, according to a case report published in the Journal of Endodontics.
Three years of follow-up showed the successful treatment
of the patient’s first maxillary premolar, which had a fracture in the
mesiodistal direction, the authors wrote in the case report/clinical technique
“Here is an alternative treatment option for a split
tooth, which allows preservation of the tooth rather than its extraction,”
noted the group, led by Alexander Schürz, DMD, of the department of
conservative dentistry at University Hospital Heidelberg in Germany.
Treatment without surgery
When a tooth contains a fracture line extending from the
occlusal surface through both marginal ridges, it is considered a split tooth.
Currently, the only treatment option for a split tooth is to extract it or
remove part of the mobile segments. The new approach used on a 48-year-old man
who experienced latent pain in his tooth was offered as a way to preserve the
tooth without surgery.
His tooth was sensitive, and it had not undergone any
prior restorative treatments. Pulp testing elicited an immediate but prolonged
reaction, and periodontal probing showed an isolated defect of 11 mm. A
fracture gap running in the mesiodistal direction was seen in the central
fissure area of the occlusal surface. Otherwise, he had a healthy mouth,
according to the authors.
After learning about possible treatment options, the man
opted for nonsurgical treatment, which occurred in the following phases:
Primary fracture treatment. Clinicians widened the
fracture gap using a dental operating microscope and obturated the apical part
of the root canals with an MTA plug. The fracture gap was sealed with MTA, a
biocompatible material. (If the inflammation of the periodontal tissue
surrounding the fracture gap does not allow immediate repair of the fracture
because of profuse bleeding, then calcium hydroxide should be applied to the
gap and root canal system, the authors noted.) Occlusal adjustments were then
Secondary fracture repair and internal stabilization of
the tooth. This session occurred within 48 hours of the first. During the
visit, the MTA layer was reduced to minimum thickness to allow for the dry
application of composite resin, then the cement and remaining fracture gap was
covered immediately with composite resin. A layered application of composite
resin was completed to fill the root canal system for internal stabilization
and complete reconstruction, they wrote.
Coronal treatment with indirect cuspal coverage
restoration. On the third visit, his tooth was prepared for the restoration.
Then, on the final visit, adhesive cementation of a lithium disilicate
restoration with dual-curing composite resin was completed. The patient also
was given oral hygiene training, including the routine use of interdental
The patient returned for follow-up visits every six
months for three years. Clinical and radiological exams showed that the
treatment corrected the problem. Part of the success of this treatment must be
attributed to the patient maintaining good oral hygiene, the authors noted.
Furthermore, split upper premolars are best suited for
this treatment procedure. Lower molars with a fracture line through the
furcation also may be suitable. However, teeth with lengthwise fractures may be
better treated by surgery with resection of the fractured root or extraoral
fracture repair followed by intentional replantation, they warned.
Nevertheless, additional studies are needed to confirm
the long-term feasibility and success rates of this new approach. Once more
clinical studies are completed, this method may be recommended for general use,
the authors wrote.
“The method of restoring split teeth with MTA and composite is a treatment option worth considering,” they wrote.
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