Case Discussion 20-9-18

CASE DISCUSSION
02
DR SAI SARATH KUMAR

CASE REPORT
Name: Master. Irfaan
Age: 10 Years
Gender: Male
Registration Number: 422508

Chief complaint: complained of broken teeth in his upper front
tooth region
History of presenting illness: patient presented to the clinic 16

hours later after a trauma and had broken his teeth followed by a
traumatic fall while involving in sports activity in a play ground.
When
how Where
Past medical history:
• No history of bleeding disorders, cardiac diseases, epilepsy, allergies
• Anti- tetanus booster was taken
• Trauma dis not cause any loss of consciousness, amnesia, drowsiness,

vomiting or headache.
Past dental history:

• First dental visit
• Had no previous trauma
Pre-natal, natal, post natal history:

• Full tern delivery, no history of jaundice or blood transfusion
• Feeding habits were combination
• Devolping milestones were normal
• History of prolonged thumb sucking habit upto 5 years

EXTRA ORAL EXAMINATION
• Oval facial form
• Symmetrical face
• Straight facial divergence
• Competent lips
• No extraoral wounds, bruises or lacerations were

seen
• No signs of swelling extraorally

SOFT TISSUE EXAMINATION
No abnormalities detected in lips, mucosa, palate, floor
of mouth, tongue and gingiva
HARD TISSUE EXAMINATION
16 55 54 53 12 11 21 22 63 64 65 26
46 85 44 8342 42 31 32 73 34 75 36
• Decayed: 16
• Missing: nil
• Filled: nil
• Other findings: fractured 21, 22
PRE-OPERATIVE OCCLUSAL VIEW
complicated crown fracture of the maxillary left central

incisor and lateral incisor
PRE-OPERATIVE MAXILLARY VIEW
Ulcerated and exposed pulp seen in 21 and 22

PRE-OPERATIVE MANDIBULAR VIEW
PROVISIONAL DIAGNOSIS
Class III (ELLIS AND DAVIS) fracture in 21 and 22
CLOSED APEX
OR
OPEN APEX
INVESTIGATIONS
periapical radiographic examination

in relation to 21 and 22 loss of
tooth structure, fracture line
involving enamel, dentin and pulp
showed complete root development,

closed apices, no periapical injury,
and no alveolar bone fractures
FINAL DIAGNOSIS
1. Class III (Ellis And Davis) – 21 and 22

(extensive fracture of crown involving considerable
dentin and exposing dental pulp)
(Or)
Crown fracture with pulpal involvement N 502.52(WHO
classification)
2. Class 1 dental caries in 16

TREATMENT PLAN
Immediate phase: root canal treatment in 21

and 22
Preparatory phase: oral prophylaxis and oral

hygiene instructions
Corrective phase: post- endodontic restoration in

21 and 22, restoration of 16
Maintenance phase: recall once in 3 months

DISCUSSION FOR TREATMENT PLAN
Selection of treatment procedure will depend upon:

1. Length of time the pulp tissue is exposed
2. Size of pulp exposure
3. Root development.
Three possible treatments:

1. Pulp capping
2. Pulpotomy
3. Complete endodontics
Pulp capping:
• Primarily indicated where pulp has not neen exposed for more
than few hours and where pulp exposure is confined to a small
area
• Prognosis of pulp capping with teeth having closed apices is not

favorable owing principally to the more confined area in the pulp
chamber
Pulpotomy:
• Indicated in a long standing pulp exposure, large pulp exposures,
teeth with incomplete root formation
• Any attempt to preserve the vitality of the pulp in a tooth with

closed apex and a large pulp exposure is not recommended
Complete endodontics:
• The treatment of choice is conventional root canal therapy
followed by a post-retained crown
VISIT O1
Patient accompanied with his grandmother
Communication was established
Case history was recorded
Pre-operative photographs and radiographs were taken
Treatment plan was discussed
Topical anesthetic agent was applied and Local anesthesia was administered in
relation to 21 and 22
Access opening was done in 21 and 22, pulp remnants were extirpated, BMP was
done.
Calcium hydroxide was placed and closed dressing was given with ZOE.
Antibiotics and analgesics were prescribed
Post-operative instructions were given

VISIT 02
Patient accompanied with grandmother
Under rubber dam isolation, access was reopened in 21 and 22,

irrigation and drying of canals, followed by obturation using lateral
compaction technique. Access was sealed with type II GIC
Post- operative instructions were given.
ROOT CANAL TREATMENT
Master cone radiograph Obturation done in 21

21- 55 and 22 with lateral
22- 50 compaction technique
VISIT 03
Oral hygiene status was reviewed
Post- space was created using GG drills and fiber

post was cemented using type I GIC in 21 and 22.
Core build up was done using packable composite
Post-operative instructions was given

POST AND CORE
Post space was created, fiber post was cemented with Type I
Glass Ionomer Cement.
Composite core build up was done in 21 and 22
VISIT 04
Oral hygiene status was reviewed
Tooth preparation was done in 21 and 22
Upper and lower alginate impressions were made
Acrylic jacket crowns were fabricated and cemented with IRM
Post-operative Instructions Given
Advised review and recall once in 3 months

TOOTH PREPARATION
Tooth preparation was done in 21 and 22,

followed by maxillary and mandibular
impressions for post-endodontic restoration
POST-ENDODONTIC RESTORATION
Acrylic jacket crowns were fabricated and

cemented with IRM in 21 and 22
3RD MONTH FOLLOW -UP
Clinical and
No symptoms or radiographic
no tooth sensitivity or
radiographic defects examination showed no
pain was registered
were present. periodontal or
periapical pathology,
the restorations were aesthetically

functionally acceptable gratifying

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CASE DISCUSSION

DR SAI SARATH KUMAR

Name: Master. Irfaan

Registration Number: 422508

History of presenting illness: patient presented to the clinic 16

• Anti- tetanus booster was taken

• Trauma dis not cause any loss of consciousness, amnesia, drowsiness,

Past dental history:

• Had no previous trauma

Pre-natal, natal, post natal history:

• Feeding habits were combination

• Devolping milestones were normal

• History of prolonged thumb sucking habit upto 5 years

• Oval facial form

• Straight facial divergence

• No extraoral wounds, bruises or lacerations were

• No signs of swelling extraorally

HARD TISSUE EXAMINATION

complicated crown fracture of the maxillary left central

Ulcerated and exposed pulp seen in 21 and 22

Class III (ELLIS AND DAVIS) fracture in 21 and 22

periapical radiographic examination

showed complete root development,

1. Class III (Ellis And Davis) – 21 and 22

2. Class 1 dental caries in 16

Immediate phase: root canal treatment in 21

Preparatory phase: oral prophylaxis and oral

Corrective phase: post- endodontic restoration in

Maintenance phase: recall once in 3 months

Selection of treatment procedure will depend upon:

Three possible treatments:

• Prognosis of pulp capping with teeth having closed apices is not

• Any attempt to preserve the vitality of the pulp in a tooth with

Patient accompanied with his grandmother

Communication was established

Case history was recorded

Pre-operative photographs and radiographs were taken

Treatment plan was discussed

Antibiotics and analgesics were prescribed

Post-operative instructions were given

Patient accompanied with grandmother

Under rubber dam isolation, access was reopened in 21 and 22,

Master cone radiograph Obturation done in 21

Oral hygiene status was reviewed

Post- space was created using GG drills and fiber

Post-operative instructions was given

Patient accompanied with grandmother

Oral hygiene status was reviewed

Tooth preparation was done in 21 and 22

Upper and lower alginate impressions were made

Acrylic jacket crowns were fabricated and cemented with IRM

Post-operative Instructions Given

Advised review and recall once in 3 months

Tooth preparation was done in 21 and 22,

Acrylic jacket crowns were fabricated and

the restorations were aesthetically

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