Conservative Treatment of a Fractured Tooth

Before

Step 1

Distal lingual cusp on tooth #19 is pressure sensitive to a tooth sleuth.  Remaining cusps are solid.

Greater Curve in place

Step 2

Distal contact opening made.  Distal lingual cusp reduced by 2 mm.  I was able to follow the fracture with a #4 slow speed bur and remove it entirely.  (When chasing fractures do not chase them into the pulp or periodiontal ligament.)   Bonding agent placed and cured throughout the prep.  Ribbond was placed over the fracture area using a flowable and cured.

Final restoration

Step 3

completed with Sonic Fill.  My 4 year recall with Sonic Fill on larger buildups are doing well.  Margins very solid. Very pleased to date.

Conclusion:

Full cut down crowns are very destructive to teeth.  Patient is doing well with this conservative approach.  Why destroy functional cusps when only one cusp needs to be restored.

I’m a disciple of Pascal Magne, Dave Alleman and others regarding treating teeth with fractures.  Their conservative approach has changed my clinical life.