Clinical case-stidies: Trauma Case by Dr J Van Rensburg
Fibredontics can be very useful in emergency cases, where a patient has lost an anterior tooth. This case illustrates this application very well.
Patient
Female, 18 years
Case history
This young female patient was unfortunate to be involved in an accident. Her upper left central was completely knocked out when she fell out of a moving vehicle and landed face first. The tooth could not be found at the scene of the accident but the peri-apical x-ray reveals a completely avulsed tooth leaving a clear socket. The other upper anterior teeth were unaffected except for the mesial incisal angle of the upper right central that was chipped. The upper left lateral incisor was slightly tender to percussion but no fractures of the roots were visible on the x-ray. The patient has a skeletal class 2 bite with a huge overjet which explains the nature of the injury. Due to the huge overjet the lower anterior incisors were not in contact with the palatal surfaces of the upper teeth—an ideal situation for bonding the fibres. All treatment options were discussed with the patient and an adhesive fibre-reinforced composite bridge turned out to be the treatment option of choice for the patient. The whole procedure was done on a Monday morning following the accident on the previous Saturday evening. The patient was very grateful to have her front teeth restored in such a short period of time. Without the fibres this quick and reliable treatment option would not have been possible.
Treatment
Local aneasthesia, Septonest, Articaine 1/100 0000 adrenalin 2.2ml was administered as the lips and gingival was very tender due to the bruising of the soft tissues. The area was isolated with rubber dam. The fibre frame was bonded to the UL2 and UR1 on the palatal surfaces. An everStick C&B fibre was used for this purpose. An additional everStick Perio fibre was bonded on the labial side of the UR1 onto the existing palatal C&B fibre. The pontic was then built up directly in the mouth using Gradia A03, A3 and NT. The Gradia Direct NT was used on the incisal edge and extended over the labial side of the pontic. All fibres were covered with composite.
Soft tissue injuries
Peri-apiocal X-ray
Rubber dam
Fibre frame made out of everStick C&B and everStick Perio
Completion of the direct FRC bridge
The patient two weeks later
Two weeks later
