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The life long affects of early trauma to teeth

June 25, 2012 by Ian Kerr

This cases highlights the long term affects of early trauma to adult front teeth. The work was done for a young person who suffered a fracture to both front teeth in early childhood. Both teeth were restored with white fillings, which failed with disappointing regularity which lead to the decision to place a crown on the left front teeth. Ordinarily this is something we would strive to avoid as we know that the amount of tooth tissue removal required for conventional crown work can have a very damaging impact on the nerve of an already traumatised young tooth. (The second slide shows the tooth once the crown was removed, revealing how much tooth tissue needed to be removed). Unfortunately the crown did not give a level of aesthetics that the patient was happy with and, as is often the case, the tooth subsequently became painful.  My involvement in the case came at a stage where the tooth was painful to hot and cold and giving spontaneous bouts of pain all of which point very definitely to an irreversibly inflamed nerve that requires root canal treatment to correct.

The patient was keen to try and improve the aesthetics of the end result which they felt involved making a much shorter crown. In actual fact although the crown was a little too long it was made to look worse than it was by an overly short neighboring tooth (it has succumbed to fracture in the original trauma and the restoration had broken off some time previously). The decision was made to replace the existing crown with an all ceramic one and to build up the adjacent tooth with a direct white filling. The direct white filling was chosen ahead of any further ceramic work as we wanted to do no further drilling to this tooth and direct composite work allowed us to proceed in this manner. The ceramic crown was made by the excellent team at Precedental Laboratories, who consistently provide excellent work.

Radiographic examination of the tooth revealed a shadow in the side of the root which may well indicate root resorption, caused by the initial trauma. At this stage we do not know if this is an ongoing process or one that took place for a while at the time of the trauma and has since remained stable. Further reviews of the tooth over the next 12 months will help to establish if this is a worsening site and further treatment may yet be needed.

The take home message from all of this is try to avoid trauma to young teeth by wearing sports guards for all contact sports but if injuries do occur try to be as “tooth kind” as possible with every step of the treatment.

The original crown and damaged adjacent tooth
The crown removed to reveal the underlying tooth, The adjacent tooth has been restored with a direct white filling
The new crown in place
The finished smile
Completed root filling with possible root resorption

If you are concerned about the appearance of any of your front teeth or are having problems with painful or sensitive teeth then please do not hesitate to contact the surgery on 01580 752202 and we will be happy to help.

Filed Under: Blog Tagged With: Clinical Cases

About Ian Kerr

Dr Ian Kerr BDS qualified in 1989 from Newcastle University Dental School and has worked ever since in both private practice and hospital settings. Following a short stint in a busy general practice in the North East Dr Kerr went to live and work in Trinidad, where he learnt a wide range of surgical skills and developed an interest in the treatment of tempero-mandibular joint dysfunction (TMD). On returning to the UK in 1994 Dr Kerr worked in a prestigious private practice in Bromley in Kent. During his time there he completed extensive post graduate training in advanced restorative techniques and further advanced his interest in TMD.

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About StoneRock Dental Care

StoneRock Dental Care is a stunning dental practice in Hawkhurst, Nr Cranbrook on the Kent and East Sussex border. We provide every level of care, from routine family dental visits to complete cosmetic dental makeovers, including dental implants, teeth whitening, veneers, bridges and other cosmetic dental and facial aesthetic techniques.

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