Anterior Composite Repair – 7 Year Follow Up – A Photo Essay

In 2009 the patient fell off his bike and resulting trauma is what he presented to the office with:

Pre op 2009

Incisal damage of # 7, Fractured Distoincisal corner with pinpoint pulp exposure and incisal edge chipped on # 9.

I have always wondered, that skilled as we might be to work magic with the modern day dental materials, are we really comfortable in prognosticating the results of our work? The temptation to prescribe the best and most comprehensive solution has to be balanced against the merits of more guarded and less aggressive treatment options. Will crowns/veneers better serve the patient in the long run or will a more conservative treatment however temporary be better approach? My hesitation with advising veneers or crowns at this stage is that given the history of recent trauma the teeth are precariously positioned to either make a full recovery or become endodontically involved. Any aggressive treatment might tilt the balance unfavorably.

Treatment recommendations discussed were: 1. Conservative composite repairs, but might require further treatment if teeth or restorations discolored or required root canal treatment. 2. RCT on # 8 and veneers/partial crowns on 8,9.

Patient agreed to the conservative option for financial reasons.

Teeth were cleaned and scrubbed with chlorhexidine before restoring with composite. Home care instructions given along with the caveat that # 8 will most likely need to be treated with root canal treatment.

Post op 2009 – PDL enlargement noticeable on # 8

7 years later:

The following picture taken at the patient’s six-month recall.

2016 No PDL enlargement

And so far no evidence of Pulpal pathology! The other surprise is how the composites have withstood the test of time especially since Composite used was Gradia® PA2, usually recommended for the posterior teeth. All in all we both felt very lucky.

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