Emergency Endodontic Treatment for Fractured Tooth

Trauma to a tooth can be uncomfortable and embarrassing, especially when it’s a front tooth. The good news is that many chipped or fractured teeth can be repaired. Success of the repair depends on how quickly you see your dentist, the severity of the trauma, and the age of the patient.

This patient fractured their front tooth the night before and kept the fragment in milk. This type of fracture is called an Ellis type III, meaning there is damage to the enamel, dentin, and the pulp (nerve tissue) is exposed. Ideally this type of fracture needs to be repaired within one hour to minimize the risk of bacteria from the mouth infecting the exposed pulp tissue. Delaying the repair beyond one hour often leads to the need for a root canal, especially in an adult.

Luckily our patient’s tooth responded normally to cold testing. Our treatment recommendation was a direct pulp cap, reattachment of the tooth fragment, and then follow-up in 6-8 weeks to reassess the health of the tooth.

A direct pulp cap is an endodontic procedure where a medication is applied to cover the exposed pulp tissue and promote healing from the trauma. In this case we used a bioceramic pulp capping material. Bioceramics are one of the newest advances in endodontic treatment and promote regeneration of the injured pulp while also offering antibacterial properties. After the pulp cap, we were able to reattach the tooth fragment using a bioactive adhesive that is both antimicrobial and promotes regeneration of healthy tooth structure.

At the eight week follow-up the root appeared normal on the x-ray, the tooth responded normally to cold testing, and cosmetically the repair was undetectable.