Considerations during crown reattachment procedure over the pulpal exposure: case report
A 26-year-old woman visited the department of conservative dentistry because of crown fracture of the right central and lateral incisors after falling down in the bathroom twenty minutes before arriving at the dental office. The patient found tooth fragments and brought them stored in milk. Clinical and radiographic examination revealed that those two teeth were fractured supragingivally involving a pin-point exposure of the pulp (). Because the pulp exposure size was minimal and exposure time was of short duration, crown fragment reattachment with direct pulp capping was planned.\nIn order to avoid the pulpal contamination, the area was carefully irrigated with chlorhexidine and normal saline under rubber dam isolation. For hemostasis of the exposed pulp, cotton pellet with 2.5% sodium hypochlorite was pressed gently against the lesion. After complete hemostasis was confirmed, the exposed pulp was covered with sterile cotton pellet in order to avoiding direct contact with acid. Enamel was etched with 35% phosphoric acid gel for 30 seconds. After rinsing and drying, the exposed pulp was capped with calcium hydroxide (Dycal, Dentsply Caulk, Milford, DE, USA) ().\nAfter setting of Dycal, Clearfil SE bond(Kuraray Medical Inc, Okayama, Japan) was applied following the manufacturer's instruction. To avoid dehydration during clinical procedure the tooth fragment were immersed in saline solution. Tooth fragment was acid etched using 37% phosphoric acid (Bisco, Schaumberg, IL, USA) for 30 seconds. The acid was eliminated by rinsing with copious water and drying with gentle air. Clearfil SE bond was applied in the same manner above. After bonding, Aelite flow A2 shade (Bisco) was used to reattach the fragment to the remaining teeth. Flowable resin was light cured for 40 seconds each from the labial and palatal directions (). The residual excess resin at the tooth surface and irregular margin surface was left untouched without finishing and polishing.\nFour days later, fracture line reinforcement and polishing was done. After shade selection (), preparation was placed on the buccal and palatal surface extending 2.5 mm coronally and apically from the fracture line with a depth of 0.3 mm (). The area around fracture line was acid etched using 37% phosphoric acid (). Then, adhesive was applied and light cured, followed by placement of resin composite to create slightly overcontoured surface. Excess composite resin was removed and polished (). Periapical view showed no periodontal or periapical pathosis ().\nAfter 14 months, patient showed no clinical symptoms and the vitalities were well maintained. In addition, radiographic examination showed normal condition (). The crowns were functionally and esthetically acceptable.