Frequently a fractured vital (live) tooth will have dentin exposed. Dentin is comprised predominantly of fluid filled microtubules. The fluid column is intimately associated with nerve endings in the pulp. Anything causing the fluid column to move, such as physical contact or thermal expansion/contraction, is painful for the patient. Additionally, the fluid filled tubules are large enough for bacteria to migrate directly into the pulp.
Smoothing a fracture site and applying bonded resin sealants serves several purposes. Smoothing the fracture site decreases plaque adherence and calculus accumulation, and decreases soft tissue irritation from the fractured surface. Plugging the dentin tubules with the bonded sealants decreases sensitivity and helps prevent infection of the pulp chamber. After the application of bonded sealants, the tooth is able to provide a permanent “patch” on the inside through the deposition of reparative dentin. Typically, this procedure is only done once per fracture site.
As mentioned previously, this technique is intended for use on live teeth with dentin exposure. Prior to applying bonded sealants, you should try to determine that the tooth is alive. Typically, a live tooth is not discolored, has no radiographic indications of disease, and transilluminates light evenly when a halogen light source is shone through the tooth.
Exam of the contralateral side can provide “normals” for reference.
The same techniques presented here can be used after reduction of traumatic occlusion, to treat teeth with enamel hypocalcification, and after reducing tight inter-proximal areas to improve access for cleaning.
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